Erysipelas of the leg: A cross-sectional study of risk factors for recurrence.

BACKGROUND: Erysipelas is a common infection of the superficial layer of skin. The main causative agent is group A ß-hemolytic streptococci. One of the most challenging aspects of this disease is its high rate of recurrence. OBJECTIVES: To identify risk factors for recurrence of erysipelas of the leg. PATIENTS AND METHODS: We included in a cross-sectional study all patients hospitalized for erysipelas of the leg seen at the dermatology department of the Ibn Rochd University Hospital in Casablanca, Morocco, from January 2015 to April 2020. Patients were divided into two groups: those with a single episode (SE) and those with recurrent erysipelas (RE). These two groups were compared for clinical and laboratory characteristics, with particular focus on systemic and local risk factors. RESULTS: The study included 270 patients, of whom 132 had SE and 138 had RE. Age, gender, hospital stay as well as laboratory findings did not differ significantly between the two groups. In multivariable analysis, cutaneous disruption [adjusted odds ratio (aOR)=1.9; 95% confidence interval (95% CI): 1.0-3.71], lymphedema [aOR=19.6; 95% CI: 8.0-57.2], and obesity [aOR=2.3; 95% CI: 1.1-5.2] were significantly associated with RE. Venous insufficiency and diabetes were not found to be associated with risk of recurrence. CONCLUSION: Our results suggest that erysipelas is a potentially chronic disease and patients with identified local risk factors or obesity should be considered as exposed to recurrence and considered as targets for antibiotic prophylaxis and other preventive methods.

Incidence des cancers chez les personnes vivant avec le VIH suivies à Casablanca / Incidence of cancer among people living with HIV at Casablanca

Objectif. Décrireles aspects épidémiologiques des cancers chez les personnes vivant avec le VIH à Casablanca. Patients et méthodes. Il s'agissait d'une étude rétrospective sur 13 ans dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca. Ont été inclus tous les patients infectés par le VIH et présentant un cancer documenté histologiquement. Les données ont été colligées à partir du Nadis. L'analyse des données a été faite sur le logiciel épi info. Une valeur de p< 0,05 était considérée significative. Résultats. Nous avons inclus 139 patients qui présentaient des pathologies cancéreuses soit un taux d'incidence de 3,7patients pour 1000 patients année. L'âge moyen était de 37ans. Le sexe ratio était de 1,72 (88H/51F). Les cancers classant sida ont représenté 84% (117 cas) contre 16 % (22 cas) de cancers non classant sida. Le sarcome de Kaposi a été le plus fréquent (58,99%). Le cancer non classant sida le plus fréquent était le lymphome de Hodgkin (6,47%)(9 cas). Les Lymphomes malins non hodgkiniens et le sarcome de Kaposi étaient corrélés au sexe masculin (p=0,002, p=0,0006). Nous avons enregistré 39 décès (28%) et 34 perdus de vue (24,48%). Conclusion. Les pathologies cancéreuses restent fréquentes au cours du VIH avec une morbi-mortalité importante. Les cancers classant sida demeurent les plus fréquents dans notre contexte.

Objective. To describe the epidemiology of malignancies in people living with HIV at Casablanca. Patients and methods. It was a 13-year retrospective study in the Infectious Diseases Department of Ibn Rochd University Hospital in Casablanca. Included were all HIV-infected patients with histologically documented cancer. Data was collected from Nadis. Data analysis was done on the software epi info. A value of p <0.05 was considered significant. Results. 139 patients had cancerous diseases, an incidence rate of 3.7 patients per 1000 patients' year. The average age was 37 years old. The sex ratio was 1.72 (88H / 51F). Cancer classifying AIDS represented 84% (117 cases) against 16% (22 cases) of non-AIDS-defining cancers. Kaposi's sarcoma was the most common with 58.99%. The most common non-classifying AIDS cancer was Hodgkin's lymphoma with 6.47% (9 cases). Non-Hodgkin's malignant lymphoma and Kaposi's sarcoma were correlated with male sex (p = 0.002, p = 0.0006). We recorded 39 deaths (28%) and 34 lost to follow-up (24.48%). Conclusion. Cancerous pathologies remain frequent during HIV with significant morbidity and mortality. Cancer classifying AIDS remains the most common in our context.

