Relationship between GII.3 norovirus infections and blood group antigens in young children in Tunisia.

Noroviruses (NoVs) constitute a major cause of gastroenteritis in Tunisia. One hundred and fourteen matched saliva and stool samples were collected from children (n = 114) suffering from acute gastroenteritis at the hospital of Monastir during the winter season 2011-2012. For 98 of 114 children, blood samples were collected for secretor genotyping. NoVs were associated with 36.8% (n = 42/114) of the gastroenteritis cases. The GII.3 genotype was the most common (69% of all NoVs). For patients who were phenotyped (n = 114) for human blood group antigens (HBGAs), the secretor and non-secretor phenotypes represented 79% and 21%, respectively. Of the NoV infections, 83% were detected in all ABO groups. Five GII.3 isolates, one GII.1 isolate and one GII.7 isolate were detected in Lewis-positive non-secretors, confirmed by genotyping of the FUT2 gene. Even though our data showed that GII.3 NoVs could infect non-secretors, no binding was observed with saliva and GII.3 baculovirus-expressed virus-like particles from the same symptomatic non-secretor individual. This suggests that other factors might also participate in NoV attachment in children and newborns.

Tracking medication pathway as per better securing drugs' use in three clinical departments at the University hospital of Monastir (Tunisia).

BACKGROUND: In Tunisia, few studies have an interest to the assessment of medication errors and the implementation of preventive measures. The aim of this study was to evaluate the barriers existing in hospital pharmacies in order to prevent medication errors and to help institutions to make improvement actions. methods: First step: a clinical audit was conducted by observation against a set of standards that are representing a guideline. Second step: interview with health professionals to identify their perceptions about medication safety. Third step: in this step we develop adverse events scenarios according to results of the clinical audit in order to be investigated by the field practice. Fourth step: organizing a multi-professional feedback meeting to raise health professional's awareness and to make them more conscientious about adverse drug events negative consequences and invite them to contribute in the establishment and implementation of corrective solutions. results: In the participating departments medical prescription did not include patient information's (age, weight medical background). Nurses do not verify systematically duration of prescription and administration route. Health professionals interview revealed that physician's have lack of awareness about prescription rules. Lack of communication was the main nurse's problem that requires improvement. CONCLUSION: This project has led to a first overview of the situation of medication use in Tunisia. Results will be used to create a dynamic process to improve the medication system safety.

Hypoxemic Bronchiolitis Related to Major Histocompatibility Class II Deficiency.

Major histocompatibility complex class II expression deficiency is an autosomal recessive primary combined immunodeficiency. The prevalence of this deficiency is the highest in Mediterranean areas, especially North Africa. Early diagnosis is essential due to high mortality in the first 2 years of life. Prognosis is very poor when bone marrow transplantation cannot be performed. We report the case of an infant with major histocompatibility complex class II expression deficiency revealed by hypoxemic bronchiolitis due to Pneumocystis jiroveci.

Cerebral sinovenous thrombosis in a child with idiopathic nephrotic syndrome.

Nephrotic syndrome (NS) is a renal disorder characterized by heavy proteinuria, hypoalbuninemia, edema and hypercholesterolemia. Nephrotic syndrome in children is known to be associated with an hypercoagulable state and thromboembolic complications. However cerebral sinovenous thrombosis (CSVT) is very rare. Here we report a seven-year-old child with steroid-dependent idopathic nephrotic syndrome resulting from a minimal change disease, developed multiple cerebral sinovenous thrombosis, presenting with headache, left sixth nerve palsy, and papilledema. The diagnosis of CSVT was established by cranial computed tomography, magnetic resonance imaging, and magnetic resonance angiography. He gradually recovered after anticoagulant therapy. CSVT is very rare in nephrotic children. The diagnosis of CSVT should be considered in any patient with nephrotic syndrome who develops neurologic symptoms. This report highlights the importance of suspecting and recognizing this potentially life threatening complication and initiating early treatment.

[Lower-limb arterial thrombosis in a relapse of nephrotic syndrome]. / Thrombose artérielle d'un membre inférieur au cours d'une rechute de syndrome néphrotique.

