Pseudotumoural pulmonary tuberculosis: a case series.

This report describes three cases of tumour-like pulmonary tuberculosis: two patients had stage C3 human immunodeficiency virus (HIV) infection (with uncontrolled HIV-1 in one case) and one patient was immunocompetent. All patients initially presented with general and respiratory symptoms, with radiological findings simulating lung carcinoma. Tuberculosis was diagnosed from microbiological testing and/or histological examination results. A disseminated form was described in one case. All patients were treated successfully with antimycobacterial therapy, with control of HIV infection in both cases.

Clinical and laboratory features of brucellosis in a university hospital in Tunisia.

AIM OF THE STUDY: The increase in the number of brucellosis cases between 2014 and 2017 (14 and 90 cases respectively) led us to study the biological and clinical-epidemiologic characteristics patients hospitalized in Rabta hospital of Tunis. MATERIAL AND METHODS: This retrospective study was conducted in Rabta Hospital in Tunis between 2016 and 2017. It includes 131 patients who had a positive bacteriological diagnosis of Brucella between 2016 and 2017. Diagnosis of brucellosis was made in blood culture by using Bactalert (Biomerieux®). Identification of Brucella was realized by Gram staining, catalase, oxydase. Serological diagnosis was made by testing sera for brucellosis agglutinins with Rose Bengale and the standard agglutination test. The collected data were analyzed by SPSS softcare version 24. RESULTS: The prevalence of Brucellosis in Rabta hospital increases from 14 cases in 2014 to 90 cases in 2017. The mean age was 45 years and ages range from 16 to 84 years. Rural origin was found in 75 cases (68%). Ninety-seven patients (89%) were hospitalized in the infectious diseases department. The average length of hospitalization was 17.25 days. Fifty-seven patients (52%) had a history of consuming unpasteurized dairy products and 45 (41%) were farmers. Fever was the predominant symptom in 104 cases (95%). Osteoarticular involvement is the most common complication of brucellosis and it occurred in 28% of patients. Blood cultures were 73 cases and 42 (57%) were positive for Brucella spp. Rose Bengale was positive in 100% of cases. High titles of the standard agglutination test (superior to 1/1280) were noted in 24 cases (22%). CONCLUSION: Brucellosis is still endemic In Tunisia. Contact with domestic animals and consumption of raw milk and milk products seems to be the major mode of transmission. Control of animal infection by vaccination, occupational and personal hygiene, farm sanitation and preventive measures can reduce disease incidence.

Asymptomatic intestinal carriage of microsporidia in HIV-positive patients in Tunisia: prevalence, species, and pathogenesis.

Asymptomatic carriage of microsporidia (ACM) has not been described in patients living with HIV (PLHIV) in Tunisia. To determine the prevalence of ACM in PLHIV followed at Tunis la Rabta hospital, describe its clinical features and course, and identify the species involved. This prospective study (2005-2009) included 71 asymptomatic PLHIV compared with 37 PLHIV with diarrhea. One stool sample per patient was examined by microscopy after Weber staining and by PCR. Species identification was confirmed by specific PCR and sequencing. In cases of ACM, a second stool sample was examined in 2010 and a clinical check-up took place in 2013. The prevalence of ACM in asymptomatic PLHIV was 11.3 % (8/71). PCR was more sensitive than microscopy (P = 0.0047). ACM was associated with stage C of HIV infection (P = 0.008) and CD4 T cells <100/µl (P = 0.033). The species involved were E. intestinalis (6 cases) and E. bieneusi (2 cases). Six PLHIV remained asymptomatic with negative stool examinations, but two developed digestive signs. ACM is common among Tunisian PLHIV and it appears to be associated with E. intestinalis.

Epidemiological and clinical characteristics of neurobrucellosis case patients in Tunisia.

