Co-infections with hepatitis B and C viruses in human immunodeficiency virus-infected patients in Morocco.

Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are major public health concerns. We aimed to determine the prevalence of HBV and HCV infections among HIV-infected patients, and to identify the main circulating hepatitis strains in Morocco. The study was carried out in 503 HIV-infected patients. Our survey indicated that the prevalence of HIV/hepatitis co-infection was 10.6%; 5.2% of patients were HBV surface antigen positive, and 5.4% of patients were anti-HCV positive. Among the HBV surface antigen-positive group, HBV DNA sequencing identified exclusively genotype D (D1: 26.7%; D7: 73.3%) in accordance with what is found in the general population. In contrast, sequencing of HCV isolates produced an unusual subtype distribution with a decreasing order of prevalence: 1a, 3a (both 23.5%), 1b, 4a (both 17.6%), 1c (11.8%) and 6h (6%).

[Benefit of the rapid test determine HIV1/2 in the clinical diagnosis of HIV infection in Ibn Rochd hospital of Casablanca, Morocco]. / Apport du test rapide Determine HIV1/2 dans le diagnostic clinique de l'infection à VIH à l'hôpital Ibn Rochd de Casablanca, Maroc.

BACKGROUND: In Morocco, diagnosis of HIV infection remains late, which seriously compromises the timely management of HIV infection in the era of HAART therapies. Rapid test represents a good opportunity to improve the access to early screening of HIV. The objective of this study is to report the experience of the infectious diseases unit of the Ibn Rochd University hospital center of Casablanca, in the use of the rapid test in clinical screening of HIV. PATIENTS AND METHODS: This retrospective study reports data relevant to the use of the rapid test Determine VIH-1/2, Abbott Diagnostics, since its introduction in the infectious diseases unit in April 2006 up to December 2009. The test was performed for patients from the infectious diseases unit and patients hospitalized in different units of the Ibn Rochd University hospital center, after their consent. Test was ordered systematically by clinicians in case of any suspected symptom related to HIV and immunodepression. Positive samples were confirmed by Western Blot test, at the National Reference Laboratory for HIV, within the Institut National d'Hygiène in Rabat. RESULTS: Between 2006 and 2009, 1105 rapid tests were performed, among which 16.3% were positive. All results were provided to patients and none were lost to follow-up. The main reasons for the prescription of an HIV test were tuberculosis (26.3%) and chronic diarrhea (9.9%) for inpatients. For outpatients, the main symptoms were sexually transmissible infections (16.7%) and weight loss (15.7%). Results of the tests allowed us to adapt the treatment in case of suspicion of pneumocystosis (12 cases) and toxoplasmosis (seven cases). CONCLUSION: The introduction of the rapid test for HIV clinical screening in the hospital facilities improved considerably the access to diagnosis and consequently allowed a timely management of HIV infection.

[Imported severe malaria in adults: a retrospective study of ten cases admitted to intensive care units in Casablanca]. / Paludisme grave d'importation chez l'adulte: étude rétrospective de dix cas admis en réanimation à Casablanca.

INTRODUCTION: We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital. MATERIAL AND METHODS: All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated. RESULTS: Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died. CONCLUSION: The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.

[Bilateral emphysematous pyelonephritis cured by medical therapy alone]. / Une pyélonéphrite emphysémateuse bilatérale d'évolution favorable après traitement médical seul.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis has a high mortality rate. We herein report one case of bilateral emphysematous pyelonephritis managed by medical therapy alone.

[A study on antiretroviral treatment compliance in Casablanca (Morocco)]. / Etude sur l'observance du traitement antirétroviral à Casablanca (Maroc).

