POS1385 AUTOIMMUNE DISEASES ASSOCIATED WITH CHRONIC LIVER DISEASES

Background:

Chronic liver diseases whatever their etiologies could be associated with immunological disturbances.

Objectives:

Our aim was to evaluate the prevalence and the characteristics of autoimmune diseases associated with chronic liver diseases.

Methods:

We performed a retrospective analysis of data from consecutive patients followed in our department for chronic liver diseases recruited from January 2010 to December 2019. Demographic, clinical, and paraclinical data were collected.

Results:

A total of 224 patients were included. The mean age was 61.02 ±13.2 years and the sex-ratio was 1.6. The main etiology of chronic liver diseases was viral infection C (32.1%) followed by viral infection B (22.8%) and non-alcoholic steatohepatitis (21.4%). The prevalence of autoimmune chronic liver diseases was 7.58%: autoimmune hepatitis (AIH) in four cases, primary biliary cholangitis (PBC) in huit cases, primary sclerosing cholangitis (PSC) in three cases and overlap syndrome (AIH-PBC) in two cases. Autoimmune diseases were noted in 31 cases (13.9%): autoimmune hemolytic anemia in 15 cases, autoimmune thyroiditis in 12 cases, one case of psoriasis, one case of CREST syndrome, one case of Sjögren’s syndrome and one case of autoimmune thrombocytopenia. Autoimmune pathologies were more associated with autoimmune chronic liver disease than other causes of chronic liver disease (47% vs 11.1%, p <0.001). Autoimmune pathologies were not statistically associated with female gender (p = 0.085) or young age (p = 0.483).

Conclusion:

In our study, the prevalence of autoimmune diseases during chronic liver diseases was 13.9%. This prevalence was higher in the case of autoimmune chronic liver diseases (47%), which would underline the importance of systematic screening for clinical and biological immune manifestations in those patients.

Disclosure of Interests:

None declared

Comorbidities, mortality and survival in patients with pyoderma gangrenosum: a Danish nationwide registry-nested case-control study

BACKGROUND

Pyoderma gangrenosum (PG) is an ulcerative skin disease associated with comorbidities and increased mortality; however, the literature on this topic is scarce.

OBJECTIVES

To investigate the mortality, prevalence and risk of comorbidities in patients with PG.

METHODS

This nationwide registry nested case-control study included all inpatients and outpatients diagnosed with PG in tertiary dermatology centres in Denmark between 1 January 1994 and 31 December 2016. Each case was matched on date of birth and sex with 10 unique controls. The Danish National Patient Registry was used to identify all patients and to gather information on comorbidity. Information on age, sex, vital status and emigration was obtained from the Danish Civil Registration System. The outcomes were 19 different comorbidities and all-cause mortality. Prevalence was assessed from odds ratios (ORs) for specific comorbidities at the time of PG diagnosis. The risk of developing specific comorbidities and death was assessed using hazard ratios (HRs) obtained using the Cox proportional-hazards model.

RESULTS

A total of 1604 patients with PG were matched with 16 039 controls. Some associations were known, e.g. inflammatory bowel disease [OR 19·15 (15·27-24·02), HR 6·51 (4·24-10·01)], while others have not been described previously, e.g. osteoporosis [OR 1·57 (1·22-2·02), HR 2·59 (2·08-3·22)]. Mortality was significantly increased among patients with PG [HR 2·79 (2·57-3·03)].

CONCLUSIONS

Patients with PG have increased mortality and an increased prevalence and risk of both previously reported and novel comorbidities that may have severe consequences if left undiagnosed. Our findings are mainly related to moderate and severe PG.

Sensibilité aux antibiotiques des souches de Streptococcus agalactiae à Monastir

OBJECTIVE

The aim of this study was to determine the antimicrobial susceptibility of Streptococcus agalactiae strains in Monastir (Tunisia).

METHOD

This retrospective study included 300 strains of S. agalactiae from several pathological samples collected at the Monastir Fattouma Borguiba Hospital. The identification was based on conventional bacteriological features. Serogrouping was performed using agglutination tests. The susceptibility to antibiotics was studied according to the Antibiogram Committee of the French Society of Microbiology recommendations.

RESULTS

S. agalactiae was mainly isolated from patients with vaginal infections (31.3%) and urinary tract infections (24.7%). All strains were susceptible to penicillin G. Resistance was mostly observed to erythromycin (38.5%) and lincomycin (36.6%). 6.5% were highly resistant to kanamycin and 0.6% to gentamicin.

CONCLUSION

Penicillin remains the most effective antibiotic, but resistance to other antibiotics is emerging. This justifies the routine studying of antimicrobial susceptibility in S. agalactiae stains.

[Azathioprine for prevention of postoperative recurrence in Crohn's disease]

BACKGROUND

Crohn's disease is a chronic inflammatory bowel disease that can involve any portion of the gastrointestinal tract. Up to 74% of patients require surgery. However, although resective surgery improves the clinical situation, relapses is frequent in most cases. THE AIM of this clinical trial was to evaluate the profile of patient who received AZA after surgical treatment in order to prevent postoperative recurrence.

