R. Abid

Méningite et méningo-encéphalite à West Nile virus: à propos de 4 cas

Introduction : le West Nile virus (WNV) est un arbovirus de la famille des flaviviridae. Il est transmis par des arthropodes vecteurs du genre Culex a partir d’un reservoir ornithologique infecte. Cliniquement, l’infection a WNV est le plus souvent asymptomatique ou se manifestant par un syndrome pseudo-grippal. Cependant elle peut se compliquer dans certains cas d’une meningo-encephalite pouvant etre mortelle. Methodes : Il s’agit d’une etude retrospective realisee au laboratoire de Microbiologie de l’hopital militaire principale d’instruction de Tunis portant sur quatre observations de meningite et de meningo-encephalite a WNV durant l’annee 2013. La confirmation d’une infection recente probable a ete effectuee par la presence des IgM anti-WNV dans le LCR et/ou dans le sang en utilisant une technique ELISA indirecte (EURIIMMUN®, Germany). Pour tous les malades nous avons releve les caracteristiques epidemiologiques, cliniques, para-cliniques et evolutives. Resultats : il s’agissait de 3 hommes et une femme. L’âge moyen etait de 44 ans avec des extremes allant de 28 a 72 ans. 2 patients etaient originaires de Ben Arous, un de Siliana et un de Nabeul. Sur le plan clinique, tous les patients etaient febriles et presentaient un syndrome meninge. Les autres signes etaient a type de douleurs articulaires (n = 2), eruption cutanee (n=1) et des signes neurologiques de focalisations (n = 2). Le diagnostic de meningite ou de meningo-encephalite a WNV etait retenu sur la positivite de la serologie VWN (type IgM) dans le sang (n = 4) ou le LCR (n = 1). Un seul patient a recu de l’aciclovir avant confirmation de la maladie. L’evolution etait favorable dans 3 cas dont un avait garde comme sequelles une diplegie faciale. Un seul patient est decede. Conclusion : les formes neuroinvasives de l’infection au VWN sont rares. Leur traitement reste symptomatique. La prevention repose sur la lutte contre le vecteur et le reservoir.

Séroprévalence de la dengue chez des militaires lors d’un bilan de réengagement

Introduction : la dengue represente la principale arbovirose des regions tropicales et subtropicales. Elle est devenue ces dernieres decennies un sujet majeur de sante publique internationale vue l’augmentation des cas recenser et la gravite de certaines formes cliniques. En Tunisie, la menace d’une epidemie de dengue est reelle vue l’augmentation de la circulation des biens et des personnes avec les pays endemiques et la possible presence du vecteur (Aedes). Pour cela, nous avons conduit cette etude preliminaire dont le but est d’estimer la seroprevalence de la dengue chez des adultes sains vivant en Tunisie. Methodes : il s’agit d’une etude prospective realisee au Laboratoire de Microbiologie de l’hopital militaire principale d’instruction de Tunis, s’etendant sur une periode de 4 mois (1 Fevrier 2015 a 31 Mai 2015). Elle a porte sur 91 militaires chez qui une recherche des anticorps de type IgM et IgG antivirus de ladengue a ete realisee lors d’un bilan de reengagement. Cette recherche a ete realisee par une technique ELISA indirect (EUROIMMUN®).

AB0920 Any Predictive Factors of Therapeutic Response in Infectious Spondylitis

Background The aim of the present work was to describe predictive factors of good or bad outcome Infectious Spondylodiscitis according to the experience of an internal medicine department in Tunisia. Methods Patients with SDI either confirmed or presumed and hospitalized in the internal medicine department of The Principle Military Hospital Of Tunis, Tunisia have been included in the Study. Results Fourty-four patients met the inclusion criteria. They have been gathered over 20 years-period. They were 24 men and 20 women with an average age at 52.5 years. The diagnosis was a Tuberculous Spondylodiscitis in 22 cases (50%): among them 10 patients had a concomitant extra spinal TB. The diagnostic delay was 231 days for TB SDI and 40.5 days for SDP. Length of hospital stay was 48.6 days (6–225 days): with a mean of 48.9 days in SDT and 45.3 days in SDP. Regular monitoring was observed in 38 patients (17 SDP, SDT 21) with an average duration of 20 months (5–48 months). Three were lost views and three died. Evolution was considered positive if there was a clinical and biological improvement and no recurrence or death. The analytical study objectified that existence of a immunosuppression, a longer diagnosis period, or hospitalization period and the follow-up duration were associated with a longer duration of treatment (p=0.038, p<0.001). The absence of orthopedic complications initially or during the evolution and treatment duration were the only factors associated with good favorable change (p<0.001, p=0.004), the existence of bacteriological evidence of multifocal involvement, the presence of epidural or spinal compression showed no significant association. Conclusions Earlier treatment with effective duration and follow up are predictive factors of favorable outcome in SDI either due to TB or regular germs. Disclosure of Interest None declared