OBJECTIVE: Compliance in HIV infection treatment is a major stake to give worldwide access to antiretroviral (ARV) treatment and especially in Africa. In September 2003, we undertook a study on compliance among HIV positive patients under antiretroviral treatment. These patients were included in a therapeutic educational program in the infectious diseases department of the Casablanca University Hospital (Morocco). The main objective of the study was to assess obstacles to compliance and to find possible solutions. DESIGN: A transversal investigation was made, based on questionnaires for patients under ARV treatment, chosen consecutively. The physician's and the educator's opinion on patient compliance was collected. RESULTS: Patients were between 21 and 65 years of age. Ninety-two patients were questioned and 89 analyzed. Treatment duration lasted from 2 to 67 months. Compliance according to educators was good (>90%) for 78 patients. The main obstacles for a good compliance were difficulty to respect administration schedule and the long distance between home and hospital, or the presence of adverse effects and other diseases. CONCLUSIONS: The role of the therapeutic educational program in improving compliance was largely highlighted.

[Kaposi's sarcoma during HIV infection in Morocco (apropos of 50 cases)]. / Maladie de Kaposi au cours de l'infection par le VIH au Maroc. (A propos de 50 cas).

Kaposi's sarcoma is the most common neoplasm to be found among AIDS patients. The purpose of this retrospective study is to determine the epidemiological, clinical, therapeutic features and the evolution of Kaposi's sarcoma in Moroccan patients suffering from AIDS. Between January 1987 and December 1999, 696 patients with AIDS were hospitalized in the department of infectious diseases of Casablanca. Fifty of them (7%) had Kaposi's sarcoma. AIDS was confirmed by ELISA and Western-Blot. The diagnosis of Kaposi's sarcoma was established by clinical aspect and I or by histologically study. It concerned 46 men and 4 women. The average age was 32.5 years. The homosexuality was noted in 38% of patients and the heterosexuality in 56% of cases. AIDS was revealed by Kaposi's sarcoma in 82% of cases. The Lesions were found in the skin (96%), in the skin and mucous membranes (56%), in the lung (14%), in the gastrointestinal tract (12%) and in the lymphatic nodes (8%). The average CD4 cells count was 212.8/mm3. The chemotherapy was instituted in 43 patients and the radiotherapy in 5 patients (alone or associated with chemotherapy). Four patients received HAART. Six patients didn't received any treatment. The evolution has been characterized by the death in 61% of patients. This death was due to Kaposi's sarcoma in six patients and to opportunistic infections in the others cases. Our study demonstrates the high incidence of Kaposi's sarcoma as an inaugurating event of AIDS, the severity of the visceral involvement, the limit of our therapeutic materials and the wrong prognosis of this disease.

HLA-B phenotype modifies the course of Behçet's disease in Moroccan patients.

In Moroccan patients, predisposition to Behçet's disease is associated with HLA-B*51, mostly in males with young age at disease onset. In addition, the disease is associated with B*15 both in females and in males with late disease onset. We analyzed the clinical presentation, the severity and the course of the disease in 86 Moroccan patients according to their HLA-B phenotype. The presence of the B*51 or B*15 did not predispose to a particular clinical manifestation, nor to a more severe presentation of the disease. By contrast, outcome of the disease significantly differed depending on HLA-B phenotype, with an increase of symptoms in most B*51+ patients and in half of B*15 patients, and a remission or a decrease of symptoms in all B*51-B*15- patients. This variable course was mostly observed for ocular lesions, skin lesions, articular symptoms, and neurological symptoms. These data may suggest that treatment should be given early in the course of the disease in B*51 or B*15-positive patients in order to stabilize the inflammatory process.

HLA class I polymorphism in a Moroccan population from Casablanca.