INTRODUCTION: Venous thromboembolic complications are well-known in patients with nephrotic syndrome. Arterial thrombosis has rarely been reported and is mainly observed in adults. CASE REPORT: A 9-year-old patient with a history of steroid-dependent nephrotic syndrome was admitted after foot trauma. He presented with severe pain in his right foot, which was cold and mottled, with reduced sensation and motor activity. No pulse was palpable in his right foot. Doppler's ultrasonography confirmed the thrombosis of anterior and posterior tibial arteries in their distal portions. The patient received treatment with an arterial vasodilator and heparin, followed by antivitamin K therapy. CONCLUSION: Arterial thrombosis is a rare complication in children with nephrotic syndrome. It is presumably attributable to a hypercoagulable state and trauma.

First molecular detection of Aichi virus in sewage and shellfish samples in the Monastir region of Tunisia.

The aims of our investigations were (1) to look for Aichi virus in environmental samples and (2) to compare the Aichi virus strains in both clinical and environmental samples in order to evaluate the role of environmental contamination as a possible vehicle for viral transmission. Aichi virus was detected in 15 (6%) sewage samples and in 4 (6.6%) shellfish samples. Aichi virus was identified for the first time in water samples. Phylogenetic analysis revealed several clusters that occurred sequentially in time, suggesting some parallelism in the evolution of environmental and human strains. Aichi virus present in sewage reflects the viruses circulating in the community.

[Pneumococcal meningitis mortality in children. Prognostic factors in a series of 73 cases]. / Mortalité par méningites à pneumocoque chez l'enfant. Facteurs pronostiques à propos d'une série de 73 observations.

OBJECTIVE: Despite advances in antibiotic therapy strategies and pediatric intensive care, prognosis of Streptococcus pneumoniae meningitis remains very poor. To determine the factors associated with hospital mortality of children with pneumococcal meningitis. METHODS: We conducted a retrospective study of 73 cases of childhood pneumococcal meningitis admitted in 4 teaching hospitals in the center of Tunisia during a 8-year period (1995-2002). RESULTS: Hospital mortality was 13.7% (10 of 71 patients), and neurologic sequela were observed in 34.5% of survivors. Based on univariable analysis, five variables were associated with the outcome: Pediatric Risk of Mortality score (p < 0.001), coma (p=0.0009), use of mechanical ventilation (p=0.0001), convulsions (p = 0.0449), and shock (p=0.0085). In multivariable analysis, only 2 factors were independently associated with in-hospital mortality: Pediatric Risk of Mortality score and the use of mechanical ventilation. 11.8% of pneumococcal isolates were intermediate and resistant to penicillin. Non-susceptible pneumococcus strains to penicillin and the use of steroids were not associated significantly with the mortality rate. CONCLUSIONS: Pneumococcal meningitis remains a devastating childhood disease. Two variables were independently associated with the in-hospital death in our series (high Pediatric Risk of Mortality score, and the use of mechanical ventilation). According to these data we may recommend the inclusion of vaccination against streptococcus pneumonia in the children's immunization program in Tunisia.

Clinical and mutational investigations of tyrosinemia type II in Northern Tunisia: identification and structural characterization of two novel TAT mutations.

Tyrosinemia type II or Richner-Hanhart Syndrome (RHS) is an autosomal recessive disorder characterized by keratitis, palmoplantar keratosis, mental retardation, and elevated blood tyrosine levels. The disease is due to a deficiency of hepatic cytosolic tyrosine aminotransferase (TATc), an enzyme involved in the tyrosine catabolic pathway. Because of the high rate of consanguinity this disorder seems to be relatively common among the Arab and Mediterranean populations. RHS is characterized by inter and intrafamilial phenotypic variability. A large spectrum of mutations within TATc gene has been shown to be responsible for RHS. In the present study, we report the clinical features and the molecular investigation of RHS in three unrelated consanguineous Tunisian families including 7 patients with confirmed biochemical diagnosis of tyrosinemia type II. Mutation analyses were performed and two novel missense mutations were identified (C151Y) and (L273P) within exon 5 and exon 8, respectively. The 3D-structural characterization of these mutations provides evidence of defective folding of the mutant proteins, and likely alteration of the enzymatic activity. Phenotype variability was observed even among individuals sharing the same pathogenic mutation.

