S. Trabelsi

Epidemiological and Etiological Study of Foot Mycosis in Tunisia

BACKGROUND Tinea pedis and onychomycosis are among the commonest fungal diseases in the world. Recently, there has been an increase in the numbers of fungal agents implicated in these conditions. OBJECTIVE To analyze the epidemiology of fungal foot diseases and to identify associated etiological factors in outpatients attending the Department of Dermatology of Charles Nicolle Hospital in Tunis, Tunisia. PATIENTS AND METHODS One hundred and forty eight patients were assessed for the presence of fungal foot diseases during the period between January and April 2009. The mean age was 41.5 years (range: 2-87 years) and sex ratio was 0.8. A complete dermatological examination was performed on all subjects, and specimens of the feet were taken from patients presenting signs of tinea pedis or onychomycosis for microscopy and fungal culture. RESULTS Fungal foot infection was suspected in 71 subjects, and the diagnosis was confirmed in 67 cases (45.3%) by positive microscopy or culture. Older age and family history of mycosis were predisposing factors for foot fungal infection. The condition was caused by dermatophytes in 57.1% of cases and Candida species in 35.7%. Trichophyton rubrum and Candida parapsilosis were the predominant dermatophyte and yeast species, respectively.

Visceral leishmaniasis after kidney transplantation: Report of a new case and a review of the literature

Visceral leishmaniasis (VL) is a parasitic disease, caused by protozoa of the genus Leishmania, transmitted by the phlebotomies sand fly. In the last 20 years, the increasing frequency of organ transplantations and the improvement of associated immunosuppressive treatments have led to the recognition of several cases of VL complicating organ transplantation. Actually, less than 100 cases of VL after kidney transplantation are reported in the literature. In this context, VL is fatal without antileishmanial treatment which constitutes a difficult challenge. We report a case of VL in Tunisian renal transplant recipient treated successfully by liposomal amphotericin B (Ambisome®, Gilead Sciences Inc). Also, we review the epidemiological, clinical, biological and therapeutic aspects of VL associated with renal transplantation reported in the literature. Our report identifies that VL should be suspected in renal transplant recipients presenting unexplained fever, splenomegaly and pancytopeny. It also suggests a serological testing for leishmaniasis in the pre-operative check-up of transplant patients and donors living or traveling in endemic areas of leishmaniasis. Moreover, recipients should be tested regularly for leishmaniasis after transplantation. Liposomal amphotericin B may be considered the treatment of choice of VL, since it has a lower incidence of side effects.

Hyalohyphomycosis Caused by Paecilomyces lilacinus After Kidney Transplantation

Hyalohyphomycosis caused by Paecilomyces has rarely been described among solid organ recipients. Its management is elusive without an established consensus concerning antifungal therapy. Herein we have reported a case of extensive cellulitis caused by Paecilomyces lilacinus observed in a 48-year-old kidney transplanted woman with hepatitis C. Kidney transplantation from a cadaveric donor was performed in October 2006 with an uneventful early course except for posttransplant diabetes mellitus and a reversible acute rejection episode. Cutaneous nodular and verrucous lesions of the left leg appeared in August 2007. In a few weeks, these lesions become ulcerated, hemorrhagic, and painful. The diagnosis was made on the basis of microbiologic culture and histological examination. There was no improvement in the skin lesions after 6 weeks treatment with itraconazole, but voriconazole yielded a good response within the first 2 weeks. There was a good tolerance to antifungal therapy; graft function and liver tests remained normal. We concluded that an increasing emerging of fungal infections is observed with the introduction of more powerful immunosuppressive drugs. Diagnosis and management of such infections is elusive. Preventive measures should be considered including the adaptation of immunosuppressive therapy among at-risk patients especially those with hepatitis C virus infection and diabetics.

Pulmonary blastomycosis: a case from Africa.

Pulmonary blastomycosis is an uncommon pathologic condition that is quite rare in Africa compared to endemic regions of Canada and the upper Midwest of the U.S. We describe a 45-year-old patient who complained of productive cough, hemoptysis, and dorsal rachiodynia. Chest imaging revealed a necrotic tissue-density pulmonary mass involving both the upper and lower right lobes. Chest MRI showed signal abnormality of the third thoracic vertebral body and the greater trochanter, consistent with metastatic lesions. Clinical and radiological findings were strongly suggestive of lung cancer. Diagnosis of pulmonary blastomycosis was made by visualization of yeast in bronchial biopsies and further confirmed by culture of bronchoalveolar lavage specimens. The patient was treated with itraconazole and his clinical condition improved markedly. Pulmonary blastomycosis is unusual in Africa and that fact caused a considerable delay in diagnosis. We suggest that this disease may be more common in Africa than has been previously suspected.

Tinea Capitis at Charles Nicolle Hospital of Tunis (Tunisia)

Introduction: Tinea capitis is an infection caused by dermatophytes which have a particular affinity for keratin. Its prevalence decreased significantly in developed countries due to the improvement of sanitary conditions and socioeconomic level. However, they are still common in developing countries including Tunisia. The aim of our study was to evaluate the epidemiological, clinical and mycological profile of tinea capitis diagnosed at Charles Nicolle Hospital of Tunis. Methods: This is a cross-sectional study of 167 mycological samples scalp performed during four years (2009-2012). Results: Tinea capitis was diagnosed in 88 patients (52.69%). Their mean age was 7.62 years. The sex ratio was 2.82. The main dermatophytes isolated were Microsporum canis and Trichophyton violaceum. The annual distribution of the dermatophytes isolated showed a decrease of the frequency of tinea capitis caused by Microsporum canis (36.36% in 2009 vs. 60.71% in 2012). Conclusion: The study of etiological profile of tinea capitis encountered in Tunis showed an increase in the frequency of microsporic tinea that exceeds in recent years trichophytic tinea and emergence of zoophilic species such as Trichophyton verrucosum and Trichophyton mentagrophytes.

Comparison between three concentration techniques for diagnosing intestinal parasites

Background Intestinal parasitoses still are a noticeable threat to public health. The direct diagnosis of such parasites requires the use of concentration techniques, whose sensitivities for protozoan cysts and helminth eggs are far from equal. Aim To compare the Willis, Ritchie and Bailenger concentration techniques in terms of parasite recovery, cost, time, and biosafety. Methods This prospective study analysed 236 stool specimens for intestinal parasites using the direct wet smear and the above-mentioned concentration techniques applied separately. Results Biphasic techniques identified significantly more positive specimens for intestinal parasites than the Willis technique, the latter leading to less concentrated and more altered parasitic elements on microscopy. No statistically significant difference emerged from comparing Ritchie’s and Bailenger’s methods. The Willis technique was the safest, yet the costliest and the most time-consuming of the studied methods. Conclusions Even though the hazardous reagents employed may raise legitimate concerns over their health implications, biphasic techniques prove to be uncostly, quick to perform, and highly sensitive for detecting faecal parasites, therefore ensuring a safe diagnosis for routine stool examinations.