Alternaria alternata infection causing rhinosinusitis and orbital involvement in an immunocompetent patient.

Invasive fungal rhinosinusitis is a rare infection that occurs primarily in immunocompromised patients. The fungal pathogen Alternaria alternata is rarely associated with rhinosinusitis. We report a case of A. alternata rhinosinusitis in an immunocompetent patient.

Demodicosis revealing an HIV infection.

We report an observation of facial and upper limb demodicosis, revealing a human immunodeficiency virus infection. After an initial improvement with metronidazole, worsening of skin lesions related to immune reconstitution inflammatory syndrome was observed, requiring the use of steroids.

Erratum to, 'Outcome of mucormycosis after treatment: report of five cases'.

[This corrects the article DOI: 10.1016/j.nmni.2014.12.002.].

Outcome of mucormycosis after treatment: report of five cases.

Mucormycoses are serious infections caused by filamentous fungi of the order Mucorales. They occur most often in immunocompromised patients. We report five cases of mucormycosis in patients hospitalized in the Infectious Diseases Department in Sousse - Tunisia between 2000 and 2013. They were 4 males and one female, mean age 60 years. Three patients were diabetic and one patient had acute leukemia. The locations of mucormycosis were rhinocerebral, rhino-orbital, auricular, pulmonary and cutaneous. The Mucorales isolated were Rhizopus arrhizus in 3 cases and Lichteimia in 2 cases. All patients were treated with amphotericin B and 2 patients had, in addition, surgical debridement. Two patients died and 2 kept peripheral facial paralysis.

[Adherence to antiretroviral therapy in HIV-infected patients in Sousse, Tunisia]. / Observance au traitement antirétroviral chez les patients infectés par le VIH à Sousse, Tunisie.

Adherence to antiretroviral therapy (ART) is a powerful predictor of survival for individuals living with human immunodeficiency virus (HIV). The purpose of this cross-sectional study conducted in December 2007 was to assess ART adherence and identify its determinants in HIV-infected patients in Sousse, Tunisia. Adherence was evaluated in a structured interview, during which questions were asked about the number of pills taken, treatment schedule, and any food restrictions within the previous 4 days. Determinants of adherence included patient characteristics, type of ART, and interpersonal relationships and were assessed from the medical records and questionnaire responses. Adherence was assessed in 30 of the 34 patients receiving ART at the time of the study. Twenty-two patients (73%) complied with all daily treatment recommendations and were considered adherent. Multivariate analysis showed that the main barriers to adherence were related to storage of the medication and doubts about its efficacy. Improvement of socioeconomic conditions and better psychosocial support are needed to optimize ART adherence by HIV-infected patients in Tunisia.

[Prescribing practices of fluoroquinolones in Tunisia]. / Evaluation des pratiques de prescription des fluoroquinolones en médecine de ville en Tunisie.

The aim of the study was to assess the prescribing practices of fluoroquinolones (FQ) among general practionners in the town of Sousse (central-eastern Tunisia). A transversal study was made between the first and the 23rd April, 2009, among general practionners working in Sousse. For each prescription, informations about patients, indications and modalities of treatment were collected on a questionnaire. These prescriptions were compared to Tunisian and/or French guidelines for antibiotics use. One hundred and eighty eight FQ prescriptions were analyzed. The mean age of patients was 50 years. FQ were more often used alone (83%) and in first line intention (84%). The molecules used were essentially ciprofloxacin (44.7%), levofloxacin (35.6%) and ofloxacin (18.6%). The indications were mainly bronchopulmonary infections (34%) and urinary tract infection (32%). These choices were in accordance with guidelines in 41% of the prescriptions. The dosage was adapted, but the duration of treatment was often excessive. Further efforts are needed, to optimize the good use of FQ in order to reduce or stabilize the rate of bacterial resistance.

[Second epidemic of West Nile virus meningoencephalitis in Tunisia]. / Une deuxième épidémie de méningo-encéphalite à virus West Nile en Tunisie.

UNLABELLED: The West Nile virus (WNV) re-emerged in Tunisia in 2003, causing an outbreak of meningoencephalitis. OBJECTIVE: The authors studied the epidemiological, clinical, biological, and imaging features of WNV-associated neurological disease observed in central eastern Tunisia. DESIGN: A retrospective descriptive study was made on patients with West Nile meningitis and/or encephalitis observed in the Sousse area, from August 15 to November 15, 2003. Screening for specific anti-WNV antibodies in serum was performed with Elisa. RESULTS: Recent central nervous system infection due to WNV was confirmed in 21 patients with a mean age of 53 years and a sex ratio of 3.2. The clinical presentation was meningitis in 11 cases, meningoencephalitis in seven cases, and encephalitis in three cases. Patients with encephalitis were older than those with meningitis. An acute flaccid limb paralysis was observed in three patients. The CSF assay showed lymphocytosis, high protein (67 %), and normal glucose levels (83 %). Brain CT scan and MRI were normal. Three patients died, the remaining evolved uneventfully. CONCLUSIONS: These first cases of WNV meningoencephalitis in Sousse area suggest a possibility of reemergence of this infection. Preventive measures and epidemiological surveillance are necessary.