[Seroprevalence and risk factors of human herpes virus 8 infection in Central-East Tunisia]. / Séroprévalence et facteurs de risque de l'infection par le virus herpès humain 8 dans le Centre-Est tunisien.

OBJECTIVE: Epidemiology of human herpesvirus 8 (HHV8) is still unknown in Tunisia. We aimed to assess the prevalence of HHV8 infection in adults and children from Central-East Tunisia and in patients with high risk of parenteral or sexual infection. METHODS: We enrolled 553 subjects: 116 blood donors, 100 pregnant women, 100 children, 50 subjects with sexually transmitted infections with positive HIV serology and 50 other without HIV infection, 107 multitransfused patients and 30 kidney transplant patients. Antibodies against HHV8 were tested using a sensitive indirect immunofluorescence assay. RESULTS: The seroprevalence of HHV8 was found to be 13.8% in blood donors, 13% in pregnant women and 12% in children. In healthy adult population, no association was found between HHV8 seropositivity and sex, sociodemographic characteristics, parenteral risk factors or serological markers of hepatitis B. Rates of HHV8 infection were significantly higher in patients having high-risk sexual behavior with or without HIV infection (P<10(-4)), in polytransfused patients (P<10(-4)) and in patients with kidney transplantation (P=0.001). CONCLUSION: Our findings suggest that HHV8 infection is widespread in Central-East Tunisia such as in the Mediterranean area. HHV8 infection appears to be acquired early in life, probably through saliva. HHV8 transmission by blood transfusion, subject of controversy in literature, is well established in our study. Early screening of this infection should be considered in populations with high risk of Kaposi's sarcoma in our areas.

[Viral infection risk in polytransfused adults: seroprevalence of seven viruses in central Tunisia]. / Le risque infectieux viral chez le polytransfusé : séroprévalence de sept agents viraux dans le centre tunisien.

The aim of this study is to evaluate the prevalence of seven transfusion-transmitted viruses in polytransfused adults and children comparatively with a group of healthy control subjects. We studied 107 polytransfused patients (59 adults and 48 children) and 160 control subjects (100 blood donors and 60 children). Immunoenzymatic tests were used for detection of HBs antigen (HBs Ag), antibodies against hepatitis C Virus (anti-HCV), and human immunodeficiency virus (anti-HIV), and IgG antibodies against human cytomegalovirus (IgG anti-CMV), human parvovirus B19 (IgG anti-PB19), and hepatitis E virus (IgG anti-HEV). An immunofluorescent assay was performed for the detection of human herpesvirus 8 antibodies (anti-HHV8). Prevalence of HBs Ag, anti-HCV, anti-HIV, IgG anti-CMV, IgG anti-PB19, IgG anti-HEV, and anti-HHV8 in polytransfused group was 8.4, 4.7, 0, 86.9, 60.7, 28.9, and 47.6%, respectively, and 1.8, 0.6, 0, 86.2, 53.1, 10, and 12.5%, respectively, in the control group. The difference in prevalence between the two groups was statistically significant for HBs Ag (P = 0.01), anti-HCV (P = 0.03), IgG anti-HEV (P < 10(-4)), and IgG anti-HHV8 (P < 10(-4)). Categorization according to age showed that hepatitis B and C risk was limited in adult polytransfused group. HHV8 infection was higher in polytransfused subjects born before the use of leucocyte-depleted blood components. Our results corroborate literature data on the risk of HEV and HHV8 infection by blood transfusion. Hepatitis B vaccination and improvement in screening tests have an important role in reduction of hepatitis B and C risk in transfusion, especially in young polytransfused persons. However, a residual risk of transmitting viral infections persists, and efforts are needed to improve transfusion safety.

Gene frequencies of the HPA-1 to -6 and -15 human platelet antigens in Tunisian blood donors.

Gene frequencies of mainly human platelet antigens (HPA) -1 to -6 and -15 were determined in 116 Tunisian blood donors. The distribution of HPA-1, -3 and -5 systems approach those found in other Maghrebian populations. Tunisians have the highest frequency of HPA-1b and -5b alleles. The distribution of HPA-1a allele and HPA-4, -6 and -15 systems is similar to Caucasians. Phylogenetic study using the neighbor-joining method and principal component multivariate analysis demonstrate that Tunisians are more closely related to western than to eastern Mediterraneans. This immunogenetic study highlights the relatedness between Mediterranean populations and will serve as a baseline study for future clinical research involving platelet disorders among Tunisians.

Platelet-specific alloantigens and antibodies in Tunisian women after three or more pregnancies.

