H. Tiouiri

Sero-epidemiological survey of Crimean-Congo hemorrhagic fever virus in Tunisia

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease associated with a high case fatality rate and transmitted mainly by Hyalomma marginatum. The geographical distribution of H. marginatum covers most of the Western Mediterranean basin. We aimed to investigate whether CCHF virus (CCHFv) is circulating in Tunisia. Samples from unexplained acute febrile patients (n = 181) and a high risk group of humans, mainly slaughter workers (n = 38), were collected in the summer of 2014 and analyzed for exposure to CCHFv using serological tests and real-time RT-PCR. Ticks were collected from Northern and Southern Tunisia during May–June 2014 and examined for the presence of CCHFv by real-time RT-PCR. Of the 181 febrile patients, 5 showed only high titers of IgM suggesting a recent exposure to CCHFv. Among 38 slaughter workers, 2 had IgG anti-CCHFv responses yielding a seroprevalence of 5.2%. No CCHFv was detected in ticks and sera. Our results provide evidence of human exposure to CCHFv in Tunisia.

Molecular diagnosis of Rickettsia infection in patients from Tunisia.

Diagnosis of rickettsioses had largely benefited from the development of molecular techniques. Unfortunately, in Tunisia, despite the large number of rickettsial cases registered every year, the Rickettsia species remain unidentified. In this study, we aimed to detect the Rickettsia species in clinical samples using molecular tests. A study was established to analyze skin biopsies, cutaneous swabs, and cerebrospinal fluid samples taken from clinically suspected patients to have rickettsial infection. Two molecular techniques were used to detect Rickettsia DNA: quantitative real time PCR (qPCR) and reverse line blot test (RLB). An analysis of the RLB hybridization assay results revealed the presence of Rickettsia DNA in skin biopsies (40.6%) and swabs (46.7%). Rickettsia conorii was the most prevalent identified species among tested samples. Other species of interest include Rickettsia typhi and Rickettsia massiliae. Using qPCR positivity rates in skin biopsies was 63.7% against 80% in swabs. R. conorii was the most frequently detected species, followed by R. typhi. The agreement between the two techniques was 68.6% (kappa=0.33). Molecular tests, especially using specific probes qPCR, allow for a rapid, better and confident diagnosis in clinical practice. They improve the survey of Mediterranean spotted fever which is considered to be the most important rickettsial infection in humans in Tunisia.

Myélite transverse révélant une maladie de Hodgkin

Resume Introduction Les complications neurologiques au cours de la maladie de Hodgkin sont rares. Leur diagnostic est parfois difficile. Nous rapportons une observation de myelite transverse. Observation Il s’agissait d’un patient de 32 ans hospitalise pour paraplegie flasque febrile evoluant depuis 1 mois avant son admission associee a une alteration progressive de son etat general. L’examen trouvait un patient febrile, conscient, avec abolition des reflexes osteotendineux aux membres inferieurs, un signe de Babinski bilateral et un niveau sensitif en D6-D7. Par ailleurs, il existait une hepatosplenomegalie sans adenopathies peripheriques. Biologiquement, on notait une bicytopenie avec un syndrome inflammatoire important et une cytolyse hepatique. L ’examen tomodensitometrique thoraco-abdominal montrait des adenopathies profondes et l’IRM medullaire trouvait un aspect de myelite transverse. La biopsie medullaire etait normale alors que la biopsie hepatique montrait une infiltration du foie par des cellules de Sternberg. L’evolution a ete rapidement fatale avant le debut du traitement. Discussion Les manifestations neurologiques polymorphes observees au cours de la maladie de Hodgkin peuvent constituer un mode de revelation. Leur association a un syndrome tumoral doit faire evoquer le diagnostic meme si les signes neurologiques ne sont pas specifiques. L’atteinte peut etre medullaire ou encephalique. Le diagnostic de certitude ne peut etre qu’histologique. Le pronostic depend de la precocite du diagnostic et de la prise en charge.

The diagnosis of tuberculosis in dialysis patients

The incidence of tuberculosis (TB) is high in patients undergoing chronic dialysis than it is in the general population. The diagnosis of TB is often difficult and extrapulmonary involvement is predominant. This study investigates the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. TB was diagnosed in 41 patients. Anti-TB drugs, adverse effects of therapy, and outcome were noted. Thirty-eight patients (92.6%) were on hemodialysis and three were on peritoneal dialysis (7.3%). The mean age at diagnosis was 50.8 years and the male/female ratio was 1.16. Four patients had a history of pulmonary TB. Extrapulmonary involvement was observed in 32 (78 %) patients. The bacteriological confirmation was made in 41.46% and histological confirmation was made in 26.83%, and in the rest, the diagnosis was retained on the criterion presumption. Nineteen patients (46.34%) developed adverse effects of antitubercular drugs. Eight patients (19.51%) died during the study from TB or adverse effects of treatment. Low urea reduction ratio and female sex were associated with poor prognosis in our study. The clinical manifestations of TB in patients on dialysis are quite nonspecific, making timely diagnosis difficult, and delaying the initiation of curative treatment, which is a major determinant of the outcome.

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.

MYCOBACT-07 - Abcès tuberculeux primitifs du psoas : difficultés diagnostic et thérapeutiques

par une bithérapie pour une durée totale moyenne de 15 mois. L’évolution était favorable dans tous les cas avec une guérison clinique, un nettoyage radiologique et une négativation des bascilloscopies. Conclusion La tuberculose broncho-pulmonaire pseudotumorale est une forme rare qui peut survenir chez l’immunocompétent. La tomodensitométrie reste insuffisante pour la différencier du CBP. Le diagnostic est souvent difficile du faite de la présentation clinique et radiologique pouvant simuler une tumeur et de la négativité habituelle des prélèvements bactériologiques. Aucun lien d’intérêt