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Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis Cvirus (HCV) are major public health concerns. We aimed to determine the prevalence of HBV and HCV infections among HIV-infected patients, and to identify the main circulating hepatitis strains in Morocco. The study was carried out in 503 HIV-infected patients. Our survey indicated that the prevalence of HIV/hepatitis co-infection was 10.6%; 5.2% of patients were HBV surface antigen positive, and 5.4% of patients were anti-HCV positive. Among the HBV surface antigen-positive group, HBV DNA sequencing identified exclusively genotype D (D1: 26.7%; D7: 73.3%) in accordance with what is found in the general population. In contrast, sequencing of HCV isolates produced an unusual subtype distribution with a decreasing order of prevalence: 1a, 3a (both 23.5%), 1b, 4a (both 17.6%), 1c (11.8%) and 6h (6%).

Background In Morocco, diagnosis of HIV infection remains late, which seriously compromises the timely management of HIV infection in the era of HAART therapies. Rapid test represents a good opportunity to improve the access to early screening of HIV. The objective of this study is to report the experience of the infectious diseases unit of the Ibn Rochd University hospital center of Casablanca, in the use of the rapid test in clinical screening of HIV. Patients and methods This retrospective study reports data relevant to the use of the rapid test Determine VIH-1/2, Abbott Diagnostics, since its introduction in the infectious diseases unit in April 2006 up to December 2009. The test was performed for patients from the infectious diseases unit and patients hospitalized in different units of the Ibn Rochd University hospital center, after their consent. Test was ordered systematically by clinicians in case of any suspected symptom related to HIV and immunodepression. Positive samples were confirmed by Western Blot test, at the National Reference Laboratory for HIV, within the Institut National d’Hygiene in Rabat. Results Between 2006 and 2009, 1105 rapid tests were performed, among which 16.3% were positive. All results were provided to patients and none were lost to follow-up. The main reasons for the prescription of an HIV test were tuberculosis (26.3%) and chronic diarrhea (9.9%) for inpatients. For outpatients, the main symptoms were sexually transmissible infections (16.7%) and weight loss (15.7%). Results of the tests allowed us to adapt the treatment in case of suspicion of pneumocystosis (12 cases) and toxoplasmosis (seven cases). Conclusion The introduction of the rapid test for HIV clinical screening in the hospital facilities improved considerably the access to diagnosis and consequently allowed a timely management of HIV infection.

Summary Objective To describe the causes of death occurring during the antiretroviral therapy in Casablanca. Methods Retrospective study of a cohort of HIV positive patients attending the infectious diseases unit of Casablanca receiving antiretroviral therapy. Files of 91patients who died were analyzed. Results Since June 1999, 1243 patients were treated and 91 deaths occurred (7, 3%). The mean age at time of death was 36 years. Forty-six patients were male (50, 5%) and 86 were stage C (94, 5%). At the initiation of treatment, mean CD4 count was 96 cells/mL (1–626) and mean plasma HIV- RNA was 5, 65 log10. They have received antiretroviral therapy for a mean of 9 months (1–48 months). At time of death, 37 patients (52, 8%) had a CD4 count greater than 200 cells/mL and 16 patients (23%) had undetectable plasma viral load. In 57 cases (63%), the death occurred within the first year after start of antiretroviral therapy. The main causes of death were: tuberculosis (35%), cryptosporidiosis (19%), cryptococcosis (13%), cerebral toxoplasmosis (9%), Kaposi sarcoma (6%), non Hodgkin's lymphoma (2%), atypical mycobacteriosis (2%), cerebral lymphoma (1%), aspergillosis (1%), HIV wasting syndrome (1%) and cancer of cervix (1%). Non AIDS related deaths were noticed in three cases (3%) and the immune reconstitution inflammatory syndrome in six cases (7%). Conclusion In Casablanca, the main cause of death among HIV-infected patients is tuberculosis. Collaboration between the national tuberculosis and AIDS programs has been established to improve the prevention, detection, diagnosis and management of HIV/tuberculosis co infection.