We have studied the distribution of HLA-A and -B alleles and haplotypes by sequence-specific primer amplification in a sample of 100 unrelated healthy individuals belonging to both Berber and Arabic-speaking groups from the region of Casablanca in Morocco. Among the 17 HLA-A and 23 HLA-B alleles observed, the most frequent were HLA-A2 (21%), -A1 (11%), -A3 (10%), -B44 (11.4%), -B50 (9.9%), -B5(8.5%) and -B35 (6.5%). Six two-locus haplotypes were observed with a frequency above 5%: A2-B50 (9.6%), A23-B44 (7.4%), A2-B15 (6.4%), A68-B39 (5.3%), A1-B51 (5.3%) and A68-B44 (4.3%). Our data confirm that, on the basis of genetic distances, the majority of present-day North Africans from Morocco are closely related to Berbers and also to Iberians. They cluster apart from Middle-Eastern Mediterranean populations, and show greater genetic distances to Eastern and other Mediterranean populations. This study will serve as a reference for further anthropological studies, as well as studies of HLA and disease associations.

[Botulism in Casablanca. (11 cases)]. / Le botulisme à Casablanca. (A propos de 11 cas).

Botulism is a rare but severe disease. Whereas until 1980, only one case of botulism had been reported in our department, in 1999, a real botulism epidemic took place in Morocco. To our knowledge, it's the first outbreak of that kind in Morocco. We report here an epidemiologic and descriptive study of 11 patients suffering from botulism, admitted at the Infectious Diseases department and in the Medical Intensive Care Unit of Ibn Rochd University Hospital, from August, the 10th to October, the 1st, 1999. Clinical diagnosis of botulism was made, at the admission, on ocular signs (diplopia, ptosis), swallowing troubles and/or muscle weakness. There was no fever, no trouble of conscience and normal reflexes, at the early stage of the disease. The average age of patients was of 23.9 years +/- 12.07. Three patients were first admitted in the Medical Intensive Care Unit. The period before symptom appearance varied between 7 and 96 hours. Dysphagia sore throat, dry mouth and dysphonia were always found in all patients, with normal conscience. The fever was noted in 3 cases, polypnea in 3 cases leading to respiratory assistance in 2 cases. Neurologic findings were dominated by ptosis and hypotonia. The search of botulism toxin B in blood was positive in 6 cases. The electromyography showed clear signs of botulism. The evolution was favourable in 10 cases. Respiratory complications were found in 2 cases and infectious complications in 4 cases. One patient died. The period of hospitalization varied between 10 to 24 days with an average stay of 15.8 days. Eating "mortadella" has been noticed in 7 patients) and investigations permitted to identify the factory of "mortadella" as well as the toxin's type B responsible for these poisoning. It appears clearly that it is important to reinforce hygiene controls. Physicians and specialists in public health must be aware of the severity of this illness, knowing that the recovery is shortened when the treatment is administered on an early stage of the disease.

HLA-B*51 and B*15 alleles confer predisposition to Behçet's disease in Moroccan patients.

HLA class I polymorphism in Moroccan patients with Behçet's disease has not been investigated so far. In this study, HLA-B* phenotype frequencies were analyzed in 86 unrelated Moroccan patients (45 males, 41 females) and 111 ethnically matched healthy controls. The predisposing effect of the B*51 was confirmed (30.2% in patients and 15.3% in controls, OR = 2.39, 95% CI [1.2-4.8], p = 0.015). It was mostly observed in males with young age at disease onset (OR= 5.5 [1.9-15.9], p = 0.002 compared to controls). The Moroccan BD group also presented a previously unknown association with HLA-B*15 (25.6% of patients versus 11.7% of controls, OR = 2.59 [1.2-5.5], p = 0.014), both in females and in males with late-onset of the disease. Altogether, the B*15 and/or B*51 alleles were expressed in 55.8% of patients compared to 27% of controls (OR = 3.4 [1.9-6.2], p < 10-4, Pc = 0.003). Our data indicate HLA-B effects on BD pathogenesis should be considered separately for men and women.

[Pregnancy and AIDS. Report of 9 cases]. / Grossesse et SIDA. A propos de 9 cas.