OBJECTIVE: We aimed to identify epidemiological, clinical, therapeutic, diagnostic, and outcome characteristics of neurobrucellosis case patients in Tunisia. PATIENTS AND METHODS: We conducted a retrospective and descriptive study over a 17-year period (January 1997-December 2013). We included all neurobrucellosis patients hospitalized in the infectious disease department of La Rabta Hospital of Tunis during the study period. RESULTS: A total of 13 patients were included in the study: 9 men and 4 women. Mean age was 31.6 years. Six patients presented with meningitis, three with encephalitis, two with meningoencephalitis, and two with meningo-myeloradiculitis. All patients had a lumbar puncture performed. Eleven patients had an abnormal cerebrospinal fluid (CSF) (84.6%): lymphocytic pleocytosis in seven patients, high level of CSF proteins in 11, and low level of CSF glucose in seven. All patients had a positive Brucella serological test in blood. A Brucella serological test was also performed in CSF and was positive for 10 patients (77%). A total of nine patients had a cerebral CT scan and/or MRI performed and abnormalities were observed in six patients. Antibiotic therapy was prescribed to all patients: a combination of rifampicin and co-trimoxazole (n=9) or doxycycline (n=4) for an average duration of eight months. Two patients also received steroids. A positive outcome was observed in 10 patients. Three patients were lost to follow up. CONCLUSION: Brucellosis may be severe when neurological involvement occurs. Brucellosis should be considered in the event of any neurological involvement associated with suggestive epidemiological features.

High temperature and composition induced phase transitions in LiZnV1-xAsxO4 phenacites: Crystal structure and Raman spectroscopy studies.

In this work, using techniques of X-ray diffraction and Raman spectroscopy, we report the composition and high-temperature induced phase transition in the system LiZnV1-xAsxO4 (0⩽x⩽1). Both techniques showed that the increase of arsenic amount induced a structural transition from R-3 LiZnVO4 type to LiZnAsO4 type belonging to R3 space group, the transition occurring between x=0.7 and x=0.8. Furthermore, increasing temperature for the compositions (0.8⩽x⩽1) manifests a transition from the LiZnAsO4 structural type with R3 space group to the R-3 LiZnVO4 structural type. For this series, the transition from the space group R3 to the centro-symmetric space group R-3 shows considerable changes in the compositional and temperature dependencies of the bands: spectral positions of all the observed Raman bands exhibit shifts linearly proportional to the temperature increase, with points of shift-rate changes revealing a symmetry change. The Raman-spectra based temperature-composition phase diagram confirms the results obtained using the method of Rietveld refinements, thus showing the R-3 to R3 transition occurring between x=0.7 and 0.8.

[Syndrome coronarien aigu sous traitement antirétroviral]. / Acute coronary syndrome during antiretroviral treatment.

AIM: The aim of this study is to determine epidemiological, clinical, therapeutic and outcome characteristics of acute coronary syndrome in AIDS patients under HAART. Results- The charts of 5 patients were reviewed. The mean age, at the time of the discovery of HIV infection, was 35 years. Three patients were smokers and one had a family history of diabetes and acute coronary syndrome (ACS). Three patients received 2 nucleoside reverse transcriptase inhibitors (NRTIs) with indinavir. The 2 others received 2 NRTIs with efavirenz with good immunovirologic response. Four patients developed mixed dyslipidemia after an average period of 26 months. Tow patients developed diabetes and one a hypertension. A specific treatment was initiated in all cases. These five patients developed an ACS after respectively 51, 95, 96,103 and 145 months of ART (median=98 months). ACS occurred in 3 patients receiving 2 NRTIs and PI and two others 2 NRTIs with efavirenz. The mean age at the onset of ACS was 46 years. One patient underwent a triple bypass surgery, tow a stenting of the stenotic coronary and the last 2 patients received medical treatment with a good clinical outcome. The PI was replaced by efavirenz in two patients. Four patients had a recurrence of ACS respectively after 2months, 3 months, 12 months, and 62 months after the first episode. The five patients are still followed with good clinical and biological outcome.

[Unilateral panuveitis following intravesical therapy with bacille of Calmette et Guerin]. / Panuveite unilaterale apres instillations intravesicales du bacille de Calmette et Guerin.

Uveitis occuring after Mycobacterium bovis-bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare. Only a few cases have been described. Its physiopathology is still unknown. Two mechanisms can be proposed at the origin of ocular inflammation: a local immune response or a direct choroidal mycobacterial infection as demonstrated by vitreous cultures. We report the case of 63-year-old man who presented with unilateral panuveitis after the fifth BCG intravesical instillation with no other systemic manifestations. There was no evidence for any other etiology for this uveitis. Loss of light perception occurred despite systemic antimycobacterial therapy and systemic prednisone therapy because of delayed diagnosis. This outlines the absolute need for a close ophthalmological monitoring of patients receiving a BCG therapy to allow an earlier diagnosis of this complication and appropriate treatment.

