Surinfection bactérienne chez les patients hospitalisés pour COVID-19

Introduction

La surinfection bactérienne associée au COVID-19 est peu décrite et concerne principalement les patients de soins intensifs. L’objectif de cette étude est de décrire les aspects épidémio-cliniques et thérapeutiques de la surinfection bactérienne chez les patients hospitalisés pour COVID-19.

Matériels et méthodes

Il s’agit d’une étude rétrospective incluant les patients hospitalisés dans un service de maladies infectieuses, pour une infection COVID-19 confirmée et compliquée d’une surinfection bactérienne, durant la période du 2 novembre 2020 au 18 janvier 2021.

Résultats

Parmi 236 patients hospitalisés pour une infection COVID-19, 58 (24,6 %) présentaient une surinfection bactérienne présumée. L’âge médian de la population inclue était de 70,4 [38 ; 88], avec prédominance masculine (31 cas ; 53,4 %). Les comorbidités étaient dominées par le diabète (33 cas ; 56,9 %) et l’hypertension artérielle (30 cas ; 51,7 %). La surinfection bactérienne était communautaire dans 55 cas (94,8 %). Les signes cliniques les plus fréquents étaient la dyspnée (51 cas ; 87,9 %), la fièvre (32 cas ; 55,2 %) et la toux (31 cas ; 53,4 %). Cliniquement, l’infection COVID-19 était sévère dans 25 cas (43,1 %), modérée dans 32 cas (55,2 %) et légère dans 1 cas (1,7 %). Les signes biologiques prédominants étaient l’élévation de la CRP (41 cas ; 70,7 %) et l’hyperleucocytose (26 cas ; 44,8 %). Le scanner thoracique, réalisé chez tous les patients, objectivait un aspect en verre dépoli associé à une condensation parenchymateuse dans 49 cas (84,5 %) et une condensation parenchymateuse isolée dans 9 cas (15,5 %). Le diagnostic de la surinfection bactérienne était présumé sur les données cliniques (expectorations purulentes, fièvre élevée, augmentation des besoins en oxygène [22 cas ; 37,9 %]), biologiques (syndrome inflammatoire biologique), radiologiques et évolutives (amélioration clinique sous antibiothérapie). L’antibiothérapie instaurée était à base de céphalosporine de 3^e génération (C3G) en monothérapie dans 52 cas (89,6 %), C3G associée à la doxycycline dans 3 cas (5,2 %) et C3G associée à la lévofloxacine dans 3 cas (5,2 %). L’évolution était favorable dans 46 cas (79,3 %), alors que 7 patients (12,1 %) étaient transférés en réanimation et 5 patients (8,6 %) étaient décédés.

Conclusion

L’infection COVID-19 peut se compliquer d’une surinfection bactérienne qu’il faut traiter à temps. Le diagnostic de la surinfection doit se reposer sur un faisceau d’arguments et doit être de préférence documenté pour éviter le recours inutile à l’antibiothérapie et l’émergence de résistance.

The ongoing challenge of Pulmonary Tuberculosis in Southern Tunisia: A review of a 22-year period

BACKGROUND

Despite the wide use of anti-tuberculosis drugs, pulmonary tuberculosis (PTB) remains one of the most important causes of mortality and morbidity, particularly in developing countries. Therefore, combining clinical and epidemiological approach would be of a great benefit. Our study aimed to describe the epidemiological and clinical specificities of PTB and its recent chronological trends.

METHODS

We conducted a retrospective study of all PTB new cases of any age diagnosed between 1995 and 2016 in Southern Tunisia. We applied the direct method of age-standardization using the World Standard Population to compute the age standardized incidence rate (ASIR) and the age standardized mortality rate (ASMR) per 100 000 inhabitants.

RESULTS

We recorded 1121 new cases with PTB among 2771 new cases of tuberculosis (40.5%). The ASIR of PTB was 5.3/100 000 inhabitants/year and didn't change over the study period (rho=0.3; P=0.2). Patients with PTB were mainly aged between 15 and 59 years (n=861; 76.8%) and came from urban areas (n=600; 55%). The median duration of treatment was 7.6 months (IQR=[6-8 months]). Successful outcome was notified in 1075 cases (95.9%). Forty-one patients died yielding an ASMR of 0.18/100 000 inhabitants/year. Factors statistically associated with unsuccessful outcome included age≥60 years (OR=5; P<0.001) and shorter treatment duration (6.15 months vs 7.76 months; P<0.001).

