Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteraemia: a series of 12 cases at Prince Sultan Military Medical City KSA.

The aim of this study was to describe the epidemiological data, clinical features and outcome of patients with Elizabethkingia meningoseptica bacteraemia and to report the antimicrobial susceptibility pattern. All patients with E. meningoseptica bacteraemia were retrospectively recruited at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, between June 2013 and May 2019. Epidemiological data, clinical features and patient outcome, as well as antimicrobial susceptibilities of E. meningoseptica, were collected from patient electronic medical records. Twelve patients (eight male and four female) with E. meningoseptica bacteraemia were included in the study. Eleven patients acquired the infection from the hospital, five of whom were in the intensive care unit. All patients had one or more underlying medical conditions or interventions, including chronic illness (eight cases), major surgery (three cases), pulmonary fibrosis (one case), sickle-cell anaemia (one case) and end-stage renal disease (one patient on haemodialysis). Eleven patients had a prolonged stay in the hospital (≥3 months), and nine patients had received prolonged antibiotic therapy. Three patients had polymicrobial bacteraemia, including Serratia marcescens (two cases) and Enterococcus faecalis (one case). All E. meningoseptica isolates were susceptible to trimethoprim/sulfamethoxazole, piperacillin/tazobactam and moxifloxacin but showed a high degree of resistance to ß-lactam antibiotics, aminoglycosides and carbapenems. These findings have important implications for the clinician selecting optimal antimicrobial regimens for patients with risk factors for E. meningoseptica infection.

Erratum to, 'Outcome of mucormycosis after treatment: report of five cases'.

[This corrects the article DOI: 10.1016/j.nmni.2014.12.002.].

Outcome of mucormycosis after treatment: report of five cases.

Mucormycoses are serious infections caused by filamentous fungi of the order Mucorales. They occur most often in immunocompromised patients. We report five cases of mucormycosis in patients hospitalized in the Infectious Diseases Department in Sousse - Tunisia between 2000 and 2013. They were 4 males and one female, mean age 60 years. Three patients were diabetic and one patient had acute leukemia. The locations of mucormycosis were rhinocerebral, rhino-orbital, auricular, pulmonary and cutaneous. The Mucorales isolated were Rhizopus arrhizus in 3 cases and Lichteimia in 2 cases. All patients were treated with amphotericin B and 2 patients had, in addition, surgical debridement. Two patients died and 2 kept peripheral facial paralysis.

[Adherence to antiretroviral therapy in HIV-infected patients in Sousse, Tunisia]. / Observance au traitement antirétroviral chez les patients infectés par le VIH à Sousse, Tunisie.

Adherence to antiretroviral therapy (ART) is a powerful predictor of survival for individuals living with human immunodeficiency virus (HIV). The purpose of this cross-sectional study conducted in December 2007 was to assess ART adherence and identify its determinants in HIV-infected patients in Sousse, Tunisia. Adherence was evaluated in a structured interview, during which questions were asked about the number of pills taken, treatment schedule, and any food restrictions within the previous 4 days. Determinants of adherence included patient characteristics, type of ART, and interpersonal relationships and were assessed from the medical records and questionnaire responses. Adherence was assessed in 30 of the 34 patients receiving ART at the time of the study. Twenty-two patients (73%) complied with all daily treatment recommendations and were considered adherent. Multivariate analysis showed that the main barriers to adherence were related to storage of the medication and doubts about its efficacy. Improvement of socioeconomic conditions and better psychosocial support are needed to optimize ART adherence by HIV-infected patients in Tunisia.

Asymptomatic carriage of Leishmania in family members of patients with visceral leishmaniasis in Central Tunisia.

INTRODUCTION: In Tunisia, asymptomatic carriage of Leishmania is poorly documented. OBJECTIVE: The aim of the present study was to estimate the frequency of asymptomatic infection among the family members of patients with patent visceral leishmaniasis by using the Western blotting kit based on 14 and 16kDa bands. MATERIAL AND METHODS: We tested 94 sera collected from 24 patients with patent visceral leishmaniasis and 70 from their families' members. RESULTS: The rate of seropositivity was 100% in the group of patients and 54.3% in the group of families' members. The analysis of the Western blotting patterns showed that the 33kDa, 24kDa and to a lesser extent the 22kDa band were very indicative of patent visceral leishmaniasis in contrast to asymptomatic infection where these bands were very rarely detected. CONCLUSION: The results reported herein showed the high frequency of asymptomatic carriers of Leishmania among the families' members of visceral leishmaniasis cases and the usefulness of the Western blotting as a screening technique and in distinguishing between patent visceral leishmaniasis and the asymptomatic carriage of Leishmania.

