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Background: Identifying the infecting bacterial flora is one of the main rules to be followed to ensure the success of antibiotherapy in the treatment of the infected diabetic foot. The aim of the work was to define the bacteriological profile of the bacteria causing the infection of the diabetic foot at the surgery unit B of Charles Nicolle's hospital in Tunis and determine the prognostic factors of this condition., Methods: It was an open prospective study. It concerned 100 diabetic patients operated on for diabetic foot infection. All patients had bacteriological samples taken through deep scraping and swabing carried out in the operating room., Results: The average age of patients was 59,5 ±11 years, with a sex-ratio of 2,4. The foot infection was represented in 82 % of cases by a wet gangrene. The enterobacteria were the most frequently isolated bacteria (73%), followed by streptococcus (10%), Staphylococcus aureus (9%). The rate of multidrug-resistant bacteria was of 9,5%. The empiric antibiotic therapy used (fusidic acid +amoxicillin/ clavulanic acid) was inactiveon 44,1% of the isolated bacteria. When we compared the group of patients with unfavourable development (who have been reoperated) and the group of patients with favourable development, we have found two poor prognosis factors : arteritis  (p=0,018 ; OR=23,7) and presence of multidrug-resistant bacteria (p=0,027 ; OR=5,8)., Conclusion: The enterobacteria were the main bacteria causing the infection of diabetic foot. The prognostic factors found, arteritis and isolation of multidrug-resistant bacteria, outpoint the importance of multidisciplinary care.

Background: A Cytomegalovirus infection (HCMV) causes severe complications in immunosuppressed individuals (transplant recipients and AIDS patients)., Aim: To detect the DNA of the HCMV by three molecular methods, and to identify the fastest method and most significant., Methods: we tested 50 samples in order to detect the presence of the HCMV. This research was carried out by molecular Hybridization, the pp65 Antigenemia and PCR on the blood of the patients presenting an infection to CMV., Results: Molecular hybridization is positive for 64%, Antigenemia is detected in 26 cases (50%) and the plasmatic PCR is positive in 13 cases (26%). These studies demonstrated that molecular hybridization permitted CMV detection of different biological liquid but Antigenemia and PCR techniques were used to determine of from leukocytes. Plasma-PCR and Hybridization assay presented the qualitatifs results., Conclusion: These studies indicate that there is a combining virological between molecular methods.

Objective: Our aim is to determine different therapeutic response profiles in Tunisian HIV-1 infected patients, to identify those with therapeutic failure and to compare the results of the genotypic resistance test used in Tunisia (INNO LiPA Test) with those of automatic sequencing to evaluate its efficacy., Methods: The retrospective survey concerns 392 infected patients enrolled from January 2001 to December 2006. Evaluation of HIV INNO LiPA test was performed by comparing these test results with those of automatic sequencing in 36 plasmatic samples for 13 infected patients with therapeutic failure., Results: on the basis of the HIV viral load evolution, 57.55% of patients present a good therapeutic response and 42.44% a bad one. Patients with therapeutic failure require genotypic resistance test. A comparison of HIV INNO LiPA test and direct sequencing showed a strong concordance between the two tests results either for reverse transcriptase gene or protease gene. However, the results obtained by INNO LiPA test (8.79% of analysed codons ) and the limited number of analysed codons were the defaults of INNO LiPA technique., Conclusion: the contribution of INNO LiPA technique in the knowledge of the epidemiological HIV resistance profiles of virus strains of HIV infected individuals failing therapy was considerable. However, due to INNO LiPA technique limitations, sequence analysis must be considered a more complete assay for the monitoring of antiretroviral resistance of HIV infected patients.

Human cytomegalovirus (HCMV), a member of the beta-virus herpes family, is a ubiquitous human pathogen. After a primary infection, HCMV establishes life latency. HCMV rarely causes symptomatic disease in an immunocompetent host, however, it is a major cause of infectious morbidity and mortality in immunocompromised individuals and developing fetuses. The HCMV genome consists of 240 kbp of double stranded DNA. Early diagnosis molecular of CMV infection is important. The objective of this study was to develop a molecular methods: Quantitative Hybrid capture for the detection of DNA CMV. We present results for 200 immunocompromised collected from 1999 to 2003 (122 men and 78 women, whom mean age was 35 years). Our results showed that 25% of women and 36% of men were positif for hybrid capture DNA CMV. This simple test (cold probe) provide quantitative and fast results. Also the efficacity of anti-CMV therapy can be followed. More over, in contrary with pp65-antigenemia assay and CMV PCR, this test can be managed on biopsy sample.

Human immunodeficiency virus (HIV) is a retrovirus infecting approximatively 40 million people worldwide. HIV is characterized by a great variability with epidemiological, diagnostic and therapeutic implications. The course of infection goes through three stages (acute infection, clinical latency and AIDS) with the evolution of virological markers (anti-HIV antibodies, p24 antigenemia, plasma RNA and proviral DNA). Direct virological diagnosis is mainly based on molecular tools allowing viral genome detection and amplification with specific primers and nucleic probes besides p24 antigenemia detection, and more rarely viral culture. Antigenic properties of viral proteins elicit in infected patients antibody synthesis, which is detected using serology (ELISA and Western blot tests). The follow-up of infected patients is carried out with plasma HIV-1 RNA quantitation and phenotypic or genotypic characterization of variant isolates. Virological tests are prescribed according to clinical presentation (screening, acute infection, newborn from HIV-infected mother). Most of these virological tools are available in Tunisia, allowing both diagnosis of HIV infection and monitoring of infected individuals. Regarding diagnostic tests indication and interpretation, multidisciplinary concertation is hopeful in order to optimize patient management.

We report a retrospective study to estimate highly active antiretroviral therapy (HAART) effect in 139 HIV infected patients. Four criteria are studied: prevalence of opportunistic infections, CD4 cell count evolution, viral load progression and mortality. Gastrointestinal side effects are the most common clinical adverse reaction (61.1 percent), and hematological side effects are the most common biological adverse reaction (61.2 percent). During the 22.8 months (3 months to 6 years) follow-up average period, CD4 cell counts remained above 500 per cubic millimeter in only 25.8 percent of cases, while 63.5 percent of patients had a viral load below 400 copies per milliliter. During the study on patients receiving HAART, opportunistic infections appeared in 17.3 percent of cases (24 cases) and mortality in 6.4 percent of cases.

The authors report a retrospective study about 92 cases of HIV-1 infections among adult tunisian women hospitalised or consulting in the department of infectious diseases at Rabta hospital over a period of 15 years and 6 months. The middle age is 33.2 years. 64.1% of patients are married, and the conjoint is HIV-1 positive in 84.1% of cases. The route of transmission is sexual in 75%, parenteral in 22.8% and unknown in 2.2%. According to CD4 level and clinical symptoms, patients are at AIDS stage in 75.5%. The main clinical symptoms are: oral candidiasis in 92.4%, diarrhea in 54.3%, pneumocystis carinii pneumoniae in 11.9%, cerebral toxoplasmosis in 10.9%, septicemia caused particularly by salmonella in 9.7%, tuberculosis in 6.7%, cryptococcal meningitis in 4.3% an Kaposi's sarcoma in 3.2%. Mother to child HIV transmission is found in 33.3%, and the mortality is noted in 43.5% of cases.