[Central Neurological Diagnosis in Patients Infected with HIV in the Infectious Diseases Unit of University Hospital of Casablanca, Morocco]. / Manifestations neurologiques centrales chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc.

The aim of this work is to study the epidemiology of central neurological system (CNS) diagnosed in the population of people living with HIV in the department of infectious diseases in UHC Ibn Rochd of Casablanca from January 2005 to May 2015. The demographic and clinical profile along with the outcome of these patients were studied. The data were collected from Nadis software. Three hundred and eighty-seven patients were admitted for CNS diagnosis, out of 3496 people living with HIV admitted during this time period, i.e., a prevalence of 11%. The sex ratio (M/F) was 1.27. The average age was 39 years (± 7). Neurological involvement was indicative of HIV infection in 225 cases (68.8%). Neurological disorders were dominated by headache (70%), focal neurological syndrome (35%), and meningeal syndrome (30%). CNS diagnosis noted were CNS tuberculosis (37%), cerebral toxoplasmosis (30%), and cryptococcal meningitis (20%). The median CD4 T-lymphocyte was 184 cells/mm3. Infection with severe immunosuppression was progressive multifocal leucoencephalitis, cryptococcal meningitis, and primary cerebral lymphoma. Lethality was 39%. In the department of infectious diseases of the UHC, the main cause of death among HIV-infected patients is tuberculosis. Collaboration between the national tuberculosis and AIDS programs has been established to improve the detection and management of these patients.

L'objectif de ce travail est d'étudier l'épidémiologie des manifestations neurologiques centrales (MNC) des patients vivant avec le VIH (PvVIH) suivis dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca entre janvier 2005 et mai 2015. La source des données était le logiciel Nadis. Trois cent quatre-vingt-sept patients ont été hospitalisés pour une MNC sur 3 496 PvVIH, soit une prévalence de 11 %. Le sex-ratio (H/F) était de 1,27. L'âge moyen des patients était de 39 ans (± 7). L'atteinte neurologique était révélatrice de l'infection à VIH dans 266 cas (69 %). Les troubles neurologiques étaient dominés par les céphalées (70 %), le syndrome neurologique focal (35 %) et le syndrome méningé (35 %). Les étiologies étaient dominées par la méningoencéphalite tuberculeuse (37 %), la toxoplasmose cérébrale (30 %) et la cryptococcose neuroméningée (CNM) (20 %). La médiane des lymphocytes T CD4 était de 184 cellules/mm3. Les atteintes survenues en cas d'immunodépression sévère étaient la leucoencéphalite multifocale progressive, la CNM et le lymphome cérébral primitif. Le taux de létalité global était de 39 %. Dans le service des maladies infectieuses du CHU prenant en charge les PvVIH, la tuberculose est la première étiologie des MNC au cours de l'infection au VIH. Une collaboration conjointe du programme national de lutte contre la tuberculose et de celui de lutte contre le sida a été mise en place pour améliorer le dépistage et la prise en charge de ces patients.

[Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco]. / Étude rétrospective de la cryptococcose neuroméningée chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc.

OBJECTIVE: To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients. PATIENTS AND METHODS: Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus. RESULTS: The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm3. The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases. CONCLUSION: Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.

Fanconi syndrome induced by tenofovir: A case report.

Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor discovered in the USA in 2001. It is currently the treatment of choice for patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus. Its antiretroviral efficacy and good tolerance are responsible for the higher frequency of prescriptions compared with other nucleoside analogs. However, it can induce acute renal toxicity causing impairment of the proximal tubular function of the kidney. This is highly dependent on factors such as associated co-prescription didanosine or a protease inhibitor "boosted" with ritonavir, preexisting renal insufficiency, low body weight, or presence of associated diabetes. In contrast, long-term renal toxicity remains highly debated. Some studies describe a decrease in estimated glomerular filtration rate during prolonged treatment with TDF. Others reported renal safety even during prolonged use. The differences between patients enrolled in the different studies, the measured parameters and their interpretation could explain these discrepancies. We describe a case of a patient infected with HIV, who presented with Fanconi syndrome with acute renal failure six months after starting antiretroviral treatment including tenofovir.