Pregnancy may allow alloimmunization against human platelet antigens (HPA), which can lead to neonatal alloimmune thrombocytopenia (NAIT). The specificities of alloantibodies are closely related to the distribution of the HPA systems. A total of 281 Tunisian multiparous women (mean number of pregnancies: 4.5) were phenotyped for the HPA-1, -3 and -5 systems, by monoclonal antibody immobilization of platelet antigens (MAIPA). We searched for antibodies against HPA-1a, HPA-3a, HPA-5b and HPA-5a in HPA-1b1b, HPA-3b3b, HPA-5a5a and HPA-5b5b individuals, respectively. The gene frequencies were: 0.83 for HPA-1a, 0.17 for HPA-1b, 0.78 for HPA-3a, 0.22 for HPA-3b, 0.82 for HPA-5a and 0.18 for HPA-5b. Anti-HPA-5b antibodies were present in eight sera and anti-HPA-3a antibodies were present in one serum. The anti-HPA-5b system is the most frequently involved in platelet alloimmunization in Tunisian multiparous women. However, prospective trials are required to confirm this result and to determine the exact frequencies and clinical relevance of platelet alloantibodies in pregnant Tunisian women.

Antibodies to anionic phospholipids and cofactors in kala-azar. Comparative study with malaria, toxoplasmosis and "autoimmune diseases".

OBJECTIVE: To investigate the distribution of various anti-anionic and anti-cofactor phospholipid antibodies in children with kala-azar, and to compare them to malaria, toxoplasmosis and auto-immune disease. PATIENTS AND METHODS: The frequency and the concentration of antibodies against cardiolipin (aCL), phosphatidylserine (aPS), phosphatidylinositol (aPI), phosphatidic acid (aPA), Beta2GPI (anti-Beta2GPI), prothrombin (aPT), annexin V (aAnnV), protein C (aPnC) and protein S (aPnS) were studied in sera from 103 children with kala-azar and compared with malaria (n=32), toxoplasmosis (n=31), systemic lupus erythematosus (SLE) (n=40) and antiphospholipid syndrome (APS) (n=35). RESULTS: The prevalence of aCL, aPS, aPI, aPA, anti-Beta2GPI, aPT, aAnnV, aPnC and aPnS was 54%, 56%, 43%, 28%, 73%, 67%, 55%, 30%, 25%, respectively. Ninety-three per cent of children with kala-azar (96/103) had one or more aPL specificities, but none had thromboses. The spectrum of aPL was quite similar to that found in patients with SLE and APS. CONCLUSION: Antiphospholipid antibodies are a frequent finding in kala-azar. The aPL produced mimic those found in autoimmune disease. However, further studies are required to assess the exact role of these aPL during leishmaniasis.

[Xg gene frequencies in Tunisia]. / Fréquence génique du système Xg dans la population tunisienne.

We report a new case of anti-Xg(a) antibody found in a man who, after receiving six units of standard red blood cells, developed a minor nonhemolytic transfusion reaction (chills-hyperthermia). The patient sera was used for an immunophenotyping scale in 777 healthy Tunisian blood donors (678 men; 99 women). The phenotype frequencies of Xg(a+) and Xg(a-) were 67.4% and 32.6% in men and 89 and 11% in women, respectively. The gene frequencies of Xg(a) and Xg were 0.67 and 0.33, respectively. These frequencies are similar to that reported in predominantly white populations.

[HPA-5b neonatal allo-immune thrombocytopenia: two cases described in Tunisia]. / Thrombopénies néonatales dues à un allo-anticorps anti-HPA-5b: à propos de deux cas observés en Tunisie.

UNLABELLED: Alloimmune thrombocytopenia is due to feto-maternal incompatibility in the HPA systems and is usually considered in the diagnosis of neonatal thrombocytopenia after other causes have been excluded. We report on two Tunisian observations of alloimmune neonatal thrombocytopenia due to anti-HPA-5b (Bra) antibodies. CASE REPORT: Two neonates presented at birth with a thrombocytopenic purpura unexplained by usual causes of neonatal thrombocytopenia. Alloimmune neonatal thrombocytopenia was diagnosed by the determination of parental and neonatal platelets antigens phenotypes and by the presence of HPA-5b (antiBra) antibodies in maternal sera. A favourable evolution was obtained after maternal platelet transfusions. CONCLUSION: Alloimmune neonatal thrombocytopenia is a serious affection, which exposes to intracranial haemorrhage. These observations of HPA-5 neonatal alloimmunisation in Tunisia provide additional information on the geographic distribution of the disease and its prognosis.

[Gastric adenocarcinoma secondary to Hodgkin's disease treatment]. / Adenocarcinome gastrique secondaire au traitement d'une maladie de Hodgkin.

