First detection of vanA positive Enterococcus faecium clonal complex 17 in hospital wastewater in Algeria: an epidemiological report.

Enterococcus spp. are Gram-positive cocci that are recognised as critical opportunistic pathogens, especially in immunocompromised patients. Vancomycin is considered as the drug of last resort for the treatment of infections caused by Enterococcus species, making vancomycin resistance a serious public health concern. In this article, we report the first environmental vanA positive Enterococcus faecium isolates in Algeria. The strains were selectively isolated from hospital wastewater and then identified using matrix-assisted laser desorption and ionisation time-of-flight mass spectrometry. Antibiotic susceptibility testing was performed using the disc diffusion method. Vancomycin resistance genes were searched for by standard PCR and the clonal relatedness of our isolates was investigated by multilocus sequence typing. A total of five highly vancomycin-resistant Gram-positive bacteria were isolated and identified as Enterococcus faecium. The isolates harboured the vanA gene and were assigned to the clonal complex 17. Our findings confirm the great potential of hospital wastewater as a reservoir and dissemination pathway of multidrug resistant organisms, and alert to the need for better regulation of hospital waste management in order to reduce their impact on the environment.

Original treatment for ischaemic stenosis of colon interposition: Report of two cases.

INTRODUCTION: The treatment of ischaemic stenosis of colon interposition for oesophageal replacement remains poorly defined. CASE REPORT: We report two cases of patients operated for ischaemic stenosis of the cervical extremity of the colon interposition for caustic stenosis of the oesophagus. Treatment consisted of resection of the stenosis with creation of a new cervical anastomosis after complete release of the colon graft via a neck and upper midline incision in one patient and a new ileocolic graft exclusively replacing the stenotic segment of the oesophagoplasty in the second patient. DISCUSSION: These two cases illustrate the complex treatment modalities required for this complication. CONCLUSION: The treatment of choice of ischaemic stenosis of colon interposition is resection with creation of a new anastomosis, but repeat graft may sometimes be the only available treatment option.

Modelling of seasonal influenza and estimation of the burden in Tunisia.

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness (ILI) per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A(H3N2) 15.5%; A(H1N1)pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza.

Modelling of seasonal influenza and estimation of the burden in Tunisia

The burden of influenza was estimated from surveillance data in Tunisia using epidemiological parameters of transmission with WHO classical tools and mathematical modelling. The incidence rates of influenza-associated influenza-like illness [ILI] per 100 000 were 18 735 in 2012/2013 season; 5536 in 2013/14 and 12 602 in 2014/15. The estimated proportions of influenza-associated ILI in the total outpatient load were 3.16%; 0.86% and 1.98% in the 3 seasons respectively. Distribution of influenza viruses among positive patients was: A[H3N2] 15.5%; A[H1N1] pdm2009 39.2%; and B virus 45.3% in 2014/2015 season. From the estimated numbers of symptomatic cases, we estimated that the critical proportions of the population that should be vaccinated were 15%, 4% and 10% respectively. Running the model for the different values of R0, we quantified the number of symptomatic clinical cases, the clinical attack rates, the symptomatic clinical attack rates and the number of deaths. More realistic versions of this model and improved estimates of parameters from surveillance data will strengthen the estimation of the burden of influenza

En Tunisie, la charge de la grippe a été estimée à partir des données de surveillance, en utilisant les paramètres épidémiologiques de la transmission avec les outils classiques de l'OMS et la modélisation mathématique. Les taux d'incidence des syndromes de type grippal [STG] associés à la grippe étaient 18 735 pour 100 000 pour la saison 2012-2013 ; 5 536 pour 2013-2014 et 12 602 pour 2014-2015. La part estimée de STG associés à la grippe pour la charge totale de patients externes était respectivement de 3,16%, 0,86% et 1,98% pour les trois saisons. Parmi les patients positifs au virus de la grippe, la répartition était la suivante pour la saison 2014-2015 : 15,5% pour le virus A[H3N2] ; 39,2% pour le virus A[H1N1]pdm2009 ; et 45,3% pour le virus B. A partir du nombre estimé de cas symptomatiques, nous avons calculé que la proportion critique de la population devant être vaccinée était respectivement de 15%, 4% et 10%. L'exécution du modèle avec les différentes valeurs de R0 nous a permis de déterminer le nombre de cas cliniques symptomatiques, les taux d'attaque clinique, les taux d'attaque clinique pour les cas symptomatiques et le nombre de décès. Des versions plus réalistes de ce modèle ainsi que des estimations améliorées des paramètres issus des données de surveillance permettront d'accroître l'utilité des modèles mathématiques

Genetic diversity of influenza B virus in 2009-2010 and 2010-2011 in Tunisia.