METHODS

This was a retrospective study including 17 patients with severe Crohn's disease attending our gastrointestinal unit from September 1998 to June 2004. Patients were eligible if they have severe Crohn's disease, undergoing curative surgical treatment and received azathioprine for the first time after surgery to prevent postoperative recurrence.

RESULTS

The study population comprised 17 patients with Crohn's disease (10 men and 7 women; mean age, 27 years). The Crohn's disease was ileo-colic in 10 cases with perineal manifestations for 2 patients and ileal in 7 cases. The indications for surgery were stenosis in 10 cases, fistula in 5 cases, perforation in 1 case and corticosteroid-resistance in 1 case. The median following-up period was 40 months (9-80 months). During this period, only 1 patient reported severe adverse event and discontinued treatment due to acute pancreatitis. 1 patient was lost to follow-up and 3 patients had moderate clinical relapse. Maintained remission was obtained for 12 patients. None of our patients had surgical relapse.

CONCLUSION

The result of this study shows the effect of Azathioprine in preventing both clinical and surgical relapses in patients with Crohn's disease who have undergone surgery.

[Vaginal colonization of the Streptococcus agalactiae in pregnant woman in Tunisia: risk factors and susceptibility of isolates to antibiotics]

Streptococcus agalactiae or Group B Streptococcus (GBS) is one of the main bacterial causes of serious infections in newborns. We have evaluated prospectively GBS vaginal colonization in pregnant women and we have tried to determine the risk factors of the colonization by GBS and the particularities of the different isolated strains. We have screened 300 pregnant women with vaginal and anal sample in a same swab. Thirty nine (13%) pregnant women are colonized by SGB, 0% in the first trimester, 10.2% in the second trimester and 17% in the third trimester. Different factors are associated significantly with GBS colonization: past history of infection in newborns, genital infection during pregnancy and parity The highest rates of resistance are found in tetracycline (97.4%), erythromycin (51.3%) and lincomycin (46.2%). All the strains were susceptible to amoxicilin and pristinamycin.

[Multiclonality of methicilin-resistant Staphylococcus aureus in a university hospital]

OBJECTIVE

The methicillin resistance of Staphylococcus aureus MRSA is a major problem for human infections. The authors present a genotypic study of these bacteria to understand the spreading of these strains in a university hospital.

PATIENTS AND METHODS

We collected 19 strains of MRSA (September 2003-March 2004) for which the presence of gene mecA had been confirmed by PCR. They were then genotyped in pulsed-field Gel electrophoresis (CHEF variety).

RESULTS

Resistant strains accounted for 12.9% of all collected S. aureus strains. Most samples came from patients hospitalized or consulting in dermatology. Eleven different antibiotypes and four genotypic profiles were determined: type A (with 8 subtypes), type B (with 2 subtypes), type C, and D.

CONCLUSION

MRSA strains have a multiclonal distribution in our hospital with a dominant endemic clone in the dermatological unit. Skin infections are the main hospital source for these strains.

Evaluation of a cefoxitin disk diffusion test for the routine detection of methicillin-resistant Staphylococcus aureus

Two oxacillin disk methods were compared with a cefoxitin disk diffusion test for detection of methicillin-resistant Staphylococcus aureus (MRSA), with PCR for mecA as the reference method. When tested with 115 MRSA and 350 methicillin-susceptible S. aureus isolates, the cefoxitin disk test (specificity 100%, sensitivity 96.5%) was superior to the oxacillin disk methods (specificity 99.1%, sensitivity 90.4%). Testing with both oxacillin and cefoxitin disks would give better sensitivity (100%) than the cefoxitin test alone, but at the expense of specificity (99.1%). The cefoxitin disk test required no special test conditions and would improve the reliability of routine tests for detection of MRSA.

Evolution of acquired resistance to third-generation cephalosporins in Enterobacteriaceae in a Tunisian hospital 1993-2001

Between January 1993 and December 2001, the overall frequency of resistance to third-generation cephalosporins in isolates of Enterobacteriaceae from Charles Nicolle Hospital, Tunis, rose from 2.4% to 7.4%. Klebsiella pneumoniae was the most prevalent species (56%), followed by Escherichia coli (15%) and Proteus mirabilis (9%). A rate of 49% was observed among isolates from paediatric patients in 1999, caused mostly by outbreaks in the neonatal intensive care unit of K. pneumoniae and P. mirabilis isolates that produced extended-spectrum beta-lactamases.

[Profile and sensitivity to antibiotics of 115 staphylococcal strains implicated in septicemia in a Tunisian general hospital]

Staphylococci remain among the main responsible bacteria for septicemia. The resistance to antibiotics already makes a prognosis difficult. We carried out a study on Staphylococcus isolated from blood culture on 3 years in general hospital in Tunisia. We present the different species and their sensitivity to antibiotics. S. aureus is the predominant isolated species. S. epidermidis is essentially isolated in newborn intensive care unit. The meticillino-resistance concerns 14% of the whole strains and 5.2 of the S. aureus. No resistance is found as regard the vancomycin and the pristinamycin; ofloxacine is inactive on 14.8% of strains and the gentamicine on 11.3%. The resistance of staphylococci of our study is lower than the rates reported in southern Europe and in North America.