Genotypic analysis of Salmonella enterica serovar Typhi collected during two successive autumnal typhoid outbreaks in southeast Tunisia.

OBJECTIVE: Investigation of two successive autumnal outbreaks of typhoid fever that occurred in southeast Tunisia. PATIENTS AND METHODS: Salmonella typhi isolates collected from confirmed cases of typhoid fever during the two outbreaks occurred in autumn 2004 and 2005 and from healthy carriers were analyzed by antibiogram and pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 86 isolates of Salmonella enterica serovar Typhi (76 from blood culture or stool of patients involved in both outbreaks and 10 from stool of healthy carriers) were obtained. All isolates of S. typhi were fully sensitive to all antibiotics tested, particularly to co-trimoxazole and ciprofloxacin. All isolates of 2004 (39 from patients and 10 from healthy carriers) appeared to be genetically identical when digested with SpeI, AvrII and XbaI. XbaI digestion of 2005 outbreak isolates gave five different patterns with predominance of the 2004 outbreak pattern. Both outbreaks were concomitant with the season of "legmi", fermented juice traditionally extracted from palm-tree. CONCLUSION: PFGE with XbaI was discriminatory and can be useful for epidemiological routine investigation of typhoid fever. Typing results suggests the monoclonality of 2004 outbreak and the multiclonality of the 2005 outbreak. The epidemic clone of S. typhi is able to persist for long period in a quiet state in the population and to give again a new outbreak, when the conditions become favorable.

[Phalengeal actinomycosis: a rare disease]. / Actinomycose des os du pied: un diagnostic à ne pas méconnaître.

INTRODUCTION: Bone involvement in actinomycosis is rare. EXEGESIS: We report a case of a 38 year-old woman with foot bone actinomycosis. The clinical symptoms were non-specific and the diagnosis was difficult. An X-ray revealed an osteolysis and a sclerosis of the proximal phalanx of the big toe. A phalengiectomy was carried out after the failure of antistaphylococcic antibiotherapy. The diagnosis of actinomycosis was substantiated by a histological examination. The clinical outcome was good after six-month treatment by penicillin G substitutes for cotrimoxazol. The patient completely recovered and was feeling well. The mean follow up was fifteen months. CONCLUSION: Clinical and therapeutic aspects of this rare localization are reviewed.

[Role of enteroviruses in aseptic meningitis in Tunisia]. / Place des entérovirus dans les méningites aseptiques en Tunisie.

Despite the favourable clinical outcome in most cases, viral meningitis can cause a serious public health problem especially when several cases occur during outbreaks. The first part of this work is a retrospective study conducted in three hospitals in Tunisia and covering a period of three years. It showed an incidence of viral meningitis 2.4. The second part of the study is a prospective one, it included 94 cases of aseptic meningitis notified during a period of 12 months. Virus isolation in cell culture was performed on CSF and stool samples, using cell lines sensitive to enteroviruses. A PCR to detect enteroviruses was also used in parallel. This study represents a first approach to viral meningitis in Tunisia. It highlights the importance of a regular surveillance of the disease and the contribution of molecular methods to a more sensitive diagnostic. However, cell culture remained necessary for viral isolation and serotyping.