[Hereditary complement deficiency in Tunisian adults with purulent meningitis]. / Le déficit héréditaire en complément au cours des méningites purulentes de l'adulte en Tunisie.

Inherited complement deficiency is a rare disease. It predisposes to autoimmune diseases, glomerulonephritis, angioedema, and meningococcal meningitis. A prospective study was conducted over five years. The goal was to evaluate the prevalence of deficiency in Tunisian patients presenting with community acquired purulent meningitis and identify the type of deficiency. We enrolled 122 patients, 15 of whom presented with a complement deficiency (12.3%). This prevalence was higher than the one observed in the global Tunisian population and in reported international data. The mean age of deficient patients (13 men and two women) was 24.7 years.

Synthesis and structure of a new copper(II) complex with 3,4'-bi-1,2,4-triazolate.

The salt diaquo-diammine-bis(3,4'-bi-1,2,4-triazolate) copper(II) of the formula [Cu(bTA-)2(NH3)2(H2O)2] has been synthesized and structurally characterized by X-ray single crystal diffraction analysis. This complex adopts a monomeric structure. This monomer crystallizes in the triclinic system, space group P1 with a=5.9657 Å; b=6.8975 Å; c=9.9892 Å; α=106.181°; ß=97.868°; γ=90.800° and Z=1. The Cu atom is coordinated by two nitrogen atoms of two monodentate bitriazolate ligands, two nitrogen atoms of NH3 and two water molecules in a distorted octahedral geometry. The complex has been also characterized by elemental analysis and studied by electronic and vibrational spectroscopy. The obtained results are in good agreement with the structure determined by X-ray diffraction analysis.

[Identification of Enterocytozoon bieneusi by PCR in stools of Tunisian immunocompromised patients]. / Identification d'Enterocytozoon bieneusi par PCR dans les selles des patients immunodéprimés tunisiens.

INTRODUCTION: Intestinal microsporidiosis is recognised as an important cause of opportunistic parasitosis in immunocompromised patients, especially HIV-infected patients. Enterocytozoon bieneusi is the common causal agent. The diagnosis of intestinal microsporidiosis has usually based on microscopic detection of the spores of microsporidia species in stool samples, requires additional staining techniques as Modified Weber's trichrome stain. However, the detection of the spores can be difficult and species determination, which is important for defining the appropriate treatment, is impossible. Polymerase chain reaction (PCR)-based methods have been successfully used for detection of microsporidian infections. They are more sensitive and are able to identify microsporidia species. The purpose of this study is to identify E. bieneusi to adapt treatment and assess the true prevalence of the intestinal microsporidiosis due to this species in compromised patients in Tunisia. PATIENTS AND METHODS: One hundred and eighteen stools from immunocompromised patients, with a symptomatology in favour of the intestinal microsporidiosis, were analysed using light microscopy after staining with Modified Weber's trichrome stain and PCR. RESULTS: Only four were positive by Modified Weber's trichrome stain whereas eleven stools were positive by PCR, giving a prevalence of 20% in HIV-infected patients and 5,35% in human immunodeficiency virus-negative patients. CONCLUSION: This study confirms the usefulness of PCR in the diagnosis of the intestinal microsporidiosis due to E. bieneusi. Indeed, PCR has greater sensitivity than Modified Weber's trichrome stain and can identify the species of microsporidia in order to adapt the treatment.

[Prevalence of hepatitis G, B and C virus infections among positive HIV population in a Tunisian Hospital, La Rabta, Tunis]. / Prévalence de l'hépatite G et des hépatites virales B et C dans la population VIH (+) de l'hôpital La Rabta, Tunis, Tunisie.

