[Vertebral osteomyelitis due to Candida tropicalis secondary to candidemia. A case report]. / Spondylodiscite à Candida tropicalis secondaire à une candidémie. À propos d'un cas.

Candida spp. vertebral osteomyelitis is rare. Clinical presentation is unspecific. Diagnosis requires mycological culture of a biopsy specimen. Therapeutic management is based on prolonged course of azole or liposomal amphotericin B. We report the case of Candida tropicalis vertebral osteomyelitis with epidural involvement in a 27 years-old male patient, followed for S-ß-thalassemia and with a history of candidemia. The fungus was isolated from a needle biopsy of the vertebral disk. The outcome was favorable under antifungal treatment by amphotericin B and voriconazole.

Serologic evidence of exposure to Rift Valley fever virus detected in Tunisia.

Rift Valley fever virus (RVFv) is capable of causing dramatic outbreaks amongst economically important animal species and is capable of causing severe symptoms and mortality in humans. RVFv is known to circulate widely throughout East Africa; serologic evidence of exposure has also been found in some northern African countries, including Mauritania. This study aimed to ascertain whether RVFv is circulating in regions beyond its known geographic range. Samples from febrile patients (n = 181) and nonfebrile healthy agricultural and slaughterhouse workers (n = 38) were collected during the summer of 2014 and surveyed for exposure to RVFv by both serologic tests and PCR. Of the 219 samples tested, 7.8% of nonfebrile participants showed immunoglobulin G reactivity to RVFv nucleoprotein and 8.3% of febrile patients showed immunoglobulin M reactivity, with the latter samples indicating recent exposure to the virus. Our results suggest an active circulation of RVFv and evidence of human exposure in the population of Tunisia.

[Evaluation and contribution of OptiMAL-IT® test for the diagnosis of imported malaria in Tunisia]. / Évaluation et apport du test OptiMAL-IT® dans le diagnostic du paludisme d'importation en Tunisie.

The rapid test OptiMAL-IT® was evaluated in the diagnosis and the screening of imported malaria in Tunisia in comparison with microscopic techniques. This prospective study focused on 500 individuals recruited from September 2010 to September 2012 in laboratory of Parasitology of Pasteur Institute of Tunis. They include 192 patients with clinical manifestations suggestive of malaria and 308 students originating from endemic areas. Microscopy of thick-and-thin blood smears and OptiMAL-IT® test were systematically performed on blood samples of all participants. Sixty individuals revealed infected by Plasmodium (12%). Positivity rates were respectively 20.3% in patients (44 cases) and 5.2% among asymptomatic students (16 cases) (p<0.01). The sensitivity and specificity of the OptiMAL-IT® test were respectively 88.6% and 100%. The concordance kappa was 0.92. The sensitivity and specificity during the screening of asymptomatic subjects were respectively 68.8% and 98.3% with a concordance of 0.67.

[Clinical manifestations, complications and treatment of brucellosis: 45-patient study]. / Aspects cliniques, microbiologiques et thérapeutiques de la brucellose : étude de 45 cas.

The aim of this study was to evaluate the clinical, laboratory findings and therapeutic features of patients with brucellosis. The diagnosis was made by clinical findings, automated blood culture, serology (Rose Bengal plate agglutination test, standard tube agglutination (Wright) and immunofluorerescence). The susceptibility of 13 strains was tested in vitro. The base sequence was determined for four strains. Forty-five cases were collected (31 acute and 14 sub-acute). Contamination was digestive in 62%. Symptoms of patients were fever (93%), sweating (82%), arthralgia (78%) and splenomegaly (51%). Elevated erythrocyte sedimentation rate was determined in 80%, leukopenia in 49% and anaemia in 37% of cases. Blood cultures were positives in 39% of cases. The four sequenced strains were identified as Brucella melitensis biovar abortus. Six strains were resistant to sufomethoxazol-trimetoprim (54%). In 93% of cases, the treatment was associated rifampicin and doxycyclin. One patient died. No relapse was reported.