Resume L’infection a VIH touche les personnes dans leur intimite. Notamment transmis par voie sexuelle, le virus envahit brusquement la conscience et l’inconscience des personnes seropositives. Il marque de son empreinte toute leur vie. Depuis l’avenement des therapies antiretrovirales et l’allongement de l’esperance de vie, la qualite de vie sexuelle et affective est une preoccupation pour les personnes vivant avec le VIH (PVVIH) et pour les soignants. Le but de notre travail est d’identifier les troubles rencontres chez les PVVIH et de determiner les facteurs influencant leur sexualite. Un echantillon de 134 patients seropositifs vivant avec le VIH, suivis au service des maladies infectieuses du centre hospitalo-universitaire Ibn Rochd de Casablanca a ete recrute. Un questionnaire preetabli par les auteurs a permis d’identifier les caracteristiques sociodemographiques, ainsi que des renseignements concernant l’infection a VIH, la sexualite et la prevention de la transmission du VIH. Le diagnostic des troubles sexuels a ete fait selon les criteres du DSM-IV. Soixante quatre pour cent des hommes inclus affirment ne pas avoir une activite sexuelle satisfaisante et 80 % rapportent des troubles sexuels, notamment un dysfonctionnement erectile ; 70 % des patientes affirment ne pas avoir une activite sexuelle satisfaisante, 69 % rapportent des troubles sexuels, notamment une baisse de la libido, une anorgasmie et une dyspareunie ; 63 % des personnes interviewees utilisent systematiquement le preservatif lors des rapports sexuels.

Summary HIV infection is a very intimate issue since it is transmitted through sexual intercourse; the virus suddenly invades the conscious and the subconscious mind of the HIV-positive person, becoming a critical element of their life. Since the use of antiretroviral therapy and increased life expectancy, the sexual and emotional aspects of quality of life have become a concern for people living with HIV (PLWHA), as well as for the health care staff. The purpose of our study is to identify sexual disorders affecting PLWHA and to determine factors influencing their sexuality. We studied a sample of 134 PLWHA attending the infectious diseases department of the Ibn Rochd Casablanca university hospital. A pre-drafted questionnaire provided information concerning sociodemographic characteristics, as well as information relating to the course of HIV infection, sexuality and the prevention of the transmission of HIV. The diagnosis of sexual disorders was made according to DSM-IV criteria. Sixty four percent of the men surveyed claim they have insufficient sexual activity and 80% report sexual disorders, in particular erectile dysfunction. Seventy percent of the women claim they have insufficient sexual activity, and 69% report sexual disorders, particularly decreased libido, anorgasmia and dyspareunia. In addition, only 63% of the persons surveyed report the systematic use of condoms during sexual intercourse.

Resume Introduction Nous avons analyse retrospectivement les cas de paludisme grave hospitalises au service de reanimation medicale du CHU Ibn-Rochd (Casablanca). Materiel et methodes Tous les patients âges de plus de 14 ans admis en reanimation medicale avec un frottis sanguin positif a Plasmodium falciparum sur une periode de six ans (1996–2001) etaient inclus. Les parametres etudies etaient : les principales donnees epidemiologiques, les motifs d'admission, la prise en charge et l'evolution. Resultats Dix patients etaient admis pour paludisme grave. L'âge moyen etait de 32 ± 4 ans. Ils avaient tous sejourne en Afrique subsaharienne (Cote-d'Ivoire) et etaient non immuns. La chimioprophylaxie etait inadequate chez tous les patients. Le delai moyen entre le debut des symptomes et le traitement etait de 9 ± 2 jours. La parasitemie etait elevee chez sept de nos patients. Les motifs d'admission en reanimation etaient des troubles de conscience (sept), une insuffisance renale aigue (quatre) et une detresse respiratoire (trois). Les signes de gravite etaient la profondeur des troubles de conscience, le syndrome de detresse respiratoire, l'acidose metabolique et la survenue d'un etat de choc. Tous les patients ont eu des pneumopathies nosocomiales a bacille Gram negatif (BGN) au cours de l'evolution. Tous les patients ont recu de la quinine intraveineuse avec une dose de charge associee au traitement symptomatique. Cinq patients sont decedes. Conclusion La letalite des formes graves du paludisme reste elevee malgre les meilleures conditions techniques de traitement. L'amelioration de la chimioprophylaxie et la precocite du diagnostic pourraient la baisser significativement.

