Pulmonary tuberculosis: Diagnostic delay in Tunisia.

OBJECTIVE: Early diagnosis and prompt effective therapy are crucial to fight against tuberculosis (TB), particularly in regions with a high prevalence. We aimed to evaluate TB diagnostic delays and identify the associated risk factors. METHODS: We conducted a survey in various health facilities in Tunisia between March 24th and October 30th, 2014. We included all patients aged ≥ 18 years who presented with pulmonary TB (PTB) and who had been initiated on an anti-TB treatment. We evaluated the time between respiratory symptom onset and treatment initiation. Treatment delays were divided into three categories: delays due to the patient, to the healthcare system, and overall delays. RESULTS: We included 352 patients in the study (242 men and 110 women). The mean age was 42.2 years±17.7. The median time from symptom onset to treatment initiation was 52.56 days. Patient delays were longer for men, for patients presenting with alcohol dependence, and for patients who already knew they were sick. Healthcare system delays were associated with older age, female patients, patients consulting a private physician, and outpatients. CONCLUSION: TB symptoms should be better explained to the population and healthcare professionals should be better trained to both reduce such delays and initiate treatment as early as possible.

[Venous thromboembolism in patients with acute tuberculosis]. / Maladie veineuse thromboembolique au cours de la tuberculose.

BACKGROUND: Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. METHODS: We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. RESULTS: Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. CONCLUSION: Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic.

Recurrent iliac hydatidosis: A case report.

INTRODUCTION: Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in bone is not common. PRESENTATION OF CASE: The authors report the case of multifocal hydatid disease appeared 3 years after the surgical treatment of a cyst of the hip. The patient presented with cough and chest pain of 2 months duration. Only the lung localization was symptomatic. The thoracic echography, the abdominal and chest scan allowed the diagnosis. DISCUSSION: Hydatid recurrence remain frequent, whatever is the nature of the treatment, surgical or chemical. CONCLUSION: The premature detection of recurrence is of great importance.

[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.

[Bilateral pleural thickening]. / Épaississement pleural bilatéral de la plèvre.

The authors report the case of a 20-year-old man in whom pulmonary and bone tuberculosis presented as bilateral pleural thickening without effusion.

[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.

[Interstitial pneumonia complicating amyopathic dermatomyositis: a case report]. / Pneumopathie interstitielle compliquant une dermatopolymyosite amyopathique : à propos d'un cas.

Amyopathic dermatomyositis (ADM) is a clinical subtype of dermatomyositis, characterized by the absence of motor weakness and the presence of normal muscle enzyme levels. ADM is sometimes accompanied by neoplasm or interstitial pneumonia that shows a rapid progressive course both of them are associated with a poor prognosis. A 56-year-old woman with no medical history was referred to the department of medicine because of arthralgia with a remarkable weight loss. She also complained of rapidly progressive dyspnea, cough and photosensitivity. Physical examination on admission showed scaly erythema on the dorsum of the hands (Gottron sign) and periorbital edema with a purplish appearance (heliotropic rash), arthritis, but no muscle weakness. Auscultation of the chest identified audible fine crackles on the lower aspects of both lungs. Results of laboratory findings on admission revealed a lymphopenia. The serum creatine kinase and serum lactate dehydrogenase concentration were normal. IRM muscle and electromyography were normal. Antinuclear antibody was positive 1:80 and anti-Jo-1 antibody and other autoantibodies to specific antigens were all negative. High resolution computed tomographic chest scans also revealed diffuse ground-glass opacities in both lungs with basilar predominance. Arterial blood gas analysis revealed hypoxia and hypocapnia. LBA was not performed because of the deterioration of respiratory symptoms. There was no neoplasm associated. The diagnosis of ADM complicated with ADM rapidly progressive interstitial pneumonia was made. Despite of IV methylprednisolone pulse therapy (1g*day-1 for 3 days) and cyclophosphamide, she died by respiratory failure.

[Tuberculous lupus]. / Le lupus tuberculeux.

UNLABELLED: Cutaneous tuberculosis accounts for 2% of all extrapulmonary tuberculosis and is one of the multiple clinical presentations of extrapulmonary tuberculosis. We report a case of cutaneous tuberculosis with unusual clinical and histological presentations. CASE REPORT: We report the case of a 29-year-old woman with plurifocal tuberculous lupus. Histological examination of cutaneous lesions revealed the presence of a granuloma with caseum necrosis. Chest X-ray showed a severe pulmonary tuberculosis lesion. The Mantoux test performed by intradermal injection was positive. Skin lesion PCR and sputum culture were negative. Both skin and pulmonary lesions responded to antituberculous treatment. COMMENTARY: Lupus vulgaris is commonly presents on the head and neck. The diagnosis may be difficult when lupus vulgaris occurs at unexpected sites or in unusual clinical presentations. Caseum necrosis observed in our patient was unusual.

[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.

[Clinical aspects and diagnosis of pleural fibromas]. / Aspects cliniques et approche diagnostique des fibromes pleuraux.

Pleural fibromas are rare malignant or benign tumors requiring pathology study for certain diagnosis. From January 1985 to January 2001, 7 patients underwent surgery in our unit for pleural fibroma: 4 females and 3 males, mean age 60 years. The inaugural symptoms were chest pain (3 patients), dyspnea (2 patients), joint pain in a patient with Pierre-Marie pneumonic hypertrophic osteo-arthropathy, and acute hypoglycemia. Radiological investigations were decisive in orienting the diagnosis (chest X-ray, ultrasound, computed tomography and MRI). Surgical resection and pathological study of the surgical specimen is required to confirm the diagnosis. Patients should be carefully followed due to the risk of malignant recurrence.

[Smoking dependence and symptoms of anxiety and depression among Tunisian smokers]. / Dépendance tabagique et troubles anxio-dépressifs chez le fumeur tunisien.

INTRODUCTION: The aim of this study was to describe the incidence of depression and anxiety, and their relationship with smoking dependence, in patients attending a Tunisian smoking cessation clinic. METHODS: We studied 72 Tunisian smokers attending the smoking-cessation clinic at the Charle Nicolle Hospital in Tunis. Nicotine dependence was assessed by the Fageström Test for Nicotine Dependence. Anxiety and depression symptoms were measured using the HAD (Hospital Anxiety Depression) Scale. RESULTS: The prevalence of anxiety and depression was 22.9% (16 patients) and 20% (14 patients) respectively with four patients (7.1%) exhibiting symptoms of both. Overall, 50% of the group had emotional morbidity with high HAD scores for depression or anxiety, or both. Smokers with symptoms of anxiety and/or depression had higher physical and psychological dependence, smoked more at times of stress, had a reduced quitting rate and endured more withdrawal symptoms than those smokers without anxiety or depression. CONCLUSIONS: The data of this survey from Tunisia, a country that has just put in place a tobacco control strategy, underline the high rates of anxiety and depression that exist in patients attending a smoking cessation clinic. It confirms the association between anxio-depressive disorders and a high level of smoking dependence.