Free-living Amoebae (FLA): morphological and molecular identification of Acanthamoeba in dental unit water.

UNLABELLED: The aim of our study was to detect free-living Amoebae (FLA) by morphological methods and to identify Acanthamoeba spp. by PCR in the dental unit water lines (DUWL). MATERIALS AND METHODS: it was a prospective study dealing with 196 water samples collected from DUWL (94 samples taken in the early morning before materials flush and patient consultations and 102 samples taken after consultations). At the same time, 39 samples from tap water were realized. RESULTS: 135 (69%) samples were positives by the morphological study with morpholypical diversity. The predominant morphotype was the monopodial (39.2%). 18 strains of Acanthamoeba spp. were detected in DUW (13.%) and three strains in tap water (10%). The amplification of 18S rDNA gene of these strains of Acanthamoeba spp. was positive for all samples. CONCLUSION: the FLA and Acanthamoeba were isolated both in tap water and in dental unit. The amoeba pathogenicity has not been demonstrated after oral or dental contamination; but the presence of intracellular and pathogenic bacteria in the amoeba could be a source of microbiological risks for patients in case of deep dental care or immunodepression. The improvement of this dental unit was necessary by putting a filter of 0.2 microns porosity before the arrival of the water in hand-pieces allowing the limitation of FLA passage.

Childhood dermatomycoses study in Sfax Hospital, Tunisia.

Mycoses are frequent affections in childhood. Fungal type varies according to the age and the affected organ. The aim of this study was to determine the aetiological agents of childhood dermatomycoses and to draw attention to the diversity of their clinical manifestations. Retrospective study dealing with children's cases with age <16-year old and having dermatomycosis diagnosed between 1991 and 2005 at the Parasitology and Mycology Laboratory of Sfax University Hospital. A total of 4559 children suspected to have superficial mycoses were examined. Dermatomycosis diagnosis was confirmed in 49.3% of cases. Dermatophytes were the most prevalent fungal agents and accounted for 1865 cases (80.6%) dominated by Trichophyton violaceum (54.1%) and Microsporum canis (24.5%). Tinea capitis (69.4%) was the most common type of infection, followed by tinea corporis (20%). Superficial yeast infections (442 cases) were dominated by Malassezia infections (71%). Candida infections were mainly due to Candida albicans (58%). The clinical features of paediatric dermatomycoses vary with the age of the children: tinea capitis and tinea corporis were more frequent before 13 years of age. After this age, tinea versicolor and onychomycoses became more common.

[Candiduria in intensive care unit: significance and value of yeast numeration in urine]. / La candidurie en milieu de réanimation: signification et intérêt de la numération des levures dans les urines.

JUSTIFICATION: Candiduria is increasingly frequent among patients admitted to intensive care units but its significance remains unclear. OBJECTIVES: Search for eventual correlation between quantitative candiduria and known risk factors for invasive candidiasis. STUDY DESIGN: Prospective. PATIENTS AND METHODS: A four-month study was conducted in 162 patients hospitalized in the intensive care unit for more than 72 hours. All patients underwent a weekly research of candiduria added to sampling from different body sites to determine the Pittet Candida colonization index. RESULTS: Candiduria has been proved in 56 cases (34%). It was superior or equal to 10(4) UFC/ml among 28 patients (50%). Candida tropicalis, Candida glabrata and Candida albicans has been isolated in 41, 22 and 20% respectively. All patients had at least one major and two minor risk factors for Candida infection. Six patients (10%) developed invasive candidiasis. The global mortality rate was at 52%. Pittet colonization index was significantly different between patients with candiduria and those with invasive candidiasis (p=0.01). There was a statistically significant correlation between candiduria superior or equal to 10(4) UFC/ml and Pittet colonization index superior or equal to 0.5 (p=0.01). CONCLUSION: Candiduria superior or equal to 10(4) UFC/ml associated with risk factors may predict invasive candidiasis in critically ill patients.

[Otomycosis due to Scopulariopsis brevicaulis]. / Otomycose à Scopulariopsis brevicaulis.

We report a case of otomycosis due to Scopulariopsis brevicaulis in a patient with left cholesteatomatous chronic otitis media who presented with otorrhea associated with left otalgia. Scopulariopsis brevicaulis is a fungus which is rarely described as causing otomycosis although it is a saprophyte and widespread in the environment. In this case the contamination could be due to intensive gardening with poor hygiene. Its mycologic diagnosis is relatively easy and nystatin remains the most effective treatment in this region.

[Rhinocerebral mucormycosis: apropos of 4 new Tunisian cases]. / Les mucormycoses rhinocérébrales: à propos de 4 nouveaux cas tunisiens.

Mucormycosis is a rare opportunistic infection but a fulminant disease. We report the 4 first cases of rhinocerebral mucormycosis diagnosed in Sfax region (Tunisia). They occurred in insulin dependent diabetes and developed varying clinical manifestations from facial cellulites to ocular and cerebral extension. The diagnosis of mucormycosis was not initially evoked, but confirmed tardively by anatomopathologic and mycologic examinations. The evolution was favourable in 2 cases by administration of amphotericine B associated with extensive surgical debridement and correction of the diabetes. Two patients had a fatal outcome. This infection has a severe prognosis and necessitates early diagnosis.

[Ocular parasitoses and mycoses: cases diagnosed in the Central University Hospital of Sfax between 1996 and 1999]. / Parasitoses et mycoses oculaires: bilan des cas diagnostiqués dans le CHU de Sfax entre 1996 et 1999.

Parasitical and fungal ophthalmic infections are polymorphic and variably severe. They are rarely reported in publications. The aim of our study has been to specify the parasitic and fungal agents isolated from the ocular samples in our district (Sfax-Tunisia). We surveyed retrospectively the different ocular parasitosis and mycosis diagnosed in our laboratory (Sfax hospital) over a 4 year-period (1996-1999). Fungal ophthalmic infections were dominated by corneal localisations: 20 cases of keratomycosis secondary to: Fusarium solani (8 cases), Aspergillus fumigatus (3 cases); Aspergillus flavus (2 cases); Alternaria sp (2 cases), Candida albicans (2 cases); Fusarium dimerium (1 case); Fusarium oxysporum (1 case) and Scedosporium sp (1 case). A prolonged treatment by ketoconazole had a successful resolution in 70% of cases; 1 case of ciliar tinea caused by Trichophyton violaceum. Parasitic agents were dominated by Demodex folliculorum (32 cases), Phthirius inguinalis (6 cases) and Oestrus ovis (2 cases). Two cases of orbital hydatidosis and 2 cases of palpebral cutaneous leishmania were noted; 21 cases of ocular toxoplasmosis were treated by clindamycine. Our survey concerned not only cosmopolite parasitosis and fungi, but also some affections endemic to our district (hydatidosis and leishmaniasis) with manifestations in isolated ophthalmic localisation. Our research has underscored the need to specify types of infection by way of adequate sampling so as to treat early and then improve prognosis.