Lamia Ammari

Serological and molecular detection of Toscana and other Phleboviruses in patients and sandflies in Tunisia

BackgroundOur aim is to detect the infection by Toscana virus (TOSV) and other Phleboviruses in the sera and cerebro-spinal fluid (CSF) of patients with meningitis in Tunisia. We examined various species of phlebotomus present in Tunisia to determine whether or not a direct relationship exists between cases of meningitis and the viruses circulating in the insect vectors.MethodsPatients with the meningeal syndrome were tested for anti-TOSV IgM and IgG using an indirect Enzyme-Linked Immunosorbent Assay (ELISA) and for the presence of TOSV and other Phleboviruses using a RT-PCR test.An entomological study was carried out using CDC light traps to trap sandflies in different bioclimatic zones of Tunisia. Collected sandflies were tested by RT-PCR for the presence of TOSV and other Phleboviruses and subsequently by viral isolation on Vero cells.ResultsOf 263 patients were tested using ELISA of which 12.16% (n = 32/263) were IgM positive for anti TOSV. Of these 32 patients, 78% (n = 25/32) were IgG positive. 12.86% (n = 18/140) of the CSF samples tested by RT-PCR were positive for the Toscana virus.One CSF sample tested by RT-PCR revealed the presence of Sandfly Fever Sicilian Virus (SFSV). The Punique virus was identified in one sandfly pool.ConclusionsThis study confirms, for the first time, that TOSV is involved in a neurological disorder in North Africa. The incidence of this involvement in Tunisia conforms with observations made in other Mediterranean countries. Moreover, for the first time, a molecular approach was used to detect SFSV in a Tunisian patient displaying neurological symptoms.

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.

Délai diagnostique du paludisme d’importation en Tunisie

Introduction : l’incidence du paludisme d’importation est en augmentation en Tunisie, mais son diagnostic semble parfois long. L’objectif ici etait d’evaluer le delai diagnostic du paludisme d’importation en Tunisie et etudier I ’origine des retards diagnostics. Methodes : tous les cas de paludisme d’importation hospitalises dans le service des maladies infectieuses entre 2012 et 2015 ont ete evalues prospectivement. Le delai diagnostic “patient” etait defini comme le delai entre le debut de la fievre et la 1ere consultation medicale. Le delai diagnostic “medecin” etait le delai entre la 1ere consultation medicale et le diagnostic parasitologique. Le delai diagnostic total etait la somme de ces deux delais. Le retard diagnostic medical etait defini par un delai diagnostic “medecin” superieur a une journee.