[Upper urinary tract infections in adults: about 261 episodes]. / Infections urinaires hautes de l'adulte: à propos de 261 épisodes.

BACKGROUND: Upper urinary tract infections are frequent. Escherichia coli is the main pathogen identified from community acquired infections. AIM: We aim to study epidemiologic, clinical and bacterial features of this infection. METHODS: We identified 261 episodes that occurred in 241 patients. They were 213 females and 48 males aged of 48.75 years. Enterobacteriaceae were the main pathogens isolated in 93.5%: E. coli in 73.3% and Klebsiella pneumoniae in 15.3%. E. coli sensitivity was of 30% for amoxicillin, 98% for cefotaxim, 96% for gentamicin, 90% for ciprofloxacin and 56% for co-trimoxazole. Anterior antibiotic use was associated with low E. coli sensitivity mainly with fluoroquinolones (96 vs 77%) and co-trimoxazole (62 vs 43%). This enhances the role of antibiotic pressure on the resistance emergence. CONCLUSION: the reasonable use of antibiotics is necessary to limit resistance extent.

Mucormycosis: four case reports.

INTRODUCTION: Mucormycosis is a rare and invasive fungal infection, but frequently fatal when it occurs. It commonly affects patients with diabetes mellitus. The aim of this study is to assess the clinical presentation, radiological findings, management and prognosis of mucormycosis. METHODS: This retrospective study was conducted in the department of infectious diseases of Rabta hospital between January 1988 and December 2004 and included patients hospitalized for mucormycosis confirmed by mycological and/or histological findings. RESULTS: the study is about four diabetic patients with mucormycosis (3 men and a woman). Three of them had diabetic ketoacidosis at the time of diagnosis. The infection was sinusal in 2 cases and rhinocerebral in the the other two cases. Treatment consisted in systemic amphotericin B combined with surgical debridement in 3 cases. A fatal outcome was noted in 2 cases. CONCLUSION: Mucormycosis remains a severe infectious disease in diabetic patients. Early diagnosis and treatment is mandatory for a successful management of this infection.

[Relapse of visceral leishmaniasis in HIV infection. Benefit of amphotericin B]. / Rechute de leishmaniose viscerale au cours de l'infection par le VIH interet de l'amphotericine B.

The reference treatment in visceral leishmaniasis is administration of antimonial compounds. Failures have been reported particularly in HIV-positive patients. The authors describe the case of a 40-year-old patient who, after 2 courses of N-methyl-glucamine, relapsed. Bone marrow cultures became negative only after adminstration of amphotericin B (1 mg x kg x d) for 28 days. He is still asymptomatic 18 months after he was cured. Amphotericin B, in case of relapse, seems to be a valuable alternative, until the availability of the liposomal form in our country.