Search

Background: Malaria has been eliminated in Tunisia since 1979, but the country remains, like all other countries harboring the vector, exposed to the potential risk of resurgence., Objectives: Describe the clinical and epidemiological investigation of 4 cases of autochthonous malaria in July 2013 and report the main actions of regional and national response., Methods: Retrospective descriptive survey of the 4 clinical observations as well as the study of the regional report data of basic health care for the region of Tunis in 2013., Results: Febrile table concomitant for 4 Tunisian male patients, aged from 21 to 27 years old ; fortuitous discovery of Plasmodium falciparum when checking thrombocytopenia of patient 1 ; diagnosis in cascade of other cases following the epidemiological investigation and field consultation with clinicians ; 3 simple forms and a neuromalaria of favorable evolution ; negative entomological survey for anopheles ; elimination of imported malaria and blood-borne ; airport malaria highly probable. The response included the establishment of a regional and national monitoring unit, an information program aimed at health professionals concerned and public opinion, the involvement of health and entomology teams for the detection and census of potential larval habitats and the implementation of local mosquito eradication measures., Conclusion: The clinical vigilance and competent biologist's eye is necessary to prevent the resurgence of this disease. The epidemiological surveillance system should be maintained and kept as well as the food safety standards monitoring at the borders.

Background: Asthma and Chronic Obstructive pulmonary Disease (COPD) are considered as a major public health problem worldwide. They are characterized by a progressive evolution with episodes of exacerbations., Objective: The aim of this work was to describe the emergency department visits for asthma and COPD according to sociodemographic characteristics of patients and to assess trends over time., Methods: We conducted a cross sectional study including all emergency department visits of the Abderrahmane Mami hospital during the period between January, 1st 2007 and the 31th of December 2010. We used a standardized questionnaire to collect age; sex and date of emergency department visits with a primary diagnosis of asthma and COPD exacerbation from the emergency register. Data analyses were performed with SPSS 17.0., Results: A total of 9814 emergency department visits were reported over the period of four years, 6499 (66,2%) for asthma and 3315 (33,8%) for COPD exacerbation. The mean age was 52±21 years; it was for asthma and COPD respectively 48±21 and 60±18 years. Aging was associated with a marked decrease in the prevalence of asthma (from 51.0% to 25.6%) and with a marked increase in the prevalence of COPD (from 6.8% to 47.5%). Men visit most frequently the emergency department for both diseases than women and particularly for COPD where the proportion of men was 75%. The number of visits increased steadily between 2007 and 2010, it peaked in January for asthma and in February for COPD and it was most important on the period from December to May., Conclusion: Asthma was most common among emergency department visits than COPD exacerbation, it affects men and women in a nearly same proportions and it is most frequent in young adults aged between 30 and 65 years. COPD exacerbation is most frequent in men aged over 65 years. Our study suggests that there is significant seasonal variation in the emergency department visits for respiratory illness. These findings suggest that greater attention and most adapted studies should be necessary to explain and to identify factors implied in these variations.

Background: High risk human papillomaviruses (HPVs) are the leading cause of cervical cancer (CC) and Pap smear screening has not been successful in preventing CC in Tunisia. HPV vaccination that targets HPV16 and 18 offers a new efficient prevention tool. Identification of HPV types in CC is thus essential to determine the impact of HPV vaccine implementation. The aim of this study is to provide specific data from Tunisia., Materials and Methods: A total of 89 histological confirmed paraffin embedded samples isolated from patients with CC diagnosed between 2001 and 2011 were collected from five medical centres from Northern and Southern Tunisia. HPV DNA was detected using a nested PCR (MY09/MY11-GP5+/GP6+) and genotyping was assessed using a reverse blot line hybridisation assay that enables the detection of 32 HPV types., Results: HPV DNA was detected in all samples. Twelve high risk types were detected; HPV16 and/or 18 were predominant, accounting together for 92.1% of all the CC cases (HPV16: 83.1%). Single infections accounted for 48.8% of the cases and were mostly linked to HPV 16 (32.6%) and less frequently to HPV 18 (2.4%). The other high risk HPV single infections were linked to HPV 35 (4.6%), 45 (4.6%), 58 (2.3%) and 59 (2.3%). Multiple infections with mixing of 2 to 4 genotypes predominately featrued HPV16 and/or 18 with HPV 35 and 45 (96.6 %) and less frequently with HPV 59, 40, 66, 73 and 58. There was no statistically significant variation in the relative distribution of HPV types with age., Conclusions: These results strongly indicate that prophylactic HPV vaccines can have a major impact in preventing CC in Tunisia.

