Alternaria alternata infection causing rhinosinusitis and orbital involvement in an immunocompetent patient.

Invasive fungal rhinosinusitis is a rare infection that occurs primarily in immunocompromised patients. The fungal pathogen Alternaria alternata is rarely associated with rhinosinusitis. We report a case of A. alternata rhinosinusitis in an immunocompetent patient.

Demodicosis revealing an HIV infection.

We report an observation of facial and upper limb demodicosis, revealing a human immunodeficiency virus infection. After an initial improvement with metronidazole, worsening of skin lesions related to immune reconstitution inflammatory syndrome was observed, requiring the use of steroids.

Impact and long-term protection of hepatitis B vaccination: 17 years after universal hepatitis B vaccination in Tunisia.

Hepatitis B virus (HBV) vaccination has been part of the Expanded Programme of Immunization (EPI) in Tunisia since 1995. The aim of this study was to evaluate, for the first time, the impact of mass vaccination in Tunisia 17 years after this programme was implemented, and in parallel, assess the long-term persistence of anti-HBs antibody in the vaccinated Tunisian population. A total of 1422 students were recruited (703 vaccinated, 719 non-vaccinated). HBV seromarkers were checked. None of the students from either group had positive HBsAg. The overall prevalence of anti-HBc was 0·8%. A Significantly higher prevalence of anti-HBc was noted in unvaccinated students than in vaccinated (1·4% vs. 0·3%, P = 0·02). The overall seroprotection rate (anti-HBs titre ⩾10 mIU/ml) was 68·9% in vaccinated subjects. Seroprotection rates and geometric mean titres decreased significantly with increasing age, reflecting waning anti-HBs titre over time. No significant difference was detected between seroprotection rates and gender or students' area of origin. Incomplete vaccination was the only factor associated with an anti-HBs titre <10 mIU/ml. This study demonstrates the excellent efficacy of the HBV vaccination programme in Tunisia 17 years after its launch. However, a significant decline of anti-HBs seroprotection has been observed in ⩾15-year-old adolescents which places them at risk of infection. Additional studies are needed in hyperendemic regions in Tunisia.

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.

[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.

[Acute cytomegalovirus infection revealing systemic lupus erythematosus]. / Infection aiguë à cytomégalovirus révélatrice d'un lupus érythémateux systémique.

Systemic lupus erythematosus (SLE) remains of unknown origin. Herpes viridae infections seem to play a role in the pathogenesis of this disease. We report a 31-year-old man who presented an acute cytomegalovirus (CMV) infection with persistent fever and myopericarditis as the presenting manifestation of SLE. This case report emphasizes a difficult differential diagnosis between SLE and an acute CMV infection and suggests a possible role of this virus in the pathogenesis of SLE.

[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.

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

[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.

[Tuberculous sacro-iliitis: a series of twenty-two cases]. / Sacro-iliites tuberculeuses: à propos de 22 cas.

BACKGROUND: Despite their relative rarity, increased awareness of tuberculous sacro-iliitis is necessary. Indeed, diagnosis is usually delayed, because of the non specific clinical features and the difficulty to explore the sacro-iliac joint. OBJECTIVE: To study the characteristics of sacro-iliac joint tuberculosis. MATERIALS AND METHODS: A retrospective study of 22 cases of tuberculous sacro-iliitis collected between 1987 and 2003 in four university hospital centres. All our patients were explored clinically and radiologically. Microbiology, biochemical and serologic tests were also performed. RESULTS: 13 cases were confirmed bacteriologically or histologically and for the remaining nine cases evidence of tuberculous sacroiliitis was based on clinical, biological, radiological features and outcome on treatment. Inflammatory pain was present in almost all cases, and a collected abscess in 11 cases. Standard radiographs were also in all cases and ultrasound and CT scan showed an abscess in 8 patients. The average duration of treatment was nine months. The outcome was excellent in the majority of cases. CONCLUSION: Sacro-iliac joint is difficult to explore and has recently beneficiated of technical improvement in imaging and diagnostic. Medical treatment of tuberculosis sacro-iliitis is often sufficient.