[Eosinophilic granuloma revealed by torticollis: a case report]. / Granulome éosinophile révélé par un torticolis: à propos d'une observation.

UNLABELLED: Langerhans cell histiocytose is a rare condition in childhood. It presents in different ways ranging from a single bony disease to a multisystemic disease involving vital organs. CASE REPORT: We report a case of single bone involvement revealed by torticollis in an eight-year-old boy. The diagnosis was evocated on radiological findings and confirmed by histologic aspects. After a period of 2,5 years, this child is in total spontaneous remission. CONCLUSION: Torticollis must be explored and watched. Eosinophilic granuloma can be a rare aetiology in children. The outcome is often favorable.

[Hypernatremic dehydration in children: retrospective study of 105 cases]. / La déshydratation hypernatrémique chez l'enfant : étude rétrospective de 105 cas.

UNLABELLED: The hypernatremic dehydration defined by a serum sodium concentration> or = to 150 mmol/l, is a particular form of acute dehydration and constitutes a medical emergency requiring a prompt and adequate diagnosis and management. PURPOSE: To precise the epidemiological profile, course, causes and therapeutic particularities of hypernatremic dehydration in children. POPULATION AND METHODS: Retrospective review of 105 children admitted in the general Paediatrics department of the Fattouma Bourguiba university hospital in Monastir (Tunisia), for hypernatremic dehydration between January 1st 1990 and December 31 2002. RESULTS: Hypernatremic dehydration represented 11.51% of all kinds of dehydration. The mean age was 6.5 months with a small male predominance. The socio-economic level of the parents was good in 62.8% of cases. Half of the children were in shock. Severe dehydration was present in 87.6% of cases and neurological signs were observed in 77.14% of cases. The initial mean serum sodium concentration was 159 mmol/L. Acidosis and acute renal failure were associated respectively in 97.2% and 76.2% of cases. Prominent cause of hypernatremic dehydration was diarrhoea (94.3%). Intravenous rehydration with 5% glucose solution at the average of 147 ml/kg/day and containing a mean sodium level of 42 mmol/L was performed in 74% of cases. In most cases (84.1%) serum sodium was normalized within the first 72 hours. Complications were noted in 5.7% of cases and mortality rate was 11.4%. CONCLUSION: Hypernatremic dehydration was common in infant and the prominent cause is still dominated by diarrhoea in our country. The management of hypernatremic dehydration is based on oral or intravenous rehydration and plasma expanding fluids when shock is present or imminent. The serum sodium concentration should be gradually corrected and should not exceed 0.5 mmol/L/h. Prevention is based on the pursuit of breastfeeding and the use of oral rehydration solution in infantile diarrhoeas.

[Neuromeningeal enterovirus infections in Tunisia: epidemiology, clinical presentation, and outcome of 26 pediatric cases]. / Entéroviroses neuroméningées en Tunisie: profil épidémiologique, clinique et évolutif. A propos de 26 cas pédiatriques.

UNLABELLED: Non-polio enteroviruses are the most common identified cause of viral neuromeningeal infections following the introduction of the mumps and polio vaccines. OBJECTIVE: The aim of this study was to describe the epidemiology, clinical presentation, and the outcome of enteroviral infections of the CNS. METHOD AND PATIENTS: We performed a prospective study on 41 children admitted for viral neuromeningeal infections in the pediatric department of Monastir between December 2001 and November 2002. Enteroviruses were detected from cerebrospinal fluid by RT-PCR. RESULTS: This study showed that enteroviruses were responsible for 63.4% of the infections. The mean age of patients was 6.1 years. Aseptic meningitis was diagnosed in 14 cases and encephalitis in 10. The most frequent symptom was fever (61.5%), followed by seizures (42.3%), and confusion (23%). On follow-up, all patients with meningitis had recovered without sequels. Neurological complications in patients with encephalitis were epilepsy (3 cases), cerebral palsy (2 cases), and mental retardation (1 case). CONCLUSION: This study confirmed that enteroviruses were the most common cause of viral infections of the CNS. Common use of RT-PCR can have a significant impact on the outcome of patients with enterovirus infections.

[Prolonged fever in children. Retrospective study of 67 cases]. / Les fièvres prolongées de l'enfant. Etude rétrospective de 67 cas.

