[Hydatid disease of bone: a report of 2 cases]

INTRODUCTION

The hydatid cyst of Echinococcus granulosus tends to develop in liver. The primary bone hydatidosis is rare. EXEGISIS: The authors report 2 cases of primary hydatidosis of bone in a 57 year old men and 60 year old diabetic women. The symptoms and signs were not specific. The ultrasound investigation: standard radiography and computed tomographic scan, was suggestive of the lesion. The chest radiograph and the abdominal ultrasound were normal. Serological tests for hydatid disease were positive. The two patients have surgical excision and medical treatment: Albendazole administrated for 6 months. Histologic evidence confirmed the diagnosis. The outcome was good for both patients without recurrence after 2 years.

CONCLUSION

Through these 2 cases and a review of the literature, the authors analyse the epidemiological and clinical aspects of bone hydatidosis and discuss the therapeutic procedures.

Une fièvre boutonneuse méditerranéenne compliquée d'une embolie pulmonaire

INTRODUCTION

Thromboembolic complications were uncommon in mediterranean spotted fever.

OBSERVATION

We report a case of 55-years- old man who was admitted for mediterranean spotted fever. Two days later, the patient developed chest pain due to a pulmonary thrombosis confirmed by angio-CT. The outcome was good with heparin therapy. The investigation for another cause of thrombosis was negative.

CONCLUSION

Mediterranean spotted fever is usually a moderately severe self-limited illness. Pulmonary thrombosis was uncommon associated with severe disease.

Multicenter pilot survey of resistant bacteria in the Mediterranean area

With the aim of testing the feasibility of a multiresistant bacteria (MRB) surveillance methodology and evaluating the level of antimicrobial resistance and dissemination of resistant pathogens in the Mediterranean area, a pilot study was carried out in nine university hospitals in Algeria, Tunisia and France. The results indicate that third-generation cephalosporin-resistant Enterobacteriaceae comprise the major MRB in Algerian and Tunisian hospitals. In France, the highest incidence rates were found for methicillin-resistant Staphylococcus aureus, while in Tunisian hospitals, imipenem-resistant Acinetobacter baumannii seems to be a particularly prevalent organism. Although the data were not representative of the participating countries as a whole, the results show the importance and ubiquity of the problem in the area and the feasibility of surveillance.

Clinical and laboratory features of murine typhus in central Tunisia: a report of seven cases

INTRODUCTION

Murine or endemic typhus, caused by Rickettsia typhi, has been reported in all continents. In the 1970s, no cases of murine typhus were diagnosed in Tunisia.

METHODS

The clinico-epidemiological characteristics of seven cases of murine typhus diagnosed at our hospitals since 1993 are reported. Diagnosis was confirmed by indirect fluorescence assay detecting specific R. typhi antibodies.

RESULTS

Murine typhus occurred in all ages from 18-80 years during the hot season in rural areas. Clinical features were: sudden onset of fever and absence of eschar in all cases, with maculo-papular rash (five cases), prostration (four cases), meningism (three cases) and pneumonia (four cases). Frequent laboratory findings were moderate thrombopenia (four cases) and elevated transaminases (four cases). Before the results of serology, clinical diagnoses were Mediterranean Spotted Fever (four cases), Q fever (one case), pneumonia (one case), and lymphocytic meningitis (one case). Serology confirmed all diagnoses with cross-reactivity with Rickettsia conorii.

CONCLUSION

Murine typhus exists in Tunisia and its prevalence is underestimated. Further, more specific studies are needed to evaluate the true prevalence.

[Pyogenic splenic abscesses. A review of 8 cases]

PURPOSE

Pyogenic splenic abscess is un uncommon and potentially life-threatening disease. Due to inconspicuous and nonspecific clinical picture, it remains a diagnostic challenge. Medical imaging progresses are helpful for diagnosis and treatment.

METHODS

We tried to establish epidemiologic and clinical features and therapeutic possibilities of 8 cases of splenic abscesses occurred between 1993 and 2002.

RESULTS

There were 5 male patients and 3 female patients. Aged ranged from 17 to 53 years, with a median of 34 years. One patient was immunocompromised (colonic carcinoma). Common clinical presentations included fever (n=8) and left upper quadrant abdominal pain (n=7). Positive blood cultures were found in only four patients (50%) : Staphylococcus aureus (3) and coagulase negative Staphylococcus (1). Staphylococcus aureus and Bacteroïdes fragilis were isolated in one abscess pus respectively. The diagnosis was obtained by ultrasonography in all 8 cases. Antibiotics were prescribed in all cases for a mean length of 60 days (30 - 110 days). Splenectomy and percutaneous CT-guided drainage were performed in one case respectively. Evolution was good in all cases.

CONCLUSION

Splenic abscesses are increasingly recognized. The combination of clinical features and imaging findings, early diagnosis and treatment can be made.

[Sweet's syndrome]

Sweet's syndrome or acute febrile neutrophilic dermatosis is relatively frequent. It can be isolated or associated to other diseases, particularly, inflammatory or autoimmune diseases, lymphoproliferative or malignant disorders. In this retrospective study, we report 10 cases of Sweet's syndrome recorded over a 42 months period. The female predominance was net (9 womens for 1 man). The mean age was 45 years. The diagnosis was established, in all cases, on clinical, biological and histological criteria. The lesions occurred most commonly on legs (9 cases). The failure of antibiotics has been noted in all patients, and colchicine has been demonstrated efficient in 6 patients. Our study confirms the interest of cutaneous biopsy in case of papulo-nodular lesions which has not respond to antibiotics.

[Lyme disease in Tunisia, results of a clinical and serological study (1992-1996)]

Lyme disease was suspected in 271 patients seeking hospital care between 1992 and 1996. The sera of all these patients were tested by ELISA for antibodies against Borrelia burgdorferi. Twenty-nine cases of Lyme disease were identified, each involving neurological and articular problems. These results demonstrate that Lyme disease occurs in Tunisia and suggest that this diagnosis should be considered more frequently in patients presenting with the characteristic symptoms.