Resume Objectifs. – L'observance dans le traitement de l'infection par le VIH est un enjeu majeur pour la poursuite de l'acces aux antiretroviraux dans le monde entier et en Afrique en particulier. Au cours du mois de septembre 2003, nous avons mene une etude sur l'observance chez les patients infectes par le VIH sous traitement antiretroviral suivis au service des maladies infectieuses de Casablanca et beneficiant d'un programme d'education therapeutique. L'objectif principal etait de mettre en evidence les obstacles a une bonne observance et de recenser les solutions possibles. Patients et methodes. – Une enquete transversale a ete realisee a partir d'un questionnaire semi-directif, aupres de patients traites par tritherapie et recrutes consecutivement. L'avis du medecin et de l'educateur sur l'observance des patients a ete recueilli. Resultats. – Les patients etaient âges de 21 a 65 ans. Au total 92 patients ont ete interroges et 89 questionnaires analyses. La duree de traitement s'etendait de 2 a 67 mois. L'observance selon les educateurs etait bonne (> 90 %) chez 78 patients. Les principaux obstacles a une bonne observance recenses etaient lies a la difficulte de respecter les horaires de prise et a l'eloignement des structures de soins ou a la presence d'effets secondaires et de pathologies associees. Conclusions. – Le role du programme d'education therapeutique a ete largement mis en evidence dans l'amelioration de l'observance.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis has a high mortality rate. We herein report one case of bilateral emphysematous pyelonephritis managed by medical therapy alone.

In Morocco, diagnosis of HIV infection remains late, which seriously compromises the timely management of HIV infection in the era of HAART therapies. Rapid test represents a good opportunity to improve the access to early screening of HIV. The objective of this study is to report the experience of the infectious diseases unit of the Ibn Rochd University hospital center of Casablanca, in the use of the rapid test in clinical screening of HIV.This retrospective study reports data relevant to the use of the rapid test Determine VIH-1/2, Abbott Diagnostics, since its introduction in the infectious diseases unit in April 2006 up to December 2009. The test was performed for patients from the infectious diseases unit and patients hospitalized in different units of the Ibn Rochd University hospital center, after their consent. Test was ordered systematically by clinicians in case of any suspected symptom related to HIV and immunodepression. Positive samples were confirmed by Western Blot test, at the National Reference Laboratory for HIV, within the Institut National d'Hygiène in Rabat.Between 2006 and 2009, 1105 rapid tests were performed, among which 16.3% were positive. All results were provided to patients and none were lost to follow-up. The main reasons for the prescription of an HIV test were tuberculosis (26.3%) and chronic diarrhea (9.9%) for inpatients. For outpatients, the main symptoms were sexually transmissible infections (16.7%) and weight loss (15.7%). Results of the tests allowed us to adapt the treatment in case of suspicion of pneumocystosis (12 cases) and toxoplasmosis (seven cases).The introduction of the rapid test for HIV clinical screening in the hospital facilities improved considerably the access to diagnosis and consequently allowed a timely management of HIV infection.

Resume Objectifs Nous avons voulu repertorier les manifestations oculaires dues au Cryptococcus neoformans, mycose opportuniste la plus frequente au cours du sida, a Casablanca, Maroc. Methode Quatorze malades (11 hommes et trois femmes) atteints de cryptococcose neuromeningee au cours de l'infection par le VIH ont ete colliges au service des maladies infectieuses du CHU Ibn-Rochd. Tous les malades ont ete examines par un ophtalmologiste. L'âge moyen etait de 32 ans. Resultats Les signes oculaires retrouves etaient un oedeme papillaire bilateral dans huit cas (57 %), des chorioretinites dans deux cas, une hyalite dans un cas et une paralysie du nerf moteur oculaire externe dans un cas. C. neoformans a ete retrouve dans le liquide cephalorachidien de tous les malades (examen a l'encre de Chine). Apres un traitement systemique par des antifongiques, la guerison a ete obtenue dans un cas. Une recidive a ete constatee chez cinq malades, apres l'arret du traitement ; 13 patients sont decedes.

