M. Beji

First Isolation of Mimivirus in a Patient With Pneumonia

BACKGROUND Mimiviridae Mimivirus, including the largest known viruses, multiply in amoebae. Mimiviruses have been linked to pneumonia, but they have never been isolated from patients. To further understand the pathogenic role of these viruses, we aimed to isolate them from a patient presenting with pneumonia. METHODS We cultured, on Acanthamoeba polyphaga amoebae, pulmonary samples from 196 Tunisian patients with community-acquired pneumonia during the period 2009-2010. An improved technique was used for Mimivirus isolation, which used agar plates where the growth of giant viruses is revealed by the formation of lysis plaques. Mimivirus serology was tested by microimmunofluorescence and by bidimensional immunoproteomic analysis using Mimivirus strains, to identify specific immunoreactive proteins. The new Mimivirus strain genome sequencing was performed on Roche 454 GS FLX Titanium, then AB SOLiD instruments. RESULTS We successfully isolated a Mimivirus (LBA111), the largest virus ever isolated in a human sample, from a 72-year-old woman presenting with pneumonia. Electron microscopy revealed a Mimivirus-like virion with a size of 554 ± 10 nm. The LBA111 genome is 1.23 megabases, and it is closely related to that of Megavirus chilensis. Furthermore, the serum from the patient reacted specifically to the virus compared to controls. CONCLUSIONS This is the first Mimivirus isolated from a human specimen. The findings presented above together with previous works establish that mimiviruses can be associated with pneumonia. The common occurrence of these viruses in water and soil makes them probable global agents that are worthy of investigation.

Épidémiologie de la tuberculose

Tuberculosis is a contagious disease caused by Mycobacterium tuberculosis. It represents, according to World Health Organization (WHO), one of the most leading causes of death worldwide. With nearly 8 million new cases each year and more than 1 million deaths per year, tuberculosis is still a public health problem. Despite of the decrease in incidence, morbidity and mortality remain important partially due to co-infection with human immunodeficiency virus and emergence of resistant bacilli. All WHO regions are not uniformly affected by TB. Africas region has the highest rates of morbidity and mortality. The epidemiological situation is also worrying in Eastern European countries where the proportion of drug-resistant tuberculosis is increasing. These regional disparities emphasize to develop screening, diagnosis and monitoring to the most vulnerable populations. In this context, the Stop TB program, developed by the WHO and its partners, aims to reduce the burden of disease in accordance with the global targets set for 2015.

Localisation cervico-thoracique d’un kyste hydatique

The authors report a case of cervico-thoracic region hydatid cyst suspected by the presence of a palpable right lower neck mass. This location is very rare. Neck ultrasound and computed tomography showed the cyst. Magnetic resonance imaging can be useful for diagnosis and provided the best anatomo-topographic evaluation before surgery.

Vitamin D deficiency and interleukin-17 relationship in severe obstructive sleep apnea–hypopnea syndrome

Purpose: We aimed to assess Vitamin D (VD) abnormalities in patients with severe obstructive sleep apnea–hypopnea syndrome (OSAHS), to study its association with clinical and polygraphic data, and to correlate VD levels with interleukin-17 (IL-17). Methods: Ninety-two patients with severe OSAHS were consecutively enrolled between September 2014 and February 2016 and compared to age-, sex-, and body mass index (BMI)-matched controls. Anthropometric parameters and medical history were collected. The serum levels of VD and IL-17 were determined by radioimmunoassay and enzyme-linked immunosorbent assay, respectively. Results: Ninety-two severe OSAHS patients and thirty controls were enrolled in the study. All OSAHS patients had VD deficiency. The mean level of VD was at 7.9 ng/ml among OSAHS group versus 16.8 ng/ml among control group. IL-17A levels were elevated (20.3 pg/ml) in OSAHS group compared to healthy group (10.05 pg/ml). VD levels were negatively correlated with nocturia severity (r = −0.26; P = 0.01) and positively correlated with mean O2saturation (r = 0.59; P = 0.02) and lowest O2saturation (r = 0.3; P = 0.03). IL-17 levels were positively correlated with nocturia severity (r = 0.24; P = 0.03) and negatively correlated with mean O2saturation (r = −0.42; P = 0.03). A significant negative association was observed between IL-7 and VD levels (r = −0.64, P = 0.2 10−4). The magnitude of this correlation was higher for important nocturia, lower MSaO2, or higher BMI. Conclusions: VD deficiency in patients with severe OSAHS is common with a negative association between IL-17 and VD serum levels. Hypoxia could play an important role in this association. Further studies are needed to clarify this relationship.

Rosai and Dorfman Disease with Pleural Involvement: Case Report

Sinus histiocytosis with massive lymphadenopathy (SHLM) disease is considered to be an indolent and self-limiting pathology. However, severe morbidity and mortality have been attributed to complications of SHLM. Lower respiratory tract involvement is rarely reported and is often unfavorable, and carries a particularly grave prognosis. A case of SHLM is reported, in which the patient had lower respiratory and pleural involvement.

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.

Une pleuro-pneumopathie droite fébrile excavée

Resume Les manifestations pleuro-pulmonaires au cours de la pyonephrose sont rares. Les auteurs rapportent un nouveau cas revele par une pleuro-pneumopathie febrile avec pleuresie purulente a Escherichia coli . L’echographie abdominale et la tomodensitometrie ont permis de redresser le diagnostic.

Tuberculosis is the main pulmonary complication of AIDS in Tunisia

While Pneumocystis carinii is the main pulmonary complication of acquired immunodeficiency syndrome (AIDS) in Europe and North America it has been rarely reported in sub-Saharan Africa possibly because many African AIDS patients die relatively early after infection with human immunodeficiency virus (HIV). AIDS is infrequent in Tunisia; fewer than 500 people infected with (HIV) were recorded from 1985 (the beginning of the epidemic) to 1994 and less than 150 AIDS cases were diagnosed. The results reported here of a study conducted on 30 Tunisian AIDS patients (14 men and 6 women age range = 30-43 years mean age = 33.6 years) with clinical pulmonary manifestations and/or radiographic abnormalities include the following: 1) 48% had fever 60% had cough and 35% had breathlessness (chest pain was another clinical symptom used); 2) although 6 patients had normal chest films the radiographs of 10 patients showed bilateral pulmonary interstitial infiltrates and those of 4 patients demonstrated unilateral or focal infiltrates; and 3) while examination using bronchofibroscopy of bronchoalveolar lavage (BAL) fluid for parasitic or bacterial agents demonstrated no opportunistic agent in 10 cases 20 cases were positive for such agents (Mycobacterium tuberculosis in 12 cases or 60% of the positives P. carinii in 3 cases or 15% of the positives an atypical mycobacterium in 1 case an aspergillus in another case and candida in 3 cases). The high prevalence of tuberculosis in Tunisia (120/100000 inhabitants) causes increased exposure to the organism. The feasibility of prophylaxis therapy against tuberculosis for patients with HIV in North Africa should be explored.

Formation tumorale framboisée à l’endoscopie bronchique simulant une tumeur carcinoïde

The authors report a case of pulmonary arteriovenous malformation in a 48-year-old man. The bronchoscopy revealed a fragile lingular tumoral formation. The diagnosis was based on the thoracotomy and the histopathological findings. The endoscopic features and the different diagnostic options of pulmonary arteriovenous malformation are discussed.