CONCLUSION

In contrast to the decline in the global PTB incidence reported worldwide and in the neighboring countries, our study revealed no significant change in the PTB rates from 1995 to 2016. Therefore, tools and strategies used to manage PTB should be strengthened by a substantial effort in both basic science and epidemiology to have better incidence curves.

[Ocular tuberculosis : A case series]

OBJECTIVES

Ocular tuberculosis is a rare form of extra pulmonary tuberculosis. It represents 1-2% of all clinical forms. The aim of this work was to focus on diagnostic and therapeutic characteristics of ocular tuberculosis.

METHODS

We report a case series of 14 patients with ocular tuberculosis seen in an infectious diseases department between 2006 and 2015. The diagnosis was retained on clinical data and a positive tuberculin skin test or interferon-gamma release assay.

RESULTS

The patient's mean age was 40.7±9years. The most common clinical presentation was uveitis (11 patients and 16 eyes). An extra ocular involvement was associated in three patients. The mean duration of antitubercular therapy was 10±2.5 months. Corticosteroid therapy was associated in 11 cases. The outcome was favorable in all cases. Two patients had maintained visual sequelae.

CONCLUSION

Ocular tuberculosis is a rare disease but still remains a diagnostic problem. It should be considered in case of any chronic ocular symptoms, especially in endemic countries. Early management can improve the visual prognosis.

[Symmetrical peripheral gangrene: 4 cases]

BACKGROUND

Symmetric peripheral gangrene (SPG) is a symmetrical distal ischemic lesion on at least 2 or more extremities in the absence of proximal arterial obstruction and vasculitis. It is a rare and severe clinical entity. The aim of this study was to describe clinical symptoms, etiological agents and the management of SPG through a series of 4 cases.

PATIENTS AND METHODS

We included all cases of SPG hospitalized between 2000 and 2014. The inclusion criterion was the presence of distal ischemic damage at two or more sites in the absence of large vessel obstruction.

RESULTS

Four patients (2 men and 2 women) were included. The mean age was 43.2±12 years. Two patients had a history of splenectomy. All patients had blackening of the tips of the fingers and toes. Three patients presented with septic shock. The etiology was bacteremia involving Streptococcus pneumoniae in two cases and a malignant form of Mediterranean spotted fever (MSF). In addition to specific antibiotics, we used a potent vasodilator (iloprost) in two cases and curative heparin therapy in two cases. The outcome was favorable in 3 cases, with regression of necrotic lesions. One case required the amputation of non-perfused necrotic fingers and toes.

CONCLUSION

SPG can complicate MSF in some rare cases. Thorough and repeated skin examinations are essential to ensure timely diagnosis and treatment of GPS in order to improve the prognosis.

[Melitococcal psoas abscesses: study of three cases and review of the literature]

Vertebral involvement is a common complication of brucellosis in adults. However psoas abscess related to brucellar spondylitis have rarely reported. The purpose of this report is to describe three cases of bilateral psoas abscess identified during workup for brucellar spondylitis. Medical imaging was helpful in confirming diagnosis of these fluid collections. Epidemiological, clinical, radiological and serological findings were consistent with melitococcal etiology. Treatment was based on a combination of antibiotics (rifampicine-doxycycline) and abscess evacuation by percutaneous drainage, needle aspiration or open surgery. Outcome was favourable. Brucellar psoas abscess is uncommon. Most caseare discovered coincidentally during investigation of melitococcal spondylitis. Management usually consists of fluid drainage and appropriate antibrucellar therapy. Prognosis is favourable.

[Staphylococcus aureus meningitis with intermediate sensitivity to glycopeptides. Therapeutic indications]

INTRODUCTION

Since 1997, several observations of glycopeptide intermediate Staphylococcus aureus (GISA) infections have been described. We report the case of meningitis.

OBSERVATION

A 46 year-old man was treated surgically on several occasions for a meningioma of the back cranial fossa. Intracranial hypertension required the placing of a cerebrospinal leading-catheter. He developed a GISA meningitis. Antibiotics and removal of the catheter cured the infection.

DISCUSSION

To our knowledge, this is the first observation of GISA meningitis. Such infections are rare and are probably underestimated due to the lack of standardized detection methods. They occur in fragile, surgical, immunodeficient patients, often living with prostheses. Prior treatment with vancomycine is often reported. The emergence of these infections is a serious therapeutic problem, since vancomycine is a major antibiotic used in the treatment of meticillin-resistant S. aureus (MRSA) infections.