[Pneumocystosis during HIV infection]. / La pneumocystose au cours de l'infection à VIH.

Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease.

[Cryptococcosis during HIV infection]. / La cryptococcose au cours de l'infection à VIH.

Cryptococcosis is a cosmopolitan fungal serious condition due to an encapsulated yeast Cryptococcus neoformans. This is the systemic fungal infection the most common in HIV infection. This yeast is present in the environment and its main entrance in the body is the respiratory tract. Its gravity is linked to its tropism for the central nervous system. It generally affects subjects with severe deficit of cellular immunity and in particular, patients living with HIV. The diagnosis of neuromeningeal cryptococcosis is based on the detection of encapsulated yeasts at microscopic examination of cerebrospinal fluid, the detection of capsular polysaccharide antigen in serum or cerebrospinal fluid, but especially on the culture. A staging is always essential. The prognosis is severe. The control of intracranial hypertension is a major element of prognosis.

Association of CD209L tandem repeats polymorphism with susceptibility to human immunodeficiency virus-1 infection, disease progression, and treatment outcomes: a Moroccan cohort study.

In order to investigate the association between length variation of the CD209L neck region and human immunodeficiency virus (HIV)-1 susceptibility, disease progression, and treatment response outcomes, we genotyped 139 HIV-1-seropositive and 109 seronegative individuals. The heterozygous genotype 6/5 showed a significant increased risk of HIV-1 infection (OR 3.03, 95% CI 0.99-9.33, p 0.046). Moreover, after highly active antiretroviral therapy (HAART), HIV-1-seropositive individuals carrying the 6/5, 7/5 and 7/7 genotypes and alleles 5, 6 and 7 showed good CD4(+) T-cell recovery. In addition, individuals with the 7/5, 6/6 and 7/7 genotypes showed a significant decrease in viral load during the treatment period as compared with baseline (p < 0.05). Interestingly, we found that alleles 4 and 6 were associated with protection against AIDS progression. D209L variation may influence susceptibility to HIV-1, response to treatment, and disease progression.

[Behçet's disease revealed by deep vein thrombosis in an HIV-1-infected patient]. / Une maladie de Behçet révélée par une thrombose veineuse profonde chez un patient infecté par le VIH1.

Behçet's disease is a multisystemic vasculitis characterized by the association of recurrent oral and genital ulcers with systemic involvements, particularly ocular, nervous and vascular manifestations. The association of Behçet's disease and aids/HIV infection is rare. The role of HIV infection in the pathomechanism of both diseases is unclear. We report a 28-year-old HIV-positive patient who presented Behçet's disease complicated by deep vein thrombosis and left lateral sinus thrombosis. This rare association raises questions about the etiopathogenic process and therapeutic management.

[Pulmonary aspergillosis and HIV infection: about two cases]. / Aspergillose pulmonaire et infection à VIH: à propos de deux cas.

The occurrence of invasive pulmonary aspergillosis is unusual during the course of AIDS. Patients at risk have a CD4 T-lymphocyte count under 50 cells/mm(3) combined with other risk factors in 50% of the cases. Positive diagnosis is based on chest CT scan imaging and isolation of Aspergillus in broncho-alveolar fluid. Detection of galactomannan antigen in serum and broncho-alveolar lavage fluid (BALF) is a reliable complementary tool in assessing the diagnosis. The first line therapy is Voriconazole. The prognosis, often severe, depends on prompt initiation of the appropriate antifungal treatment. We report two cases of invasive pulmonary aspergillosis in AIDS patients.

[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.

[Cryptococcal neuromeningitis in an immunocompetent patient]. / Cryptococcose neuroméningée chez un sujet immunocompétent.

The authors report a case of cryptococcal neuromeningitis (CNM) in a 27-year-old man, non HIV-infected, with a normal CD(4) T-lymphocyte count. He had a clinical history of subacute meningitis. The evolution was fatal. CNM is a rare infection the prognosis of which remains bad, even in immunocompetent patient.

[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.