We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital.All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated.Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died.The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis has a high mortality rate. We herein report one case of bilateral emphysematous pyelonephritis managed by medical therapy alone.

Compliance in HIV infection treatment is a major stake to give worldwide access to antiretroviral (ARV) treatment and especially in Africa. In September 2003, we undertook a study on compliance among HIV positive patients under antiretroviral treatment. These patients were included in a therapeutic educational program in the infectious diseases department of the Casablanca University Hospital (Morocco). The main objective of the study was to assess obstacles to compliance and to find possible solutions.A transversal investigation was made, based on questionnaires for patients under ARV treatment, chosen consecutively. The physician's and the educator's opinion on patient compliance was collected.Patients were between 21 and 65 years of age. Ninety-two patients were questioned and 89 analyzed. Treatment duration lasted from 2 to 67 months. Compliance according to educators was good (90%) for 78 patients. The main obstacles for a good compliance were difficulty to respect administration schedule and the long distance between home and hospital, or the presence of adverse effects and other diseases.The role of the therapeutic educational program in improving compliance was largely highlighted.

Kaposi's sarcoma is the most common neoplasm to be found among AIDS patients. The purpose of this retrospective study is to determine the epidemiological, clinical, therapeutic features and the evolution of Kaposi's sarcoma in Moroccan patients suffering from AIDS. Between January 1987 and December 1999, 696 patients with AIDS were hospitalized in the department of infectious diseases of Casablanca. Fifty of them (7%) had Kaposi's sarcoma. AIDS was confirmed by ELISA and Western-Blot. The diagnosis of Kaposi's sarcoma was established by clinical aspect and I or by histologically study. It concerned 46 men and 4 women. The average age was 32.5 years. The homosexuality was noted in 38% of patients and the heterosexuality in 56% of cases. AIDS was revealed by Kaposi's sarcoma in 82% of cases. The Lesions were found in the skin (96%), in the skin and mucous membranes (56%), in the lung (14%), in the gastrointestinal tract (12%) and in the lymphatic nodes (8%). The average CD4 cells count was 212.8/mm3. The chemotherapy was instituted in 43 patients and the radiotherapy in 5 patients (alone or associated with chemotherapy). Four patients received HAART. Six patients didn't received any treatment. The evolution has been characterized by the death in 61% of patients. This death was due to Kaposi's sarcoma in six patients and to opportunistic infections in the others cases. Our study demonstrates the high incidence of Kaposi's sarcoma as an inaugurating event of AIDS, the severity of the visceral involvement, the limit of our therapeutic materials and the wrong prognosis of this disease.

In Moroccan patients, predisposition to Behçet's disease is associated with HLA-B*51, mostly in males with young age at disease onset. In addition, the disease is associated with B*15 both in females and in males with late disease onset. We analyzed the clinical presentation, the severity and the course of the disease in 86 Moroccan patients according to their HLA-B phenotype. The presence of the B*51 or B*15 did not predispose to a particular clinical manifestation, nor to a more severe presentation of the disease. By contrast, outcome of the disease significantly differed depending on HLA-B phenotype, with an increase of symptoms in most B*51+ patients and in half of B*15 patients, and a remission or a decrease of symptoms in all B*51-B*15- patients. This variable course was mostly observed for ocular lesions, skin lesions, articular symptoms, and neurological symptoms. These data may suggest that treatment should be given early in the course of the disease in B*51 or B*15-positive patients in order to stabilize the inflammatory process.

