Détermination des concentrations plasmatiques de l'isoniazide et la rifampicine chez les patients sous antituberculeux

Introduction : La tuberculose est un problème de santé publique dans le monde entier. Son traitement est basé sur quatre antituberculeux majeurs dont l'isoniazide et la rifampicine qui ont bouleversé le pronostic de cette maladie. L'objectif de cette étude était de montrer l'apport du suivi thérapeutique pharmacologique dans la prévention des échecs thérapeutiques en cas de sous-dosage et de toxicité en cas de surdosage.Matériels et méthodes : Il s'agit d'une étude rétrospective faite à l'Hôpital Moulay Youssef et le laboratoire de toxicologie et de pharmacologie du centre anti-poison et de pharmacovigilance du Maroc sur une période de 9 mois, et menée sur 142 patients ayant tous bénéficié d'un suivi thérapeutique pharmacologique de l'isoniazide et la rifampicine. Les dosages étaient réalisés par chromatographie liquide haute performance après extraction liquide-liquide. Résultats : Notre étude a montré qu'à dose thérapeutique, 78,2% des patients tuberculeux avaient des concentrations plasmatiques de rifampicine au-dessous de la fourchette thérapeutique et 35,4% des patients avaient des concentrations plasmatiques d'isoniazide au-dessus de la fourchette thérapeutique.Conclusion : Dans le cadre du traitement antituberculeux, le recours au suivi thérapeutique pharmacologique permet aux cliniciens

[Hypothermia due to anti-tuberculosis drugs: first case]. / Hypothermie secondaire au traitement antibacillaire: 1(e) cas rapporté

Hypothermia - an adverse reaction of drug use potentially severe - requires an early diagnosis and an adapted management. We report the first case, to our knowledge of hypothermia due to anti-tuberculosis drugs.

[An unusual cause of hemoptysis: a leech]. / Cause inhabituelle d'hémoptysie: la sangsue.

We report an exceptional case of hemoptysis observed in a 71-year-old woman with an uneventful past history. After 48 hours of admission, the patient spontaneously expelled a leech from the nose. The parasite was examined in parasitology laboratory, which confirmed the hemiptera. The infestation of the airway by a leech is not uncommon; however, this diagnosis is rarely mentioned. The clinical symptoms are variable depending on location and the diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

Qualitative study of perceived causes of tuberculosis treatment default among health care workers in Morocco.

SETTING: In Morocco, tuberculosis (TB) treatment default is increasing in some urban areas. OBJECTIVE: To provide a detailed description of factors that contribute to patient default and solutions from the point of view of health care professionals who participate in TB care. DESIGN: In-depth interviews were conducted with 62 physicians and nurses at nine regional public pulmonary clinics and local health clinics. RESULTS: Participants had a median of 24 years of experience in health care. Treatment default was seen as a result of multilevel factors related to the patient (lack of means, being a migrant worker, distance to treatment site, poor understanding of treatment, drug use, mental illness), medical team (high patient load, low motivation, lack of resources for tracking defaulters), treatment organization (poor communication between treatment sites, no systematic strategy for patient education or tracking, incomplete record keeping), and health care system and society. Tailored recommendations for low- and higher-cost interventions are provided. CONCLUSIONS: Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.

[A rare form of rifampicin-induced skin toxicity: bullous pemphigoid]. / Une forme rare de toxidermie induite par la rifampicine: la pemphigoïde bulleuse.

INTRODUCTION: Rifampicin is an antituberculous drug causing minor cutaneous reactions. Rifampicin-induced bullous skin reactions are rare. CASE REPORT: We describe a 48-year-old man who was given rifampicin, streptomycin, isoniazid and pyrazinamide for pulmonary tuberculosis. Seventy-two hours later, he developed generalized pruritus, and an urticarial eruption developed 5 days later. He was admitted to hospital and the drugs were discontinued. He could remember no history of previous administration of antituberculous drugs and no other drugs had been taken recently. General physical examination yielded no relevant findings. On dermatological examination, Nikolsky's sign was negative. There were tiny symmetrical cutaneous vesicles overlying normal skin of all four limbs. These rapidly became confluent, forming large tense bullous lesions containing clear fluid, suggesting bullous pemphigoid. Blood tests showed a neutrophil leukocytosis and mild eosinophilia. Other biological tests were normal. Skin biopsy was refused by the patient. He was given intravenous antihistamine and dry bandages were applied to the forearms and legs. The antituberculous drugs were discontinued for two weeks and the lesions healed spontaneously. The drugs were then progressively reintroduced, streptomycin being excluded initially. A few hours after the first dose of rifampicin, a recurrence was noted and it was substituted by ethambutol. Subsequent introduction of streptomycin was uneventful. No recurrence occurred over 18 months follow up. CONCLUSION: The authors describe a rare case of rifampicin-induced skin toxicity and the related diagnostic and therapeutic difficulties.

