A comparison of human metapneumovirus and respiratory syncytial virus WHO-defined severe pneumonia in Moroccan children.

Acute respiratory infections remain the principal cause of morbidity and mortality in Moroccan children. Besides bacterial infections, respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are prominent among other viruses due to their high prevalence and association with severe clinical episodes. We aimed to describe and compare RSV- and hMPV-associated cases of WHO-defined severe pneumonia in a paediatric population admitted to Morocco's reference hospital. Children aged 2-59 months admitted to the Hôpital d'Enfants de Rabat, Morocco meeting WHO-defined severe pneumonia criteria were recruited during 14 months and thoroughly investigated to ascertain a definitive diagnosis. Viral prevalence of RSV, hMPV and other viruses causing respiratory symptoms was investigated in nasopharyngeal aspirate samples through the use of molecular methods. Of the 683 children recruited and included in the final analysis, 61/683 (8·9%) and 124/683 (18·2%) were infected with hMPV and RSV, respectively. Besides a borderline significant tendency for higher age in hMPV cases, patients infected with either of the viruses behaved similarly in terms of demographics, patient history, past morbidity and comorbidity, vaccination history, socioeconomic background and family environment. Clinical presentation on arrival was also similar for both viruses, but hMPV cases were associated with more severity than RSV cases, had a higher risk of intensive care need, and received antibiotic treatment more frequently. RSV and hMPV are common and potentially life-threatening causes of WHO-defined pneumonia in Moroccan children. Both viruses show indistinctive clinical symptomatology, but in Moroccan children, hMPV was associated with a more severe evolution.

[Bacterial endophthalmitis: retrospective clinical and microbiological study in Rabat Specialty Hospital]. / Endophtalmies bactériennes: étude rétrospective clinique et microbiologique à l'hôpital des spécialités de Rabat.

OBJECTIVES: To study and discuss the epidemiological, clinical, microbiological, and risk factors of bacterial endophthalmitis treated in the Rabat Specialty Hospital ophthalmology department. PATIENTS AND METHODS: This is a retrospective study over a period of 10 months of patients hospitalized for suspected acute infectious endophthalmitis. An intake form was completed for each patient. Each sample underwent direct examination and culture. All patients underwent the same protocol, providing for at least one intravitreal antibiotic injection and instillation of fortified eye drops. RESULTS: Twenty cases of endophthalmitis were recorded during the study period. Decreased visual acuity, intraocular inflammation, pain and conjunctival hyperemia were found in all patients. The median onset of symptoms was 4 days. Vitreous tap or anterior chamber paracentesis was performed in all patients. Bacteria were found in seven samples (40%). Gram positive organisms accounted for 85% of positive cultures. Amphotericin B was required in four patients, and systemic antibiotic therapy in ten patients. Corticosteroid treatment was administered secondarily in eight patients. DISCUSSION: In this retrospective series, epidemiological, clinical and microbiological data are consistent with those already published.

[Primitive aspergillosis of the posterior cerebral fossa in immunocompetent patient]. / Aspergillose primitive de la fosse cérébrale postérieure chez un patient immunocompétent.

Cerebral aspergillosis arises in the great majority of cases during an invasive aspergillosis with hematogene scattering from the lung hurts. The cerebral, not rare location is one of the worse criteria forecast during the invasive aspergillosis. We report the case of patient who was hospitalized in the neurosurgery department for syndrome of increased intracranial pressure, hemiparesis and cerebellar syndrome in febrile context. The radiological exploration objectified a collection of the posterior fossa. A stereotactic biopsy was performed. It collected fragments biopsy and pus. The pathological and microbiological analysis allowed the identification of Aspergillus fumigatus. The originality of this observation comes from the rare location in the posterior fossa of aspergillosis and because the patient is immunocompetent and no primary location is found. The patient presents however a viral hepatitis B of fortuitous discovery. He is put under treatment by amphotericin B. The evolution is marked by meningitis comment-diversion. Antibiotics are prescribed, and then the patient is operated for total ablation of the tumor. He dies following an osmolar coma associated with thrombopenia and a secondary renal insufficiency due to his treatment by the amphotericin B.