OBJECTIVE: The authors had for aim to characterize influenza B strains having circulated in Tunisia to identify new mutations and compare them with reference strains. METHODS: The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infected by influenza B strains isolated in several regions of Tunisia in 2009-2010 and in 2010-2011. Laboratory identification and detection of mutations in the segment encoding hemagglutinin of influenza viruses was performed by real time PCR and sequencing. RESULTS: The two influenza B Tunisian strains of the 2009-2010 season belonged to the Victoria lineage, whereas 2010-2011 season strains belonged to B/Victoria/2/87 and B/Yamagata/16/88 lineages with a dominance of the Yamagata lineage (76%). This study allowed identifying amino acid substitutions: T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V and K253R in the B/Yamagata lineage; L58P, N75K, K109N, N165K, S172P and K257R into the B/Victoria lineage. These mutations were specific of Tunisian groups of variants. Most influenza B-Yamagata lineage viruses (69%) were associated with severe cases. CONCLUSION: Molecular analysis of the various influenza B strains circulating in Tunisia is useful to detect new mutations that can modify the phenotype of influenza strains.

T-tube drainage of the common bile duct choleperitoneum: etiology and management.

External drainage of the common bile duct by placement of a T-tube is a common practice after choledochotomy. This practice may result in the specific complication of bile peritonitis due to leakage after removal of the T-tube. This complication has multiple causes: some are patient-related (corticotherapy, chemotherapy, ascites), and others are due to technical factors (inappropriate suturing of the drain to the ductal wall, minimal inflammatory reaction related to some drain materials). The clinical presentation is quite variable depending on the amount and rapidity of intra-peritoneal spread of of bile leakage. Abdominal ultrasound (US), with US-guided needle aspiration and occasionally Technetium(99) scintigraphy are useful for diagnosis. Traditional therapy consists of surgical intervention including peritoneal lavage and re-intubation of the choledochal fistulous tract to allow for a further period of external drainage. When leakage is walled off and well-tolerated, a more nuanced and less invasive conservative therapy may combine percutaneous drainage with endoscopic placement of a trans-ampullary biliary drainage.

Gas gangrene of the abdominal wall due to late-onset enteric fistula after polyester mesh repair of an incisional hernia.

The occurrence of enteric fistulae after wall repair using a prosthetic mesh is a serious but, fortunately, rare complication. We report the case of a 66-year-old diabetic man who presented with gas gangrene of the abdominal wall due to an intra-abdominal abscess caused by intestinal erosion six years after an incisional hernia repair using a polyester mesh. The aim of this case report is to illustrate the seriousness of enteric fistula after parietal repair using a synthetic material.

Surgical treatment of late dysfunction of an esophagocoloplasty.

Replacement of the esophagus by colon interposition often has late complications, frequently due to technical defects. We report the case of a patient who presented 12 years after surgery with complex dysfunctions of a colonic interposition, including cervical and retrosternal strictures associated with a redundant portion of the colon graft. The interest of this case lies in its combination of many late complications of this surgery in a single person together with the simplicity of the treatment.

[Functional outcome after resection followed by a coloanal anastomosis for cancer of the rectum]. / Resultats fonctionnels des resections avec anastomose colo-anale dans les cancers du rectum.

The aim of the study was to asseses the operative, functional results of total proctectomy with coloanal anastomosis (CAA). Between 1990 and 2002, 24 patients (14 males and 10 females ) with a mean age of 50,6 years were operated on for cancer of the rectum and they underwent a total proctectomy with CAA. There was one operative death. 3 patients developed non specific complications. 4 patients experienced a supra anastomosis stenosis and underwent a new straight CAA Functional outcome were evaluated by a scoring system fonction and were considered good in 87 and 84% at 1 and 2 years respectively. Low anterior resection combined with CAA provides good treatment for mid-rectal cancers and for some distal rectal cancers. It had a good functional outcome. However Both procedures and selection of patients who underwent radiotherapy must be carefully performed.