Botulism is a rare but severe disease. Whereas until 1980, only one case of botulism had been reported in our department, in 1999, a real botulism epidemic took place in Morocco. To our knowledge, it's the first outbreak of that kind in Morocco. We report here an epidemiologic and descriptive study of 11 patients suffering from botulism, admitted at the Infectious Diseases department and in the Medical Intensive Care Unit of Ibn Rochd University Hospital, from August, the 10th to October, the 1st, 1999. Clinical diagnosis of botulism was made, at the admission, on ocular signs (diplopia, ptosis), swallowing troubles and/or muscle weakness. There was no fever, no trouble of conscience and normal reflexes, at the early stage of the disease. The average age of patients was of 23.9 years +/- 12.07. Three patients were first admitted in the Medical Intensive Care Unit. The period before symptom appearance varied between 7 and 96 hours. Dysphagia sore throat, dry mouth and dysphonia were always found in all patients, with normal conscience. The fever was noted in 3 cases, polypnea in 3 cases leading to respiratory assistance in 2 cases. Neurologic findings were dominated by ptosis and hypotonia. The search of botulism toxin B in blood was positive in 6 cases. The electromyography showed clear signs of botulism. The evolution was favourable in 10 cases. Respiratory complications were found in 2 cases and infectious complications in 4 cases. One patient died. The period of hospitalization varied between 10 to 24 days with an average stay of 15.8 days. Eating "mortadella" has been noticed in 7 patients) and investigations permitted to identify the factory of "mortadella" as well as the toxin's type B responsible for these poisoning. It appears clearly that it is important to reinforce hygiene controls. Physicians and specialists in public health must be aware of the severity of this illness, knowing that the recovery is shortened when the treatment is administered on an early stage of the disease.

We have studied the distribution of HLA-A and -B alleles and haplotypes by sequence-specific primer amplification in a sample of 100 unrelated healthy individuals belonging to both Berber and Arabic-speaking groups from the region of Casablanca in Morocco. Among the 17 HLA-A and 23 HLA-B alleles observed, the most frequent were HLA-A2 (21%), -A1 (11%), -A3 (10%), -B44 (11.4%), -B50 (9.9%), -B5(8.5%) and -B35 (6.5%). Six two-locus haplotypes were observed with a frequency above 5%: A2-B50 (9.6%), A23-B44 (7.4%), A2-B15 (6.4%), A68-B39 (5.3%), A1-B51 (5.3%) and A68-B44 (4.3%). Our data confirm that, on the basis of genetic distances, the majority of present-day North Africans from Morocco are closely related to Berbers and also to Iberians. They cluster apart from Middle-Eastern Mediterranean populations, and show greater genetic distances to Eastern and other Mediterranean populations. This study will serve as a reference for further anthropological studies, as well as studies of HLA and disease associations.

The pregnancy at women infected by the HIV characterizes by the risk of transmission of the HIV to the child. The goal of this retrospective study concerning 9 deliveries of women infected by the HIV cured in the Infectious Diseases Service and the Lalla Meryem's Maternity of Casablanca CHU Ibn-rochd during 10 years (1990-1999) is to specify the experience of two services of concerning plug in cost of the patients infected by HIV by trying to pull some a protocol of plug in cost. The antiretroviral therapy has been used in 8 cases out 9. The AZT long protocol has been used in 6 cases and the bitherapy in 2 cases. The delivery has taken place by the natural way under cover of AZT in all cases. All babies have received the AZT in syrup and none has been breastfed to the breast. Two newborns on 9 out 9 have been contaminated by the HIV.

Short-term treatment with ceftriaxone 2 g once daily for two days (group 1) was compared to treatment with a standard regimen of penicillin G (group 2) for six days in adults with meningococcal meningitis. Thirty-six patients were allocated in a randomized fashion to a treatment group: 16 to group 1 and 20 to group 2. The clinical and microbiological results were comparable in the two treatment groups. In both groups cultures of cerebrospinal fluid were sterile after 24 hours. One patient in each group died. In group 1 one case of fulminant meningococcemia and one case of brain abscess required further antibiotic treatment. It is concluded that short-term treatment with ceftriaxone is feasible but patients with severe forms of meningitis would not be eligible for treatment with this regimen, and careful follow-up of the patients receiving ceftriaxone is necessary.