[Demographic, clinical and therapeutic features of adult visceral leishmaniasis at the Rabta hospital in Tunis (tunisia) from 1983 to 2002]. / Aspects épidémiologiques, cliniques et thérapeutiques de la leishmaniose viscérale de l'adulte à l'hôpital de la Rabta à Tunis (tunisie) entre 1983 et 2002.

The purpose of this study was to evaluate in a retrospective analysis, cases of Mediterranean visceral leishmaniasis (VL) diagnosed in adults during a 20-year period in a department of infectious diseases. Demographic data, clinical and laboratory features and therapeutic findings were considered. During the study period, 22 cases of VL were diagnosed, and 6 (27%) were associated with HIV infection. Fever and splenomegaly were observed in all cases. Anaemia was constant. The anti-leishmanial IF titer was positive among 21 patients (95%). Smears from bone marrow aspiration were positive at microscopy in 95% of cases. Zymodeme analysis was carried out in nine isolates. L. infantum zymodeme MON-1 was characterized in all cases. Seventeen patients (77%) received meglumine antimoniate (MA) (20 mg SbV/kg per day) and 5 (23%) patients amphotericin B (AB) (0.5-1 mg/kg per day) for an average period of 25 days (10-49 days). Adverse events occurred in 7 patients (32%), among them 4 received AB. Clinical cure was achieved with success in 21 patients (95%). After a successful MA treatment of the initial episode, VL relapse was observed in one HIV-positive patient. Only one HIV-positive patient died from neurological disorders. VL is rare in adults. However, its incidence is increasing everywhere in the world, because of HIV-related cases. Its prognosis depends on the precocity of diagnosis and treatment.

[Melitococcal psoas abscesses: study of three cases and review of the literature]. / Les abcès mélitococciques du psoas: etude de 3 cas et revue de la litterature.

Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.

[Neuroradiologic manifestations of central nervous system tuberculosis in 122 adults]. / Manifestations neuroradiologiques initiales de la tuberculose du système nerveux central de l'adulte. A propos de 122 cas.

PURPOSE: Central nervous system (CNS) tuberculosis remains a public health problem, particularly in developing countries. The aim of this study is to characterize neuroradiologic findings of various intracranial lesions. METHODS: We retrospectively reviewed data of 122 patients with CNS tuberculosis, without immunosuppression. CT scan was performed in all patients, whereas 17 patients had CT scan and MRI. RESULTS: We included 74 women (61%) and 48 men (39%) with a mean age of 37 years (17 -88y). 18 patients (14,7%) had a history of tuberculosis. Tuberculous meningitis was the most frequent clinical presentation (119 cases). Mycobacterium tuberculosis was isolated in cerebrospinal fluid of 18 patients (15%). Several types of lesions were identified : hydrocephalus (35 cases), tuberculomas (29 cases), leptomeningitis (26 cases), infarction (15 cases), abcesses (2 cases). Hydrocephalus was associated to other lesions in 26 cases. Communication hydrocephalus was present in 28 cases. Multiple tuberculomas were seen in 23 cases (80%), with miliary aspects in some cases. In 3 cases, tuberculoma was present without meningitis. Patients with leptomeningitis showed thick meningeal contrast enhancement involving all basal cisterns. Infarction resulted from arterial englobement or embols, and involved the area of middle cerebral artery (12 cases). CONCLUSION: Central nervous system tuberculosis has different appearences, mostly hydrocephalus and tuberculomas. MR with contrast is necessary for diagnosis and for follow-up during treatment.

[Bacterial spondylodiskitis: pyogenic or tuberculous?]. / Les spondylodiscites bactériennes: à pyogènes ou tuberculeuses?