[Pulmonary alveolar microlithiasis: report of four cases]. / La microlithiase alvéolaire pulmonaire: à propos de quatre cas.

INTRODUCTION: Pulmonary alveolar microlithiasis is a rare disease characterised by the formation and deposition of calcium phosphate microliths in the lung. It is an autosomal recessive disorder, for which mutation in the SLC34A2 gene was recently found to be responsible for the disease. OBSERVATIONS: We report on four cases of pulmonary alveolar microlithiasis. Three patients were asymptomatic. The diagnosis was made after histological confirmation in three patients. The outcome was marked by the death of one patient. CONCLUSION: Pulmonary alveolar microlithiasis is a rare disease. Diagnosis is made with high-resolution computed tomography, which exhibits the calcic character and distribution of the lesions, thus avoiding the need to perform lung biopsy. We suggest that a literature review be performed.

[Intracardiac thrombus and pulmonary artery aneurysm in Behcet's disease]. / Thrombose intracardiaque et anévrysmes de l'artère pulmonaire au cours de la maladie de Behçet.

UNLABELLED: Intracardiac thrombus is a rare manifestation of Behcet's disease. OBSERVATION: we report the case of a 60 year old male patient with Behçet's disease who presented with dyspnea and haemoptysis. CT angiography and echocardiography was performed allowing the identification of right heart thrombus associated with pulmonary artery aneurysm. The outcome was favourable with medical management. CONCLUSION: Intracardiac thrombus is a rare complication of Behcet's disease, but the diagnosis should be sought early in order to allow medical management to be considered.

[Renal failure in sarcoidosis: case report]. / Sarcoïdose et insuffisance rénale: à propos de deux cas.

Renal involvement in sarcoidosis is rare and more often related to calcium metabolism disorders or granulomatous interstitial nephritis, glomerulonephritis is exceptional. The two cases of renal failure reported in this article illustrate the gravity of this complication, whose treatment remains difficult.

[The pseudoalveolar form of sarcoïdosis: a diagnostic pitfall]. / La forme pseudo-alvéolaire de la sarcoïdose: un piège diagnostique à ne pas méconnaître.

BACKGROUND: Sarcoïdosis is a benign systemic granulomatosis whose aetiology remains unknown. Lung is the most frequently involved organ. The pseudoalveolar form of this disease is known to have an acute onset and is quite uncommon. Therefore, diagnosing such a rare variety of sarcoidosis is rather often challenging. OBSERVATIONS: In the present article, the authors report two cases of pseudoalveolar sarcoidosis. The patients, both young adults, showed no suggestive signs of sarcoidosis at first presentation. This resulted in a considerable delay to diagnosis and to the corticosteroid therapy. CONCLUSION: The authors emphasize the rarity of the pseudoalveolar form of sarcoidosis. They insist on its roentgenographic characteristics and demonstrate the functional benefits allowed by the precocious medical management. They also propose a current review of the literature.

[Congenital esophagobronchial fistula in an adult. Case report]. / Fistule oeso-bronchique congénitale chez l'adulte. A propos d'un cas.

Congenital esophagobronchial fistulae are uncommon anomalies generally discovered during the neonatal period due to overt symptoms. Rarely symptoms are discrete, leading to discovery in adulthood; exceptionally the patients are totally symptom free or present minimal signs such as coughing at ingestion of fluids. Less than 200 adult cases have been reported in the literature. We report a new case of this type II congenital esophagobronchial fistula. A 59-year-old woman was hospitalized for exploration of cough at ingestion of fluids. The radiographic work-up reveal dilatation of the left bronchial tree and suspected esophagobronchial fistula. An esophago-gastro-duodenal barium study demonstrated a fistula between the mid esophagus and the left posterobasal bronchus. Fistulectomy and left lower lobectomy were performed. Outcome was favorable. The diagnosis of adult esophagobronchial fistula should be entertained in patients with an uneventful history who present localized bronchial dilatation associated with cough induced by fluid ingestion.