The objective of this study was to report ocular manifestations in Moroccan patients infected with HIV/AIDS. 400 patients were surveyed retrospectively from 1993 to 1998 as part of a co-operative study undertaken by the departments of infectious diseases and ophtalmology of the Casablanca Teaching Hospital. Of the 400 patients, 127 had an infection of the posterior segment and 7 showed signs of a palpebral infection. We also found 44 cases of opportunist retinal infections, dominated by the Cytomegalovirus (CMV) (18 cases). Our sample study indicates an intermediary position between western countries where the widespread use of the tritherapy has increased the life expectancy of patients and sub-Saharan Africa where epidemiological data are still characterised by high mortality and increasing endemic disease.

Non-A, Non-B hepatitis and their sequelae seem to be as frequent as HBV infections in Morocco. These diseases represent an important problem of public health because their high incidence and high fatal rate. Some aspects of the epidemiology of Non-A, Non B acute hepatitis were evoking a high incidence of enterically transmitted hepatitis E. That was confirmed by serum studies having shown that hepatitis E antibodies were detected in more than 60% of patients with acute Non-A, Non-B hepatitis. However this type of hepatitis has been recognized only as sporadic (non-epidemic), mainly transmitted by personal contacts in low hygiene conditions. Other Non-A, Non-B acute hepatitis (around 35%) were certainly due to hepatitis C virus infection, because the presence of hepatitis C antibodies in the serum of the patients. However, in our study, hepatitis C seemed to be rarely transmitted by transfusion or other blood related route. Chronic liver diseases related to Non-A, Non-B virus infection appeared to be as frequent as the ones due to hepatitis B virus. Serological studies had shown that about seventy-four per cent of the studied cases were related to an infection by hepatitis C virus (presence of hepatitis C antibodies). Among other Non-A, Non-B chronic liver diseases the possible existence of some cases due to hepatitis E virus infection cannot be ruled out but this hypothesis needs further investigations to be verified. The prevalence of the markers of past hepatitis B infection in convalescent patients from Non-A, Non-B hepatitis is comparable to the prevalence of hepatitis B infection markers in blood donors. However, chronic HBV infection could be a factor facilitating the clinical expression of the Non-A, Non-B hepatitis.

Resume Vingt malades adultes atteints de meningite purulente ont recu un traitement a base d'amoxicilline a raison de 1,5 g par voie intraveineuse en 2 injections espacees de 4 heures, puis par voie orale a la dose de 150 mg/kg/jour des la 8eme heure. L'apyrexie a ete obtenue en 5,4 jours en moyenne. La duree du traitement est de 7,4 jours en moyenne. L'evolution est favorable dans tous les cas et tous les malades guerissent sans sequelles ; aucune rechute n'a ete notee. Les taux d'amoxicilline rachidiens (pics et taux residuels) sont superieurs aux CMI des germes habituellement responsables des meningites purulentes de l'adulte. Ce relais oral precoce peut avoir un interet en cas d'abord veineux difficile ou en cas de foyers epidemiques.

The incidence of delta infections in Morocco has been investigated to explain the high rate of severe hepatitis B (HB) observed in this country. The presence of delta antigen (D Ag) and antibodies to delta agent (D Ab) was tested by radio-immuno-assay in the sera from 85 HBs Ag positive patients, hospitalized in Casablanca: among them 57 suffered from acute or fulminant HB (12 deceased), 10 from chronic hepatitis and 18 from cirrhosis. Neither D Ag nor D Ab were found, excepted once in a patient with cirrhosis having shown the presence of D Ab. In contrast with the high endemicity of delta agent reported in other countries of North Africa, the incidence of delta infections seems to be very low in Morocco.

Measurement of cerebrospinal fluid lactic acid by an enzymatic test has been evaluated in 164 patients. The upper limit of normal CSF lactate was 300 mg/l. The CSF lactate level is useful for differential diagnosis between partially treated pyogenic meningitis and tuberculous meningitis. The increase of CSF lactate is not specific for meningitis and must be interpreted taking into account the clinical situation.