OBJECTIVE: The viral hepatitis G and HIV coinfection has been largely treated in the litterature. The aim of this study was to evaluate the coinfection rate in our hospital and to compare the HGV frequency to other hepatitis viruses (B and C) in positive HIV subjects at the Rabta hospital in Tunis, Tunisia. PATIENTS AND METHODS: The studied population included 125 HIV positives patients from the infectious diseases unit. The detection of the hepatitis B and C was carried out using serologic test (Elisa-Biorad). The molecular detection of the HGV was realized by reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: The prevalence of serological markers of hepatitis B (antibodies and/or antigens) and C (antibodies) was respectively 32.25% and 26.4%. HGV RNA was detected in 36.8% of the studied population. The unprotected intercourse was the predominant risk factor of the HGV contamination. Among the HGV (+) patients, 28.2% were carriers of the hepatitis C antibodies (anti-HCV). CONCLUSION: This work was the first study enabling to assess the coinfection rate of viral hepatitis B, C and G with HIV patients (+) in Rabta Hospital. The regular screening of HGV is recommended regarding its high frequency and the possibility of its pathogenic role.

[Rhino-orbito-cerebral mucormycosis in the diabetic: a better known pathology in Tunisia]. / La mucormycose rhino-orbito-cérébrale chez le diabétique: une pathologie mieux connue en Tunisie.

This is a retrospective study including 17 patients with rhino-orbito-cerebral mucormycosis diagnosed in a period of 16 years, between 1992 and 2007, in 8 men and 9 women. All patients were diabetic with ketoacidosis diabetes in 8 cases. Necrosis facial and ophthalmic symptoms were the most frequent presenting manifestations. The diagnosis was confirmed by mycological examination, with or without histopathology, identifying Rhizopus oryzae in 12 cases. Treatment consisted in systemic amphotericin B combined with surgical treatment in only 7 cases. The mortality rate was high (65%) due principally to the delay in diagnosis and absence of surgical treatment.

[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.

[Asymptomatic bearing of Leishmania infantum among Tunisian HIV infected patients]. / Portage asymptomatique de Leishmania infantum chez des malades tunisiens infectés par le VIH.

The number of visceral leishmaniasis (VL) cases is in continuous growth in Mediterranean countries. In Tunisia, in addition to the traditional infantile form, more and more cases in immunocompetent or immunocompromised adults have been reported. However, co-infection VL-HIV remains rare in Tunisia and diagnosis of all the cases up till now has been done using traditional techniques (serology, direct examination and culture of bone marrow). However, the last years, several studies proved the greatest sensitivity of PCR in VL diagnosis. We carried out a systematic detection of Leishmania in peripheral blood for 25 HIV infected patients (10 were asymptomatic, 6 presented a fever and/or a paleness and/or an asthenia, and 9 had an opportunist infection other than VL). In all cases, the culture on Novy-Nicolle-McNeal (NNN) medium was negative by the end of the month. Serology carried out for 22 patients was negative in IFI in 17 cases, positive at the 1/20 for four others and positive at the 1/40 for one patient (confirmed by Western Blot technique). A PCR using the primers Lei70L-Lei70R, specific of the gene of Leishmania infantum, allowed the display of the specific band of 345 bp for 17 samples. The higher sensitivity of PCR compared to conventional methods is subject to the difficulty of result interpretation in PCR positive testing among patients not having any other marker of the disease which raises the question of significance for this asymptomatic bearing.

[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.

Secondary measles vaccine failure in healthcare workers exposed to infected patients.

OBJECTIVE: To describe 4 healthcare workers who developed measles despite pre-existing antimeasles antibody levels. DESIGN: Hospital employees working in patient care areas from July through November 1990 were screened for measles antibody levels using a commercially available enzyme immunoassay (EIA). The clinical course and laboratory evaluation of the 4 healthcare workers who developed measles were reviewed. SETTING: An academic tertiary care children's hospital. PARTICIPANTS: A convenience sample of resident physicians, nurses, ward clerks, Child Life workers, physical and occupational therapists, radiology technicians, and housekeeping staff were screened regardless of age, immunization status, or history of measles infection. RESULTS: Of 1,311 employees working in patient care areas, 900 (68.6%) had sera tested for measles antibody. Fourteen (1.5%) were negative, 338 (37.6%) had low positive antibody levels, 372 (41.3%) were mid-positive, and 171 (19%) were high-positive; 5 (0.6%) showed equivocal results. Four healthcare workers vaccinated in the past developed measles. All had positive pre-illness measles antibody levels and all had a significant rise in measles-specific IgG following infection. Three of the them had received at least 2 live measles vaccinations prior to caring for patients with measles. CONCLUSIONS: These cases raise concerns regarding detection of adequate protective measles immunity. We recommend that all healthcare workers observe respiratory precautions in caring for patients with measles.