The pregnancy at women infected by the HIV characterizes by the risk of transmission of the HIV to the child. The goal of this retrospective study concerning 9 deliveries of women infected by the HIV cured in the Infectious Diseases Service and the Lalla Meryem's Maternity of Casablanca CHU Ibn-rochd during 10 years (1990-1999) is to specify the experience of two services of concerning plug in cost of the patients infected by HIV by trying to pull some a protocol of plug in cost. The antiretroviral therapy has been used in 8 cases out 9. The AZT long protocol has been used in 6 cases and the bitherapy in 2 cases. The delivery has taken place by the natural way under cover of AZT in all cases. All babies have received the AZT in syrup and none has been breastfed to the breast. Two newborns on 9 out 9 have been contaminated by the HIV.

[Ocular damage during HIV infection at the University Hospital Center of Casablanca. (Apropos of 400 cases)]. / Les atteintes oculaires au cours de l'infection par le VIH au CHU de Casablanca. (A propos de 400 cas).

The objective of this study was to report ocular manifestations in Moroccan patients infected with HIV/AIDS. 400 patients were surveyed retrospectively from 1993 to 1998 as part of a co-operative study undertaken by the departments of infectious diseases and ophtalmology of the Casablanca Teaching Hospital. Of the 400 patients, 127 had an infection of the posterior segment and 7 showed signs of a palpebral infection. We also found 44 cases of opportunist retinal infections, dominated by the Cytomegalovirus (CMV) (18 cases). Our sample study indicates an intermediary position between western countries where the widespread use of the tritherapy has increased the life expectancy of patients and sub-Saharan Africa where epidemiological data are still characterised by high mortality and increasing endemic disease.

Ceftriaxone versus penicillin G in the short-term treatment of meningococcal meningitis in adults.

Short-term treatment with ceftriaxone 2 g once daily for two days (group 1) was compared to treatment with a standard regimen of penicillin G (group 2) for six days in adults with meningococcal meningitis. Thirty-six patients were allocated in a randomized fashion to a treatment group: 16 to group 1 and 20 to group 2. The clinical and microbiological results were comparable in the two treatment groups. In both groups cultures of cerebrospinal fluid were sterile after 24 hours. One patient in each group died. In group 1 one case of fulminant meningococcemia and one case of brain abscess required further antibiotic treatment. It is concluded that short-term treatment with ceftriaxone is feasible but patients with severe forms of meningitis would not be eligible for treatment with this regimen, and careful follow-up of the patients receiving ceftriaxone is necessary.

[High incidence of sporadic non-A, non-B hepatitis in Morocco: epidemiologic study]. / Forte incidence des hépatites non-A, non-B sporadiques au Maroc: étude épidémiologique.

Non-A, Non-B hepatitis and their sequelae seem to be as frequent as HBV infections in Morocco. These diseases represent an important problem of public health because their high incidence and high fatal rate. Some aspects of the epidemiology of Non-A, Non B acute hepatitis were evoking a high incidence of enterically transmitted hepatitis E. That was confirmed by serum studies having shown that hepatitis E antibodies were detected in more than 60% of patients with acute Non-A, Non-B hepatitis. However this type of hepatitis has been recognized only as sporadic (non-epidemic), mainly transmitted by personal contacts in low hygiene conditions. Other Non-A, Non-B acute hepatitis (around 35%) were certainly due to hepatitis C virus infection, because the presence of hepatitis C antibodies in the serum of the patients. However, in our study, hepatitis C seemed to be rarely transmitted by transfusion or other blood related route. Chronic liver diseases related to Non-A, Non-B virus infection appeared to be as frequent as the ones due to hepatitis B virus. Serological studies had shown that about seventy-four per cent of the studied cases were related to an infection by hepatitis C virus (presence of hepatitis C antibodies). Among other Non-A, Non-B chronic liver diseases the possible existence of some cases due to hepatitis E virus infection cannot be ruled out but this hypothesis needs further investigations to be verified. The prevalence of the markers of past hepatitis B infection in convalescent patients from Non-A, Non-B hepatitis is comparable to the prevalence of hepatitis B infection markers in blood donors. However, chronic HBV infection could be a factor facilitating the clinical expression of the Non-A, Non-B hepatitis.