M. Khalifa

Serologic Study of Rickettsioses among Acute Febrile Patients in Central Tunisia

Abstract:  Although Mediterranean spotted or “boutonneuse” fever (MSF) has been documented in central Tunisia, other spotted fever group rickettsioses (SFGR) and typhus group rickettsioses (TGR) have received little attention in our region. We sought to determine the role of rickettsioses, Q fever, ehrlichioses, and bartonelloses among patients with acute fever. The results of this study of 47 persons with acute fever of undetermined origin are reported in this paper. We concluded that SFGR, murine typhus, and acute Q fever are common causes of acute isolate fever in summer in central Tunisia and should be investigated systematically in patients with acute fever of unknown origin.

Epidemiological and clinical features of giant cell arteritis in Tunisia

BACKGROUND Giant cell arteritis (GCA) is a systemic vasculitis of the elderly that could result in vision loss or even be life threatening. Unlike western countries, this disease is considered exceptional in Tunisia. OBJECTIVE The aims of this study were to determine epidemiological and clinical features of GCA in Tunisian population and to identify management difficulties. PATIENTS AND METHODS A multicentric study of 96 patients in whom GCA was diagnosed between 1986 and 2003. All patients fulfilled the ACR criteria for classification of GCA. RESULTS The majority of cases (77%) were diagnosed since 1994. The male/female ratio was 0.88 and the mean age at the time of diagnosis was 70.8+/-7.7 years. Clinical features were characterized by gradual onset in 64.4% of cases. The most frequent clinical manifestations were headache (91.7%), abnormalities in temporal arteries (85.4%), severe ischemic manifestations (80.2%), constitutional symptoms (75%), and polymyalgia rheumatica (56.3%). Biological inflammatory syndrome was noted in all patients. Temporal artery biopsy established histological diagnosis in 73% of cases. All patients were treated by corticosteroids. Remission was obtained in 45.6%. Relapses occurred in 40.4% of cases and 30 patients were still receiving corticosteroids at the time of study. Four patients died and irreversible ischemic complications were noted in 15.6% of cases. Steroid adverse effects occurred in 56 patients. CONCLUSION GCA is not exceptional to Tunisia. It occurs amongst elderly patients with no female predominance noticed. Clinical features are similar to those reported in other series.

Granulocytic sarcoma of the rectum: Report of one case that presented with rectal bleeding

Granulocytic sarcoma is an uncommon and localized extramedullary tumor composed of immature granulocytic cells. It may present in association with acute myeloid leukaemia, myelodysplastic syndrome and chronic myelogenous leukaemia. Granulocytic sarcoma may occur in any anatomical site but involvement of the gastrointestinal tract is rare, especially in the rectum. We report on the case of a 17 year old female who presented with rectal bleeding, abdominal pain and weight loss one mo prior to admission. Rectosigmoidoscopy revealed a rectal polypoid and ulcerated mass. The histological examination of the mass showed granulocytic sarcoma. Bone marrow examination was compatible with acute promyelocytic leukaemia (FAB type M3). This case report is a reminder of this peculiar sign of tumoral syndrome in acute myeloid leukaemia. We also discuss diagnostic methods and analyze the disease course.

La maladie de Takayasu dans la région centre de la Tunisie. À propos de 27 cas

BACKGROUND Takayasus arteritis is a rare inflammatory disease and few data are available in Tunisia. The aim of this study is to evaluate clinical and radiological features of the disease in the centre of Tunisia. METHODS We retrospectively studied medical records of patients treated in departments of internal medicine or cardiology from three university hospitals in Sousse and Monastir over the period 1985-2005. The criteria for inclusion were those proposed by the American College of Rheumatology. RESULTS Twenty-seven patients were identified. The mean age at presentation was 33.2 years (range 16-68 years) and 88.9% were female. The mean delay from the onset of the symptoms to the time of diagnosis was 4.2 years. Intermittent claudication was the most common presentation (81.5%) and hypertension was noted in 40.7% of cases. Arterial localization most frequently involved was subclavian artery. The aorta was involved in 52.3% and renal arteries in 36.3% of cases. Stenosis or occlusions was constant but aneurysms were noted in 7.4%. Functional difficulty was the main complaint in the follow-up, death related to Takayasus disease was noted in 3.7%. The mean follow-up time was 75.8 months (6.3 years). CONCLUSION There is no epidemiologic particularity of Takayasus disease in Tunisia, however involvement of the subclavian artery was more frequent than the aortic localization.

Prévalence de l’hépatite virale C chez le personnel de santé au Centre tunisien

Les professionnels de santé sont confrontés au risque de ontamination par les virus de l’hépatite virale B et C, et ce par ’intermédiaire du sang et des liquides biologiques. Dans la littéature, les résultats de la prévalence de l’hépatite virale C (HVC) hez le personnel de santé sont discordants. En Tunisie, aucune tude de prévalence de l’HVC n’a été publiée. L’objectif de ce ravail était de déterminer la prévalence des anticorps antivirus e l’hépatite C (VHC) chez les personnels de santé de l’hôpital arhat-Hached de Sousse.

