Antituberculous fight in the Maghreb: the balance sheet.

The fight against tuberculosis remains a priority for world leaders: a re-emerging disease in developed countries, endemic elsewhere, it was declared in 1993, as a "world emergency" by the World Health Organization (WHO). The aim of programs is to prevent infection from spreading and perpetuating; the recommended strategies were the subject of common consent by expert committees convened by international agencies, primarily the WHO. As a result, programs of the Maghreb countries have great similarities. Though the regression in cases's number, especially primary and post-primary forms, as well as extensive, deleterious pulmonary tuberculosis in adults, the endemic persists. The proportion of extra-pulmonary tuberculosis (PET) is high. Control of "contacts" would be lacking or delayed in almost half of the cases. The cover by an effective treatment of these cases in Libya and in Mauritania stays below the required 85 %. Taken as a whole, the constituent countries of the Maghreb entity count approximately 78 000 tuberculosis patients for a population close to 100 million inhabitants, with an incidence rate of 76 for 100 000. Reducing the incidence of tuberculosis by 90 % and the mortality by 95%, to ensure that by the end of 2035 tuberculosis is no longer a public health problem is a goal within the reach of Maghreb countries. It can be postulated that by this deadline, the conditions for success will be met.

[Treatment of tuberculosis]. / Traitement de la tuberculose.

The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis. Most patients follow TB standard treatment recommended by WHO that depend on category of patient. It is a combination of four essential tuberculosis drugs of the first group: isoniazid, rifampicin, pyrazinamid and ethambutol; in some cases streptomycin can replace ethambutol. This initial phase of intensive treatment is followed by a consolidation phase. Drugs should be administered in the morning on an empty stomach one hour before meals. Treatment of latent tuberculosis (TB) infection is an important component of TB control programs. Preventive treatment can reduce the risk of developing active TB.

[Symptoms and natural history of hospital chronic obstructive pulmonary disease]. / Symptômes et histoire naturelle de la broncho-pneumopathie chronique obstructive en milieu hospitalier.

BACKGROUND: Since few years, the data describing the chronic obstructive pulmonary disease (COPD) have changed and new concepts have emerged. AIM: To study the clinical characteristics and outcome of patients with COPD in a Tunisian population. METHODS: It is a retrospective study including 150 patients with COPD admitted at the pulmonary department of Charles Nicolle Hospital in Tunis, during a period of ten years. RESULTS: Data from 150 patients hospitalized at the pulmonary department of Charles Nicolle Hospital in Tunis, were analyzed. They were 126 men and 24 women with a mean age of 67 years. Tobacco was the predominant risk factor. Eighty-two (55%) patients were classified GOLD stage IV at diagnosis. The number of exacerbation varied from 1 to 7 with an average higher in patients classified as stage IV (p = 0.007). CONCLUSION: The COPD is pathology of smoking men. Comorbidities and exacerbations prevalence increase according the disease severity. In fact, better knowledge of exacerbations etiologies allows considering better measurement of prevention.

[Lung mycosis in non neuropenic patients]. / Infections pulmonaires mycosiques chez des patients non neutropéniques.

UNLABELLED: Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS: It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS: From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.

[Persistent pleuropneumopathy in a young woman]. / Une infection pleuropulmonaire non résolutive chez une femme jeune.

Bronchopulmonary sequestration is a rare malformation characterized by lung tissue fed by one or several aberrant systemic arteries. The authors present the case of a 35-year-old woman in whom extralobar sequestration was fortuitously detected at the time of persistent pleuropneumopathy. Computed tomography was used in the diagnosis of pulmonary sequestration. The most common and recommended treatment is the surgical removal of the pulmonary sequestration.

[Acute rhabdomyolysis during pneumococcal pneumonia: two cases]. / Rhabdomyolyse aiguë au cours des pneumonies à pneumocoque. A propos de deux observations.