BACKGROUND: The first problem to face in prolonged fever is its etiologic diagnosis. Its incidence varies between 0,5 to 3% of all paediatric hospital-stay. Precise diagnosis need an extensive questionnary, complete physical examination and an algorithm of complementary exams. PURPOSE: To precise the epidemiologic profile and causes of prolonged fever in a children. POPULATION AND METHODS: Retrospective review of 67 children between two and 15 years old admitted in the general paediatrics department of the Fattouma Bourguiba university hospital in Monastir (Tunisia), for prolonged fever between 1(st) January 1988 and 31 December 1998. RESULTS: The incidence of prolonged fever was 1,02%. The mean age was seven years with female predominance. The mean fever duration was 30 days. Fever was isolated in 23,9% of cases. Fever was associated to rheumatic or respiratory signs in respectively 26,9% and 20,9% of cases. Hospital-stay was of 11 days in 50% of cases. Prominent causes were dominated by infectious diseases (56,7%) with predominance of localized infections, followed by inflammatory diseases (20,9%) with predominance of rheumatic fever and neoplasms (3%). Fever remained of unknown origin was seen in 19,4% of cases. CONCLUSION: Prolonged fever is still dominated by infectious and inflammatory diseases and depend on local epidemiological particularities. In fact we noted in this study the relative high-frequency of visceral leishmaniasis, complicated pulmonary hydatic cyst and rheumatic fever. The diagnosis approach should be based on complementary exams of first and second stage because of their high number and cost. Prognosis of fever of unknown origin is often favorable.

[Infantile visceral leishmaniasis: difficult diagnosis in cases complicated by hemophagocytosis]. / Leishmaniose viscérale infantile: un diagnostic difficile en cas d'hémophagocytose associée.

BACKGROUND: Hemophagocytosis has already been reported in cases of visceral leishmaniasis and thus may complicate search for diagnosis. CASE REPORT: A previously healthy 2 year-old boy was referred for fever and splenomegaly with pancytopenia. An initial diagnosis of kala-azar was refuted because of absence of biological inflammatory syndrome, negativity of bone-marrow aspiration and splenic ponction and of specific serology. After three months of clinical deterioration and apparition of active hemophagocytosis, both bone marrow aspiration and specific serology for visceral leishmaniasis became positive. The boy was given sodium stibogluconate for 20 days; he improved gradually with complete and definitive remission. CONCLUSION: Diagnosis of visceral leishmaniasis may be difficult, even in countries where this condition is relatively frequent; the association with hemophagocytosis is possible and does not constitute a poor factor of prognosis if specific therapy is proposed.

[Factors associated with low birth weight in Tunisian Sahel]. / Facteurs associés aux faibles poids de naissance dans le Sahel tunisien.

The aim of this study, which was carried out in the area of Monastir from September 1st to December 31, 1989 was to evaluate the incidence of and to identify the factors associated with low birth weight (LBW). The results showed that LBW neonates make up 7.6% (n = 413) of the 5,419 live births, 57.4% of which being small for dates at term. 48% of prematures also had intra-uterine growth retardation. The average LBW was 1,913 +/- 497 g (20% of the LBW neonates had a weight below 1,500 g). Factors associated with LBW were: extreme ages of the mothers, illiteracy, working class, previous history of stillbirth or death before 1 year of age, abnormal issue of the previous pregnancy, multiple pregnancies, insufficient medical supervision and prenatal care, congenital malformations in the child. Improvement in prenatal care and adequate monitoring of at risk pregnancies might decrease the occurrence of LBW in this Tunisian area.

[Epidemiology of hydatidosis in Tunisian children and adolescents]. / Epidémiologie de l'hydatidose chez l'enfant et l'adolescent tunisiens.

Analysis of the operative reports of hospitals in the central area of Tunisia allowed to define the epidemiology of echinococcosis in children and adolescents. Four hundred forty-three patients under 20 years of age were operated on between 1980 and 1985. In children less than 10 years of age, boys are more often concerned than girls, whereas prevalence in girls occurs after 10 years of age. Liver involvement is more frequent in girls, whatever their ages. Prevention programs should consider the high frequency in young children.