UNLABELLED: Second malignant neoplasms are a major cause of late morbidity and mortality following treatment for Hodgkin's disease. Gastric carcinoma belong to the rare secondary malignancies induced by radiation-therapy and it is associated with a poor prognosis. We report a patient treated for Hodgkin's disease by 6 ABVD and total lymphoid radiation therapy, who developed a gastric carcinoma 9 years after completing treatment. Our case fits the criteria for radiation induced malignancies reported from the literature: IN CONCLUSION: recommendations are presented for both prevention and early detection of the tumours we recommend a strict follow-up for patients treated for HD to detect second cancers.

[Neonatal hemorrhagic syndromes]. / Syndromes hémorragiques du nouveau-né.

PURPOSE: The purpose of our study was to clarify the frequency of these causes. PATIENTS AND METHODS: Retrospective study using reports of newborns in the neonatal unit in Sousse (Tunisia) from 1991 to 1996, hospitalized for hemorrhagic syndrome defined by bleeding, exteriorized or not, whatever its importance, severity, causes and the associated clinical and biological disorders. Isolated meningeal hemorrhages, limited cutaneo-mucous hemorrhages (conjunctival hemorrhages, bruises), and genital crises of the newborn, were excluded. RESULTS: One hundred and fifty-five hemorrhagic syndromes were observed from 7,128 newborn infants (2.17% of hospitalization). Sex ratio was 1.42. Prematurity rate was 35.7%. The Apgar score was < 7 at one minute in 40.7% of cases. Disorders associated with hemorrhagic syndromes were observed in 118 newborn infants (76.1%) with a predominance of neonatal infections (35.6%). The etiology of neonatal hemorrhages was specified in 93% of cases: newborn hemorrhagic disease (27.7%), disseminated intravascular coagulation (27.1%), isolated thrombocytopenia (9%), digestive lesions (13.5%), and obstetrical trauma (2.6%). CONCLUSION: The frequency of the newborns hemorrhagic syndromes underlines the need for its systematic prevention by vitamin K in the antenatal period to the mother and after birth to the newborn.

Extramedullary hematopoiesis in a patient with beta-thalassemia intermedia manifesting as symptomatic pleural effusion.

A case of bilateral paravertebral extramedullary hematopoietic masses with symptomatic pleural effusion in a patient with beta-thalassemia intermedia is reported. The pleural effusion was controlled by pleurodesis using tetracycline. We review the literature on this uncommon complication of beta-thalassemia intermedia and discuss the options for diagnosis and treatment.

[Acquired amegakaryocytic thrombocytopenic purpura treated with intravenous immunoglobulins]. / Le purpura thrombopénique amégacaryocytaire acquis traité par des immunoglobulines intraveineuses.

Acquired amegakaryocytic thrombocytopenic purpura is a rare disorder characterized by severe thrombocytopenia due to the absence of bone marrow megakaryocytes. The pathogenic mechanisms of this disorder have not well defined; consequently, several empirical therapies are used. We reported the case of a 38-year-old mean who was hospitalized for serious bleeding syndrome. The platelet count was 10 yen10(9)/L. The bone marrow aspirate and biopsy showed the absence of megakaryocytes but otherwise normal granulocyte and erythroid precursors. No definable etiology has been found. After the unsuccessful use of prednisone, intravenous immunoglobulin therapy was started and resulted in favorable reponse.

Frequency of the polymorphonuclear neutrophil Fc gamma receptor III deficiency in the French population and its involvement in the development of neonatal alloimmune neutropenia.

We report the case of a healthy woman (K.M.) who, after multiple pregnancies, developed an antibody directed against a nonpolymorphic region of the polymorphonuclear neutrophil (PMN) Fc gamma receptor III (FcRIII-CD16), which caused transient neonatal alloimmune neutropenia (NAIN). The antigenic target of the antibody was determined by an immunoprecipitation procedure and by phenotyping the mother's PMN. These latter did not react with monoclonal CD16 or polyclonal and monoclonal NA1 and NA2 antibodies, demonstrating the absence of PMN-FcRIII and, consequently, the NA-null phenotype. We also determined the frequency of the NA-null phenotype in a healthy, white population. Among 3,377 random blood donors, only four (in addition to K.M.) were PMN-FcRIII-deficient. These five individuals were healthy and only one (K.M.) presented an allo-CD16 antibody. The gene frequency of the NA-null phenotype was calculated as 0.0274 +/- 0.0059. We conclude that PMN-FcRIII deficiency is a rare phenomenon that can lead to CD16 alloimmunization and thus cause NAIN.