[Associated rhinosinus and pleural sarcoidosis]. / Association de localisations rhino-sinusienne et pleurale au cours d'un cas de sarcoïdose.

Sarcoidosis manifestations in the upper airways and pleura are exceptional, observed in 5% and 1% of cases. We report an exceptional observation of an association of these two localizations in addition to mediastinopulmonary involvement. After confirmation of the diagnosis obtained on bronchial biopsies and nasal mucosa biopsies, pleural sarcoidosis was retained because of the clinical context and the spontaneous resolution of the effusion. The major problem is the absence of a therapeutic consensus on proper management, oral corticosteroid therapy being proposed by some for these particular forms of sarcoidosis.

[Pulmonary leptospirosis. Two cases]. / Atteinte pulmonaire au cours de la leptospirose. A propos de deux cas.

Leptospirosis is a systemic infection transmitted to man by a variety of animals. Classical manifestations include fever, liver and renal involvement, meningoencephalitis and hemorrhage. Pulmonary involvement is less common, generally expressed by hemoptysis and bilateral reticulonodular infiltration on the chest x-ray. Pulmonary disease is one of the principal causes of mortality. We report the cases of two patients aged 22 and 32 years who were hospitalized for moderately abundant hemopysis and fever. The diagnosis of leptospirosis with pulmonary involvement, strongly suggested by the classical extrapulmonary signs and was confirmed later. The patients were given antibiotics (amoxicillin, cycline). Clinical, biological and radiological outcome was favorable.

[Chordoma: atypical mediastinal mass. Report of a case]. / Le chordome: une masse médiastinale atypique. A propos d'un cas.

Chordoma is a rare tumor which develops from remnant notochord tissue. Sacro-coccygeal and spheno-occipital localizations predominate. We report a thoracic chordoma of the fifth thoracic vertebra with mediastinal expansion in a 70-year-old woman. Pathology confirmed the diagnosis revealing a lobulated architecture, presence of physaliphorous cells and intracellular mucoid substance. Immunohistochemistry can also be very helpful in atypical cases: positive for anti-cytokeratine, antivimetin and anti-protein S100 antibodies. Spontaneous outcome is fatal. Early and complete resection is the only way to improve prognosis.

[Endobronchial tuberculosis. Report of 21 cases]. / La tuberculose endobronchique. A propos de 21 observations.

Since the advent of antituberculosis drugs, endobronchial tuberculosis has become an exceptional finding, often in a misleading context. Cases reported generally occur in patients with immune deficit. We report 21 cases of endobronchial tuberculosis in immunocompetent patients (mean age 37 years). Clinical and radiological signs were not specific. Bronchial fibroscopy was essential for certain diagnosis, particularly in budding forms. Early treatment reduced the risk of complications. Based on our experience with these 21 cases, we propose a discussion of the pathogenic mechanisms involved and the diagnostic difficulties encountered as well as the disease course and risk of complications that can be expected.

[Pleurisy and sarcoidosis. Apropos of 2 cases]. / Pleurésie et sarcoïdose. A propos de 2 cas.

Pleural involvement is uncommon in sarcoidosis, observed in less than 5% of cases. We report two cases. Both patients were women. In the first patient, signs of sarcoidosis included pleural, mediastinal node, and multiple joint involvement as well as nasal obstruction, sicca syndrome and subcutaneous nodules. Diagnosis was established on pleural and nasal biopsies. For the second patient, in addition to the pleural involvement, there was interstitial lung disease and cervical, epitrochleal and deep abdominal node enlargement. Diagnosis was established from serial bronchial biopsies, pleural biopsies and peripheral node biopsies. Pleurisy is generally observed in cases with extensive lung involvement with extrathoracic localizations. Blind pleural biopsy is not very sensitive for diagnosis of sarcoidosic pleurisy. Light yellow exsudative fluid with a high lymphocyte count in a patient with a radiological and clinical presentation suggestive of tuberculosis, which must be ruled out, is a characteristic feature.