Acute rhabdomyolysis is a clinical and biological syndrome generally with a toxic or traumatic cause. Only 5% of cases are infectious, and rarely in relation to a pneumococcal infection. We report two cases of acute rhabdomyolysis which developed in patients with severe Streptococcus pneumoniae pneumonia. No other cause could be identified in these two patients aged 32 and 37 years. Rhabdomyolysis was discovered in the first patient because of acute kidney failure and elevated serum transaminase levels. The second patient presented an inflammatory edema affecting the soft tissues. Blood cultures isolated a pneumococcus in both patients. The rhabdomyolysis regressed favorably in both patients despite the transient renal failure in the first patient. Prognosis is generally poor for rhabdomyolysis during the course of pneumococcal pneumonia, with increased morbidity and mortality for these infections. Early detection of bacteriemia enables rapid and adequate treatment and prevention of renal failure.

[Smoking cessation program in Tunisia: experience of a respiratory service]. / Aide au sevrage tabagique en Tunisie: expérience d'un service de pneumologie.

A tobacco cessation programme was recently introduced into medical practice in Tunisia. The medical staff in the pulmonary disease ward at Charles Nicolle Hospital, Tunis, has been the first to implement such a programme for people motivated to quit smoking. This programme has been run for 3 years in the respiratory disease out-patient department. It acts essentially against psychological and pharmacological dependence on tobacco. The results obtained were very encouraging: 298 smokers have participated in this programme. The global success rate at 12 months of tobacco withdrawal was about 25% for people who were followed up, and 17% for the whole sample. Medical help for smoking cessation should be more widely promoted in Tunisia to increase the number of smokers who consult and improve the quality of medical intervention.

[Reexpansion pulmonary edema]. / Oedèmes pulmonaires à vacuo.

Reexpansion pulmonary edema is an uncommon complication which sometimes occurs after evacuation of a large amount of air or fluid from the pleural space. We report two cases that illustrate the diversity of the clinical expression, severe in one case and latent in the other. The pathophysiology of reexpansion pulmonary edema remains obscure. Increased pulmonary capillary permeability, favored by previous atelectatic parenchyma and rapid reexpansion appears to be the main cause. Treatment is basically preventive. Curative treatment is based on adequate oxygenation and circulation. Lower aspiration pressure and oxygenation were sufficient in our patients. Severe clinical prognosis has been reported in the literature with a 15 to 20% mortality despite use of mechanical ventilation in particularly serious situations.

[Broncho-pulmonary cancer associated with pulmonary tuberculosis. Report of 4 cases]. / Association cancer broncho-pulmonaire et tuberculose pulmonaire. A propos de 4 cas.

The association between bronchopulmonary carcinoma and pulmonary tuberculosis would not be fortuitous but related to increased susceptibility to opportunistic infections and tuberculosis in cancer patients. We present four cases demonstrating the gravity of the situation and the difficulties encountered in diagnosis and treatment. Diagnosis of tuberculosis in patients with bronchopulmonary carcinoma requires pathological evidence from histology biopsies or bacteriology samples. The diagnosis is further complicated in early stage neoplasms. In case of tuberculosis, surgical treatment of bronchopulmonary carcinoma may have to be postponed or even contraindicated. Inversely, chemotherapy and radiotherapy may favor extension of the tuberculosis.

[Bronchiectasis in hemorrhagic rectocolitis. Apropos of a case]. / Les bronchectasies au cours de la rectocolite hémorragique. A propos d'une observation.

Bronchectasis is a rare complication of haemorrhagic rectocolitis, 28 case have been reported in the literature. We report a case in a 40-year-old patient who presented respiratory signs 13 years after the onset of haemorrhagic rectocolitis. The diagnosis was confirmed on the bronchogram showing involvement of the lower lobes on the right and the left. Local corticosteroids given by inhalation decreased the volume of the expectorations and improved bronchial obstruction. Abundant bronchorrhoea is characteristic of bronchectasia in haemorrhagic rectocolitis as in primary bronchectasia. Response to inhaled or systemic corticosteroids is good.