Aim: The study was conducted in order to identify high risk areas for hydatidosis in Tunisia witch would be eligible for a Hydatidosis control program initiation., Methods: The most recent epidemiological investigation on surgical incidence of hydatidosis was used to classify governorates according to their incidence rate. A "global hydatidosis risk score" was calculated for each governorate, combining some parameters related to the hygiene conditions of the population, the literacy rate, the canine density and livestock census. Spearman correlation coefficient was used to compare scores and surgical incidences. Mapping analysis has been conducted. The surgical incidence rate of hydatidosis classifies each governorate regarding occurrence of human cases. The global hydatidosis risk score, by governorate, pointed out the most exposed areas to the disease., Results: The mapping analysis showed a good agreement between the incidence rate of the disease and the global hydatidosis risk score and made it possible to identify the population of the center and the west of the country as a most exposed population for the diseases., Conclusion: In order to have a chance for implementation, hydatidosis control program should target the three jointed governorates of Kasserine, Siliana and Kef, which have the highest incidence rates and the worst scores.

Objective: The objective of this study was to assess the completeness of the epidemiological surveillance system for invasive meningococcal diseases in greater Tunis., Patients and Methods: A six-year retrospective study (2003-2008) identified all cases of invasive meningococcal disease reported on Mandatory Notification records of the Tunis Regional Department of Health and those reported by the Tunis Children's hospital microbiology laboratory, considered to be the main source of diagnoses of invasive meningococcal disease in Greater Tunis. The "capture-recapture" method was applied., Results: Thirty-eight cases of invasive meningococcal disease reported to the Regional Department of Health and 47 cases provided by the children's hospital were analysed during the study period and 25 cases common to both sources were identified. The total number of cases of invasive meningococcal disease was estimated to be 71 (95% CI = [60-82]), using the capture-recapture method. Completeness rates were 53.5% (95% CI = [46.6 to 62.9]) for Mandatory Notification to the Regional Department of Health and 66.2% (95% CI = [57.6 to 77.8]) for children's hospital. Stratified analyses suggest that the two data sources were probably independent., Conclusions: The capture-recapture method applied to the invasive meningococcal disease surveillance system in Greater Tunis showed a poor sensitivity of the Mandatory Notification. Factors influencing under-reporting of cases should be identified to improve this surveillance.

Acne is a chronic disease that is especially common among adolescents. It can have a considerable psychological and social impact that is not always correlated with clinical severity. The aim of this paper was to evaluate clinical severity and alteration of quality of life in acne patients, and to investigate a possible correlation between the two. A total of 82 patients with juvenile acne were included in this study. The clinical severity of acne was evaluated using the Echelle de Cotation des Lésions d'Acné (ECLA) scale. The Cardiff Acne Disability Index (CADI) was used to assess acne-related quality of life. Acne was mild to moderate in 61% of patients (ECLA < or = 12). A considerable alteration of quality of life was present in 51% of cases. There was a positive correlation between overall scores on the ECLA and CADI scales (P = .012) before and after treatment. Additionally, CADI score improved after effective treatment of acne. Acne may have an important impact on teenagers' psychological and social life. An objective assessment of this impact seems to be necessary. ECLA and CADI scores appear to be objective and simple instruments that may be used in acne management.

Aim: To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis (AHO) in children., Methods: Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed., Results: 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization (18.66%). Fever higher than 38° on admission was found in 92.8% of patients. Creactive protein (CRP) was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. A micro organism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible (SAMS) was the predominant germ. Staphylococcus aureus methicillin resistant (SAMR) accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections., Conclusion: The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy.

Background: Kaposi's sarcoma (KS) is a mutifocal angiogenic process characterized by cellular and vascular proliferation., Aim: To identify the epidemio-clinical, histological and therapeutic features of KS., Methods: Retrospective study of 75 cases of KS at the dermatology department of Rabta hospital in Tunis during a period of 25 years (1982-2007)., Results: Three epidemio-clinical forms of KS were observed in our study: the classic KS (70 cases), the AIDS-related KS (4 cases) and the iatrogenic KS (1 case). The mean age of our patients at diagnosis was 69.16 years with a sex ratio of 2.33. Elective site of cutaneous lesions in the classic KS was the limbs (87.1%). The cephalic part was concerned in 17.1% of cases. Mucosal involvement was found in 28.5% of patients. Extra dermatological localizations of KS were observed in 32.9%., Conclusion: Our study identified some epidemio-clinical features of the classic KS especially the high frequency of mucosal and cephalic involvement as well as extra dermatological localizations. Thus further exploration is required even without alarm signs.