[Prescribing practices of fluoroquinolones in Tunisia]. / Evaluation des pratiques de prescription des fluoroquinolones en médecine de ville en Tunisie.

The aim of the study was to assess the prescribing practices of fluoroquinolones (FQ) among general practionners in the town of Sousse (central-eastern Tunisia). A transversal study was made between the first and the 23rd April, 2009, among general practionners working in Sousse. For each prescription, informations about patients, indications and modalities of treatment were collected on a questionnaire. These prescriptions were compared to Tunisian and/or French guidelines for antibiotics use. One hundred and eighty eight FQ prescriptions were analyzed. The mean age of patients was 50 years. FQ were more often used alone (83%) and in first line intention (84%). The molecules used were essentially ciprofloxacin (44.7%), levofloxacin (35.6%) and ofloxacin (18.6%). The indications were mainly bronchopulmonary infections (34%) and urinary tract infection (32%). These choices were in accordance with guidelines in 41% of the prescriptions. The dosage was adapted, but the duration of treatment was often excessive. Further efforts are needed, to optimize the good use of FQ in order to reduce or stabilize the rate of bacterial resistance.

[Second epidemic of West Nile virus meningoencephalitis in Tunisia]. / Une deuxième épidémie de méningo-encéphalite à virus West Nile en Tunisie.

UNLABELLED: The West Nile virus (WNV) re-emerged in Tunisia in 2003, causing an outbreak of meningoencephalitis. OBJECTIVE: The authors studied the epidemiological, clinical, biological, and imaging features of WNV-associated neurological disease observed in central eastern Tunisia. DESIGN: A retrospective descriptive study was made on patients with West Nile meningitis and/or encephalitis observed in the Sousse area, from August 15 to November 15, 2003. Screening for specific anti-WNV antibodies in serum was performed with Elisa. RESULTS: Recent central nervous system infection due to WNV was confirmed in 21 patients with a mean age of 53 years and a sex ratio of 3.2. The clinical presentation was meningitis in 11 cases, meningoencephalitis in seven cases, and encephalitis in three cases. Patients with encephalitis were older than those with meningitis. An acute flaccid limb paralysis was observed in three patients. The CSF assay showed lymphocytosis, high protein (67 %), and normal glucose levels (83 %). Brain CT scan and MRI were normal. Three patients died, the remaining evolved uneventfully. CONCLUSIONS: These first cases of WNV meningoencephalitis in Sousse area suggest a possibility of reemergence of this infection. Preventive measures and epidemiological surveillance are necessary.

Primary antiphospholipid syndrome and Evan's syndrome: 2 case reports.

The main clinical features of primary antiphospholipid syndrome are recurrent foetal loss, arterial or venous thrombosis and thrombocytopaenia. Evan's syndrome is characterized by simultaneous or sequential association of autoimmune anaemia and thombocytopaenia, rarely reported in primary antiphospholipid syndrome. We describe 2 cases of this association. Treatment with steroids was started in both cases, the follow-up was marked by the normalization of haemoglobin value and platelet count, without relapse.

[Q Fever in Tunisia]. / La fièvre Q en Tunisie.

Q fever is a common zoonosis with almost a worldwide distribution caused by Coxiella burnetii. Farm animals and pets are the main reservoirs of infection and transmission to humans is usually via inhalation of contaminated aerosols. Infection in humans is often asymptomatic, but it can manifest as an acute disease (usually a self-limited flu-like illness, pneumonia or hepatitis) or as a chronic form (mainly endocarditis, but also hepatitis and chronic-fatigue syndrome). In Tunisia, although prevalence of anti-Coxiella burnetii was high among blood donors, Q fever was rarely reported and frequently miss diagnosed by physicians. This study is a review of epidemiological and clinical particularities of Q fever in Tunisia.

