S. Belhadj

Visceral leishmaniasis in Tunisia: result of the isoenzymatic characterization of 65 Leishmania infantum strains

The isoenzymatic characterization of 65 Tunisian strains of Leishmania, isolated from human cases of visceral leishmaniasis between June 1998 and August 2001, revealed the existence of 3 zymodemes of the L. infantum complex: MON-1 the most common (93.8%), followed by MON-24 (3.1%) and MON-80 (3.1%). 72% of the strains were obtained from children under the age of 5 years. The majority of the studied strains originated from 8 provinces of northern Tunisia, particularly the province of Zaghouan.

La mucormycose rhino-orbito-cérébrale chez le diabétique : une pathologie mieux connue en Tunisie

This is a retrospective study including 17 patients with rhino-orbito-cerebral mucormycosis diagnosed in a period of 16 years, between 1992 and 2007, in 8 men and 9 women. All patients were diabetic with ketoacidosis diabetes in 8 cases. Necrosis facial and ophthalmic symptoms were the most frequent presenting manifestations. The diagnosis was confirmed by mycological examination, with or without histopathology, identifying Rhizopus oryzae in 12 cases. Treatment consisted in systemic amphotericin B combined with surgical treatment in only 7 cases. The mortality rate was high (65%) due principally to the delay in diagnosis and absence of surgical treatment.

Le paludisme d’importation en Tunisie : bilan de 291 cas diagnostiqués à l’hôpital La Rabta de Tunis (1991-2006)

Resume La Tunisie connait depuis 1979, date du dernier cas autochtone du paludisme, un arret de la transmission active de cette parasitose. L’etude de 291 cas de paludisme d’importation diagnostiques sur une periode de 15 ans (1991-2006), au laboratoire de parasitologie-mycologie de l’hopital La Rabta de Tunis, nous a permis de degager les caracteristiques de cette pathologie dans notre pays. Il s’agit de 165 sujets symptomatiques (56,7 %), ayant comme principal signe clinique la fievre (98 %) et 126 sujets asymptomatiques (43,3 %) depistes dans le cadre du controle systematique realise chaque annee pour les etudiants originaires des zones endemiques. Nos patients sont âges entre 20 et 29 ans dans 63,6 % des cas et de sexe masculin dans 88,7 % des cas. Ils sont originaires ou ayant sejourne en Afrique sub-saharienne dans 275 cas (94,5 %). La majorite de ces cas sont diagnostiques entre le mois de juin et d’octobre (69,8 %). Plasmodium falciparum est la principale espece importee (64,5 %). La bonne connaissance des caracteristiques de ces cas permet de minimiser le risque potentiel de reintroduction de cette parasitose dans notre pays par un diagnostic precoce, une prise en charge adequate et par un renforcement des controles sanitaires aux frontieres, d’autant plus justifie que le diagnostic de la majorite des cas coincide avec la saison des anopheles adultes vecteurs de cette parasitose.

Choix des amorces : élément déterminant dans le diagnostic moléculaire de la leishmaniose cutanée

The cutaneous leishmaniasis (CL) is a parasitic disease which represents a serious problem for the public health not only in Tunisia but also all over the world. Its diagnosis is based on the techniques which are usually used, direct examination and in vitro culture. Because of several factors, these techniques lack sensitivity. The molecular biology, which is indeed more rapid and more sensitive, has proved its effectiveness in diagnosis of the CL. There are two main aims for our research work. First, to show the contribution of the Polymerase Chain Reaction (PCR) during the diagnosis of CL (of course by comparing the results obtained when using this technique with those found through the direct examination); second, to compare the two pairs of primers which amplify the leishmanien gene coding for the 18s ribosomal sub-unit: the pair R221/R332 (PCR1) and the pair Lei70L/Lei70R (PCR2). Our work was carried out upon 299 samples. One hundred and eighty-eight of them were positive using the direct examination and/or the PCR and 111 were negative. Only two samples were positive using of course the direct examination in comparison with 74 which were positive when using only the PCR (PCR1 and/or PCR2). Among these 74 samples, 64 where positive using only PCR2 in comparison with two samples which were positive using only PCR1. The eight remaining samples were at once positive for the PCR1 and the PCR2. The PCR (notably the PCR2) has proved a more significant percentage of positivity in comparison with direct examination: 98.98% for the PCR and 60.6% for direct examination.

Subcutaneous dirofilariasis of the upper lip in Tunisia

INTRODUCTION Dirofilariasis is a rare anthroponotic disease caused by Dirofilaria, the principal reservoir of which is the dog. The first case of subcutaneous dirofilariasis in Tunisia was reported in 1990. CASE REPORT We report a case involving a 40-year-old woman living in northeastern Tunisia who presented with a subcutaneous lesion of the upper lip resembling a sebaceous cyst. Excisional biopsy released a worm identified on morphologic examination as Dirofilaria repens. Only excision allows simultaneous diagnosis and treatment. CONCLUSION This is the 14th case of dirofilariasis reported in Tunisia. This parasitic disease is probably underestimated in our country. It should be considered for all subcutaneous nodules, regardless of localisation.