We retrospectively studied the epidemiological, clinical, radiological and evolutive aspects of bacterial spondylodiskitis observed in 39 patients diagnosed from January 1989 to December 1998, in order to find criteria to distinguish between pyogenic spondylodiskitis (PS) and tuberculous spondylodiskitis (TS). During the study period, we collected 13 patients (33.3%) with PS and 26 patients (66.7%) with TS. The mean age was 44 years. The delay in diagnosis was much longer in TS (8.4 months) than in PS (2 months). Diagnosis was certain in 6 cases (46%) of PS and in 12 cases (46%) of TS. Clinically, paravertebral abscesses and neurologic complications were significantly more frequent in TS. The main causative agents in PS were staphylococci. Diagnosis of spondylodiskitis is based on the imaging techniques, especially magnetic resonance imaging which is more sensitive and specific than computed tomography. Except in patients with positive blood cultures or positive urine culture in PS, and isolation of Mycobacterium tuberculosis in another visceral foci in TS, bacteriologic diagnosis was based on discovertebral needle biopsy. The yield of this technique was poor in our study (12.5%), even if bacteriologic confirmation of spondylodiskitis was made in 15 patients (38.5%). In the other cases, diagnosis rested on a set of clinical, biological and radiological criteria.

[Study of psychosocial factors in HIV infected patients in Tunisia]. / Etude des facteurs psychosociaux des patients infectés par le VIH en Tunisie.

We conducted a prospective study using an anonymous questionnaire and semistructured interviews on 60 patients with HIV to assess the psychological and socioenvironmental factors that may result in risk-taking behaviour. The patients were mainly young males (mean age 33.1 +/- 7.0 years) (sex ratio 2.3) deprived in both social and educational terms. Injecting drug use was the predominant risk factor and was characteristic of a first group of young men raised in large families shattered by rural-urban migration, with an antisocial personality. A second group consisted of women, mostly illiterate from traditional rural settings. They had been infected by their spouses who had worked abroad, whether drug users or not. Approaches for the prevention of HIV infection are proposed.

[Study of psychosocial factors of HIV infected patients in Tunisia]

We conducted a prospective study using an anonymous questionnaire and semistructured interviews on 60 patients with HIV to assess the psychological and socioenvironmental factors that may result in risk-taking behaviour. The patients were mainly young males [mean age 33.1 +/- 7.0 years] [sex ratio 2.3] deprived in both social and educational terms. Injecting drug use was the predominant risk factor and was characteristic of a first group of young men raised in large families shattered by rural-urban migration, with an antisocial personality. A second group consisted of women, mostly illiterate from traditional rural settings. They had been infected by their spouses who had worked abroad, whether drug users or not. Approaches for the prevention of HIV infection are proposed

[Standard radiological characteristics of thoracic sites of tuberculosis in patients with AIDS in a Tunisian population]. / Particularités radiologiques standards des localisations thoraciques de la tuberculose chez des sidéens dans une population Tunisienne.

Aspects of tuberculosis on the standard chest X-ray in a population of 18 AIDS patients in Tunisia were examined. The diagnosis of pulmonary tuberculosis was confirmed in all cases with bacteriology tests. Diffuse lesions of the parenchyma predominated contrasting with the exceptional nature of cavernous formations. Localized infiltrations were infrequent and intrathoracic node enlagement was rare. Cases with no abnormal radiological signs were also seen in advanced HIV infection. Such atypical cases, in agreement with data in the literature, would be explained by immunoradiologic correlation. Thus it is necessary to search for the tuberculosis bacilli in all patients with HIV infection whatever the aspect on the standard chest X-ray.

PIP: The chest X-ray is a fundamental element in the diagnosis of pulmonary tuberculosis (TB). In the person co-infected with HIV and TB, radiological signs can be deceiving given the degree of immunodepression and the resulting clinical manifestations. TB is endemic in Tunisia with a prevalence of 120 people infected per 100,000 population. TB affects 42% of people with AIDS in Tunisia, the major opportunistic infection in that population. The authors report upon their examination of aspects of TB in the standard chest X-ray of 18 AIDS patients in Tunisia. The diagnosis of pulmonary TB was confirmed in all cases with bacteriology tests. Diffuse lesions of the parenchyma predominated contrasting with the exceptional nature of cavernous formations. Localized infiltrations were infrequent and intrathoracic node enlargement was rare. Cases with no abnormal radiological signs were also seen in advanced HIV infection. Such atypical cases, in agreement with data in the literature, could be explained by immunoradiologic correlation. The authors stress the need to search for the TB bacilli in all patients with HIV infection regardless of the aspect on the standard chest X-ray.