Actinomycose abdominale. A propos de quatre cas

L'actinomycose abdominale (AA) est une maladie chronique suppurative; rare et souvent meconnue. Elle est due a une bacterie anaerobie Gram positif ; Actinomyces sp. le plus souvent Israelii. L'actinomycose abdominale est responsable dans la plupart du temps d'un syndrome pseudotumoral conduisant; dans le doute d'une neoplasie; a une chirurgie d'exerese large et mutilante alors qu'une antibiotherapie prolongee aurait permis de guerir la maladie. C'est generalement l'examen anatomopathologique des pieces operatoires qui redresse le diagnostic. Nous rapportons 4 cas d'actinomycose abdominale dont le mode de revelation etait un syndrome eudotumoral. Le diagnostic n'a ete pose qu'en post operatoire sur les pieces d'exerese. Malgre une antibiotherapie de plusieurs mois; deux de nos patientes ont eu une recidive de leur actinomycose. Ces 4 observations confirment ainsi les difficultes diagnostiques et therapeutiques deja rapportees par d'autres auteurs

Eosinophilic fasciitis and toxic thyroid adenoma--a novel association.

Eosinophilic fasciitis is characterized by skin induration, peripheral blood eosinophilia, hypergammaglobulinaemia and thickening, fibrosis and inflammatory cell infiltration of the fascia. There have been several reports of illness particularly haematological disorders in patients with eosinophilic fasciitis. However, their association with thyroid disorders has rarely been described and includes autoimmune thyroiditis rather than toxic thyroid adenoma. We describe a case of a 53-year-old woman with simultaneous association of eosinophilic fasciitis and subclinical hyperthyroidism caused by toxic thyroid adenoma. Corticosteroids, antithyroid drugs and radioiodine therapy were started, with a good follow-up

[Chemotherapy-induced febrile neutropenia: about 200 episodes. Clinical, microbiological and therapeutic characteristics]. / Les neutropénies fébriles chimio-induites : à propos de 200 épisodes. Profil clinique, microbiologique et thérapeutique.

Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.

[Abdominal actinomycosis: four cases]. / Actinomycose abdominale: à propos de quatre cas.

The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors.

Regression of skin lesions of Kyrle's disease with metronidazole in a diabetic patient.

We describe here in a case of a 41-year-old man, with diabetes mellitus, who presented manifestations of Kyrle's disease. Administration of metronidazole, 500 mg twice daily for 1 month, resulted in complete regression of skin lesions with no recurrence during 12 months of follow-up. This successful antibiotic treatment is to support the role of infectious agents (anaerobic bacteria) in the pathogenesis of Kyrle's disease.

Infection in systemic lupus erythematosus.

BACKGROUND: Infections are common in patients with systemic lupus erythematosus (SLE) throughout the course of their disease and remain a source of mortality. The aim of this study was to determine the prevalence of infections, to describe their nature, and analyze their risk factors in adults with SLE. PATIENTS AND METHODS: We performed a descriptive study, at the Farhat-Hached Hospital in Sousse, and retrospectively analyzed the charts of 75 patients with SLE seen between 1990 and 2004. The group of patients with documented infections was compared to a control group. A logistic regression analysis was performed to determine risk factors associated with infection. RESULTS: Our study included 64 women and 11 men (median age of 31.4 years). Forty-three patients (57.5%) had 82 infectious episodes: 23 patients had at least two infectious episodes. Most infections were community acquired, and 80% were severe. The most common infections involved the urinary tract (28%), the skin and soft tissue (26.8%), and the respiratory tract (18.3%). Documented pathogens were: 45 common bacteria, 11 Candida albicans and four Mycobacterium tuberculosis. Localized herpes zoster was noted in three cases. Factors associated with infection, found in univariate analysis, were renal involvement, serum albumin lower than 25 g/l, and corticosteroids treatment. Only corticosteroids therapy remained statistically significant after multivariate analysis.

[Kikuchi-Fujimoto's disease: 3 cases report]. / La maladie de Kikuchi-Fujimoto: à propos de 3 cas.

OBJECTIVE: Kikuchi-Fujimoto's is a rare disease, characterized by the diversity of clinical symptoms, with predominance of enlarged cervical lymph nodes and fever. We report three cases with different presentations. MATERIAL AND METHOD: The first one was a classic form, frequently described in literature. The second was characterized by concomitant association with systemic lupus erythematosus. Histologic findings of Kikuchi's disease were the presence of nuclear debris, absence of haemathoxilin bodies and neutrophils polynuclears. The presentation of the third case was acute meningitis with cervical lymphadenopathy. Lumber puncture showed lymphocytic meningitis, mild hypoglycorrhachia and hyperproteinrrhachia. Favourable evolution was noted in all cases without recurrence. CONCLUSION: Wathever its presentation the prognosis of the Kikuchi-Fujimoto's disease is generally benign with a spontaneously favorable evolution between 1 to 6 months.