Pefloxacin, which has been shown to have a high in vitro activity against Salmonella spp., was compared to cotrimoxazole in the treatment of typhoid fever in adults. In a prospective, randomized trial, 42 patients with bacteriologically documented typhoid fever received either 400 mg pefloxacin b.i.d. or 160/800 mg cotrimoxazole b.i.d. Duration of treatment was 14 days in both groups. All patients were cured without experiencing a relapse or becoming a salmonella carrier. Apyrexia and resolution of digestive and neurological symptoms were obtained in a significantly shorter time with pefloxacin than with cotrimoxazole. Pefloxacin was well tolerated and more effective than cotrimoxazole in the treatment of typhoid fever.

A prospective study was carried out in 43 hospitalized patients with respiratory or other serious bacterial infections requiring intravenous antibiotic therapy to assess the efficacy and tolerance of amoxycillin/clavulanic acid ('Augmentin'). After bacteriological and laboratory investigations patients were started on 1 g amoxycillin plus 200 mg clavulanic acid intravenously every 8 hours for the first 3 days and then were treated orally at the same dosage. Duration of treatment varied according to the type and severity of the infection, with a minimum of 10 days. Efficacy of treatment was evaluated by the clinical response, judged by the resolution of signs and symptoms of infection. The results showed that there was a clinical cure rate of 88.4%. Local tolerance was excellent and there were few side-effects reported. Six patients experienced vomiting which led to the withdrawal of treatment in 1 patient.

The authors report three cases. Hemostasis abnormalities and lowering of complement fractions was observed. Severe shock was lethal in two cases associated with severe local lesions. The role of unadapted treatment like corticosteroids and the lack of early penicillino therapy is discussed to explain this evolution.

In a retrospective study of 51 cases of acute pneumococcal pneumonia in Morocco, predominantly male subjects were affected without past medical history or pathology. The pneumonia was accompanied by an effusion in 18% and a bacteraemia in 11%. The most serious pneumonias were those complicated by meningitis (12% of cases) or septic shock (1 case). The presence of factors implying a poor prognosis (meningitis, septic shock, bacteraemia, advanced age) increases the mortality. Penicillin G is the antibiotic of choice. In low doses it is sufficient to achieve a cure in uncomplicated cases. In the severe forms, high doses do not always prevent a fatal outcome. The availability of a vaccine adapted for the African serotypes would enable people with special risk factors to be treated.

The authors report 21 cases of congenital mitral incompetence undergoing surgery between 1972 and 1977. There were 3 operative deaths and 2 late deaths. Of the survivors, 10 had a good result and 5 a fair result. The factors influencing the results have been associated lesions (aortic stenosis and ventricular septal defects are more serious than atrial septal defects and abnormalities of origin of the left coronary artery), the type of repair (which is better if it seeks to correct the frequently complex valvular abnormality at all levels), and especially the degree of dilatation of the left ventricle. By contrast, age had no influence either on the operative risk or on the quality of the results.

BackgroundThe aim of this study was to assess the cost-effectiveness of HIV treatment alternatives – with and without highly active antiretroviral therapy (HAART) – within alternative strata based on the CD4+T-cell count at the initiation of treatment in a low-resource setting.MethodsA retrospective observational study was conducted following 286 HIV-positive individuals admitted to the principal teaching hospital in Casablanca, Morocco, between 1995 and 2002. Patients were stratified by CD4+T-cell count and regression models were fitted to determine risk of opportunistic infection. Data on healthcare resource use were derived from patient records and were evaluated from the hospital perspective.ResultsHAART led to a significant reduction in the number of HIV-related opportunistic infections ( P+T-cell count 3, but this increased to nearly three times GDP per capita when HAART was initiated at CD4+T-cell counts above this threshold.ConclusionsHAART is more cost-effective than treating HIV-related opportunistic infections and, contrary to conclusions drawn in developed countries, HAART is more cost-effective when the CD4+T-cell count drops to 3.