Noninvasive Fibrosis Markers for the Prediction of Significant Fibrosis in Patients With Chronic Hepatitis C Virus Infection in Tunisia

Summary:Optimized clinical management of chronic hepatitis C requires precise definition of the stage of liver fibrosis. Liver biopsy is viewed as the criterion standard for staging fibrosis in chronic hepatitis, but simple, noninvasive tests for the detection of significant fibrosis would be beneficial. Aim:To evaluate and compare the diagnostic accuracies of the simple fibrosis tests such as aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), platelet count, and aspartate aminotransferase-to-platelet ratio index (APRI) for the prediction of significant fibrosis in patients with chronic hepatitis C. Methods:We studied 38 patients with chronic hepatitis C who underwent a liver biopsy. To evaluate diagnostic accuracies of the simple fibrosis tests, sensitivity, specificity, and the area under the receiver operating characteristic curve were calculated. Results:The AAR increased and platelet count decreased as liver fibrosis worsened, but there was no significant correlation with the fibrosis score. The receiver operating characteristic curves of AAR, platelet count, and APRI were 0.68, 0.38, and 0.91, respectively. The APRI identified patients with significant fibrosis with a positive predictive value of 86.6%. Conclusions:Our study confirms that the APRI can predict significant fibrosis in chronic hepatitis C patients with a high degree of accuracy.

Acute Q fever in hospitalised patients in Central Tunisia: report of 21 cases

F. Bellazreg, N. Kaabia, W. Hachfi, M. Khalifa, E. Ben Jazia, N. Ghanouchi, A. Brahem, F. Bahri andA. LetaiefInfectious Diseases Unit, Farhat Hached Hospital, Sousse, TunisiaINTRODUCTIONQ fever is caused by Coxiella burnetii, which is anobligate intracellular bacterium. In Tunisia,although the prevalence of Q fever among blooddonors is high (26%) [1], this disease is rarelydiagnosed. The aim of this study was to describeepidemiological and clinical features of acute Qfever in adults in central Tunisia.PATIENTS AND METHODS

A case of primary biliary cirrhosis associated with pernicious anemia: a case report

Primary biliary cirrhosis is often associated with autoimmune diseases. However, its association with pernicious anemia has rarely been reported.We report a case of a 68-year-old woman who presented jaundice and pruritus. Mildly elevated serum levels of alkaline phosphatase and γ-glutamyl transpeptidase were detected. The titer of anti-mitochondrial M2 anti-body was elevated. Histology of liver biopsy showed features of primary biliary cirrhosis. In addition, aregenerative macrocytic anemia was found in the full blood count. The diagnosis of pernicious anemia was established by megaloblastosis in bone marrow, atrophic gastritis without Helicobacter pylori, low level of vitamin B12 and good response to treatment regimen of vitamin B12. The association of primary biliary cirrhosis and pernicious anemia is unlikely to be casual and may be explained by autoimmune mechanism commonly shared by the diseases.

Tc-99m and I-131 uptake in widespread bone metastases from undetectable digestive adenocarcinoma.

We present a case of a 44-year-old man admitted to the hospital because of rapid deterioration of his general condition. Uptake of both Tc-99m pertechnetate and radioiodine 131 was observed in widespread bone metastases. Histologic findings and serum tumor markers excluded thyroid origin and confirmed digestive origin.

Takayasu's disease in the center of Tunisia: 27 cases.

BACKGROUND Takayasus arteritis is a rare inflammatory disease and few data are available in Tunisia. The aim of this study is to evaluate clinical and radiological features of the disease in the centre of Tunisia. METHODS We retrospectively studied medical records of patients treated in departments of internal medicine or cardiology from three university hospitals in Sousse and Monastir over the period 1985-2005. The criteria for inclusion were those proposed by the American College of Rheumatology. RESULTS Twenty-seven patients were identified. The mean age at presentation was 33.2 years (range 16-68 years) and 88.9% were female. The mean delay from the onset of the symptoms to the time of diagnosis was 4.2 years. Intermittent claudication was the most common presentation (81.5%) and hypertension was noted in 40.7% of cases. Arterial localization most frequently involved was subclavian artery. The aorta was involved in 52.3% and renal arteries in 36.3% of cases. Stenosis or occlusions was constant but aneurysms were noted in 7.4%. Functional difficulty was the main complaint in the follow-up, death related to Takayasus disease was noted in 3.7%. The mean follow-up time was 75.8 months (6.3 years). CONCLUSION There is no epidemiologic particularity of Takayasus disease in Tunisia, however involvement of the subclavian artery was more frequent than the aortic localization.