[Resistance to fluoroquinolone among Klebsiella spp strains producing extended-spectrum betalactamases isolated from urine]. / La résistance aux fluoroquinolones chez des souches de Klebsiella spp productrices de bêtalactamase à spectre étendu isolées dans les urines.

The aim of the study was to assess the frequency of resistance to fluoroquinolones in extended-spectrum beta-lactamase (ESBLs) Klebsiella spp isolated from urines of consulting and hospitalized patients in Rabat Specialities Hospital. A retrospective survey was made over 3 years (2006-2008). Two hundred ant fifty three patients presented with confirmed urinary tractus infection (UTI). Klebsiella spp was the etiologic agent in 28% (72/253) of reported UTI. Among them, 86% of Klebsiella pneumoniae and 14% of Klebsiella oxytoca. The frequency of Klebsiella spp resistance to fluoroquinolones was 33% and to third generation cephalosporins was 35%. Thirteen Klebsiella spp strains were producing extended-spectrum beta-lactamase witch corresponds to 18% of all the klebsiella. The extended-spectrum beta-lactamase strains with resistance to fluoroquinolones were 85% (11/13) or 15 % of all klebsiella (11/72). None of those strains was resistant to imipenem. In conclusions resistance of enterobacteries such as Klebsiella spp to fluoroquinolones is becoming worrying among consulting and hospitalized patients. Eleven strains multiresistant (ESBL + resistance to fluoroquinolones), isolated probably because of plasmids carrying genes of ESBL and fluoroquinolones resistances. This increasingly frequent resistance mechanism should lead to a more careful use of first line fluoroquinolones for UTI.

[Prevalence of Acinetobacter baumannii and Pseudomonas aeruginosa isolates resistant to imipenem by production of metallo-beta-lactamase]. / Prévalence des souches d'Acinetobacter baumannii et de Pseudomonas aeruginosa résistantes à l'imipénème par production de métallo-beta-lactamases.

UNLABELLED: Metallo-beta-lactamases (MBL) are enzymes produced by Gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter baumannii. These enzymes make these isolates resistant to imipenem. AIM: The aim of this study was to determine the prevalence of this resistance mechanism in Pseudomonas aeruginosa and Acinetobacter baumannii strains identified in the bacteriology laboratory of the Rabat Ibn Sina teaching hospital, Morocco. MATERIALS AND METHOD: Screening for MBL was systematic in all resistant strains and/or strains with decreased sensitivity to imipenem, according to Dongeun Yong et al.'s method, using a sterilized solution of EDTA 0.5 M pH 8. RESULTS: Eighty-five bacterial strains (48 P. aeruginosa and 37 A. baumannii) were identified 23% (11) and 57% (21) of which were respectively resistant to the imipenem. The prevalence of MbetaL producing strains was 27% for P. aeruginosa and 38% for A. baumannii. CONCLUSION: These results show that the frequency of these strains is increases in our hospital and that their emergence represents a serious therapeutic and epidemiological problem. This means that we need to implement the supervision of hospital microbial environment and strictly apply hygiene measures.

[Chronic gastritis and intestinal metaplasia (author's transl)]. / Gastrites chroniques et métaplasie intestinale. Modalités évolutives.

The diagnosis of chronic gastritis can be made from the macroscopic lesions seen on endoscopy, and the severity of the changes noted in the mucosa after biopsy under direct vision. Gastric intubation can also be used to confirm the pathological results. If the atrophied mucosa shows highly differentiated diffuse intestinal metaplasia, the examinations should be repeated at regular intervals, as they could herald the onset of malignant changes. The authors discovered 312 cases of intestinal metaplasia in 4 920 patients who had been gastroscoped in the Digestive Endoscopy Center of François-Moutier. A total of 157 of them, were noted to have very highly differentiated diffuse lesions, and 54 of these cases had at least yearly repeat gastroscopies. A diagnosis of intrinsic cancer was made in four patients, and this was confirmed by taking serial sections of the specimens removed.