AB0921 Infectious Spondylodiscitis Features: about 44 Cases

Background Spinal infections can be described aetiologically as pyogenic, granulomatous (tuberculous, brucellar, fungal) and parasitic. Its early diagnosis is crucial to the establishment of adequate treatment in order to get favorable outcomes. The aim of the present work was to describe clinical, diagnostic and therapeutic aspects of Infectious Spondylodiscitis according to the experience of an internal medicine department in Tunisia. Methods Patients with SDI either confirmed or presumed and hospitalized in the internal medicine department of The Principle Military Hospital Of Tunis, Tunisia have been included in the Study. Results Fourty-four patients met the inclusion criteria. They have been gathered over 20 years-period. They were 24 men and 20 women with an average age at 52.5 years. The diagnosis was a Tuberculous Spondylodiscitis in 22 cases (50%): among them 10 patients had a concomitant extra spinal TB. The diagnostic delay was 231 days for TB SDI and 40.5 days for SDP. Revealing symptoms were dominated by pain:, often mixed (61%). Radicular pain was noted in 15 cases. Fever was found in 17 cases. On examination: spinal syndrom was present in 65.9% of cases, spinal cord compression signs were found in 8 patients. MRI was contributive in all cases showing a disc enhancement in 50% (SDP in 67%, TSDI in 33%), epiduritis in 63.5% (SDP 60%, TSDI 67%). The disc biopsy was contributive in 71% of cases. The diagnosis was certain in 15 cases, highly probable in 18 cases and presumptive in 11 cases. Treatment duration was 13 months for SDT and 18 weeks for SDP. The outcome was favorable in 30 cases (SDP 13, TSDI 17). Conclusions Infectious sondylodiscitis remains a diagnostic and therapeutic problem in our country. Only an early care can enhance its prognosis. Disclosure of Interest None declared

AB0852 Residual Pain in The Infectious Spondylodiscitis, When To Expect It?

Background Residual pain after Infectious spondylodiscitis can result in a major handicap in social and professional life. The aim of the present work was to describe predictive factors of Residual pain after Infectious Spondylodiscitis according to the experience of an internal medicine department in Tunisia. Methods Patients with SDI either confirmed or presumed and hospitalized in the internal medicine department of The Principle Military Hospital Of Tunis, Tunisia have been included in the Study. Factors correlated with later pain are gathered in this study. Results See Table 1.Table 1 Residual pain P yes No Pain at initial examination (ie) Yes 4 8 0.026 No 20 67 Neurological compression signs (ie) Yes 7 9 0.049 No 17 5 Cutaneous infection Yes 10 7 0.03 No 9 0 Germ identified Yes 1 7 0.008 No 23 7 SD group SDT 9 12 0.003 SDP 15 2 MRI signs of compression yes 11 13 0.048 no 5 1 Fourty-four patients met the inclusion criteria. They have been gathered over 20 years-period. They were 24 men and 20 women with an average age at 52.5 years. The diagnosis was a Tuberculous Spondylodiscitis in 22 cases (50%): among them 10 patients had a concomitant extra spinal TB. The diagnostic delay was 231 days for TB SDI and 40.5 days for SDP. Treatment duration was 13 months for SDT and 18 weeks for SDP. The outcome was favorabl Regular monitoring was observed in 38 patients (17 SDP, SDT 21) with an average duration of 20 months (5–48 months). Conclusions Neurological signs at first examination and MRI are main factors of residual pain in SDI. Disclosure of Interest None declared

AB0939 Factors of Immunodepression in Patients with Tuberculosis in Internal Medecine

Background Immunodepressed patients are a high-risk group for tuberculosis. Objectives The aim is to study the differences in presentation, diagnosis and therapeutic management of tuberculosis according to the immune status of patients. Methods A retrospective study of the files of patients hospitalized in the internal department of military hospital of Tunisia for a Mycobacterium tuberculosis infection. Comparison of two populations: immunodepressed versus non immunodepressed. Results 129 patients aged 20 to 90 were included, 49 patients were considered immunodepressed and 80 non immunodepressed. The causes of immunodepression were: age ≥65years (n=27), diabetes (n=20), immunosuppressive drugs (n=16), chronic inflammatory diseases (n=9), chronic renal failure (n=7), neoplasia (n=8), chronic hepatopathy (n=4), and HIV infection (n=2). Comparison between the 2 populations revealed a more frequent history of absence of vaccination in the immunodepressed (p=0.0001), shorter duration of hospitalisation (p=0.01), greater frequency of disseminated forms (p=0.02), more frequent use of corticoids (p=0,007) and enhanced mortality (p=0.04). There was no difference in the 2 groups with regard to the clinical signs having evoked tuberculosis, the diagnostic method and the bacteriological results. Conclusions The severity and the frequency of tuberculosis in immunodepressed patients should incite clinicians to evoke tuberculosis and to initiate rapidly an efficient treatment. In case of alteration in immune defenses, prophylactic treatment Disclosure of Interest None declared

AB0934 Cervical Infectious Spondylodiscitis: About Three Cases

Background Cervical spondylodiscitis diseases are rare. They represent 3 to 15% of spine infections. Moreover, they present some slight epidemiological and clinical differences.It can endanger the patient either locally because of severe destruction, often with concomitant neurological deficits Objectives To report some cases of cervical spondylodiscitis and presenting its characteristics Methods We report 3 cases (two women and one man) with a mean age of 44 years. Results Causative agents were a mycobacterium tuberculosis (MT) in two cases and a staphylococcus in one case. Infection of the upper cervical spine (C1-C2) was noted in one case. Disco vertebral needle biopsy permitted, in one case, to make a bacteriological diagnosis (MT). Spondylodiscitis is associated with paravertebral abscess (one case), epiduritis (2 cases), spinal cord compression (2 cases), vertebral instability (2 cases). Medical management with A combined broad-spectrum antibiotic therapy was performed associated with orthopedic immobilization of the spine and was successful in all cases. Conclusions Risk of spine instability and frequency of neurological complications (observed in 20 to 40% of cases) make of cervical spondylodiscitis a serious disease. Urgent and multidisciplinary management is necessary, based on adapted antibiotherapy and orthopedic and surgical immobilization of the cervical spine.Surgery is indicated if a neurological deficit, symptoms of sepsis, epidural abscess formation with consecutive stenosis, instability or severe deformity were present Disclosure of Interest None declared