Background: Old world Zoonotic Cutaneous Leishmaniasis (ZCL) is a vector-borne human disease caused by Leishmania major, a unicellular eukaryotic parasite transmitted by pool blood-feeding sand flies mainly to wild rodents, such as Psammomys obesus. The human beings who share the rodent and sand fly habitats can be subverted as both sand fly blood resource. ZCL is endemic in the Middle East, Central Asia, Subsaharan and North Africa. Like other vector-borne diseases, the incidence of ZCL displayed by humans varies with environmental and climate factors. However, so far no study has addressed the temporal dynamics or the impact of climate factors on the ZCL risk., Principal Findings: Seasonality during the same epidemiologic year and interval between ZCL epidemics ranging from 4 to 7 years were demonstrated. Models showed that ZCL incidence is raising i) by 1.8% (95% confidence intervals CI:0.0-3.6%) when there is 1 mm increase in the rainfall lagged by 12 to 14 months ii) by 5.0% (95% CI: 0.8-9.4%) when there is a 1% increase in humidity from July to September in the same epidemiologic year., Conclusion/significance: Higher rainfall is expected to result in increased density of chenopods, a halophytic plant that constitutes the exclusive food of Psammomys obesus. Consequently, following a high density of Psammomys obesus, the pool of Leishmania major transmissible from the rodents to blood-feeding female sand flies could lead to a higher probability of transmission to humans over the next season. These findings provide the evidence that ZCL is highly influenced by climate factors that could affect both Psammomys obesus and the sand fly population densities.

The aim of this study was to assess the efficacy of the national Tuberculosis Control Programme in Tunisia, by applying the 8-stage model proposed by Piot (1967). Two retrospective cohorts of tuberculosis cases, including all new smear-positive cases detected by all laboratories in the study area during the study period, were selected at least 2 years after treatment began. The real number of new active cases during the study period was estimated at 142, the case detection rate at 61%. In all, 70% of patients started tuberculosis treatment, and regular use of the home treatment varied from 87% (including irregular use) to 71% (excluding irregular use). The low global efficacy of the program, which ranged from 26 to 31%, indicates the need for improved application of the strategy by programme managers.

Background: The genes encoding renin-angiotensin system (RAS) components are potent candidate genes in both hypertension and diabetes namely ACE encoding the angiotensin converting enzyme and AGT encoding angiotensinogen. It has been suggested that the insertion/deletion (I/D) polymorphism in intron 16 of ACE gene is associated with ACE levels, and M235T gene polymorphism is associated with plasma AGT levels., Aim: We examined in this report the association between ACE I/D and AGT M235T polymorphisms with hypertension status in Tunisian type 2 diabetic subjects., Methods: Thirty nine hypertensive and 22 normotensive type 2 diabetic Tunisian patients were recruited for this study. The I/D polymorphism of ACE gene was analysed with nested PCR in order to avoid mistyping heterozygous individuals and the M235T polymorphism of AGT gene was analysed using PCR and allele specific restriction., Results: The distribution of DD, ID and II genotypes did not significantly differ between type 2 diabetic patients with or without hypertension (DD: 49%; ID: 41%; II: 10% vs DD: 36%; ID: 55%; II: 9%, respectively) (chi2=1.06, p=0.58). There was also no significant statistical difference between these two groups for the M235T polymorphism (TT: 20%; MT: 54%; MM: 26% vs TT: 27%; MT: 41%; MM: 32%, respectively) (chi2=0.95, p=0.62)., Conclusion: RAS polymorphisms do not seem to play a role in the development of hypertension in the studied Tunisian type 2 diabetic subjects.

Background: The detection of antibodies in saliva samples proved to be effective in the diagnosis of several microbial diseases. These antibodies were screened in saliva samples of patients with hydatid cysts., Methods: Anti-hydatid fluid antigen IgG and IgA antibodies were screened in saliva and sera of patients with hydatid cysts (n=37) as well as in healthy controls (n=30) using an in-house developed immunoenzymatic assay., Results: Salivary anti-hydatid fluid antigen IgG showed a sensitivity of 86.5% and a specificity of 80%. A positive correlation was observed between anti-hydatid fluid antigen IgG in saliva and in serum (r = 0.364; p = 0.02)., Conclusions: The detection of anti-hydatid fluid antigen IgG antibodies in saliva using ELISA promises to be interesting for the diagnosis of cystic echinococcosis.

Forty-two patients with visceral leishmaniasis in Tunisia were treated with meglumine antimoniate and followed-up for clinical improvement and blood parasite load determined by quantitative real-time polymerase chain reaction (PCR). Parasite loads before treatment ranged from 27 to 5.3 x 10(7) parasites/mL. At the end of treatment, parasite load decreased significantly in 39 cured patients (P < 0.001). The decrease in parasite load after treatment was greater than 99% for 34 patients and PCR results became negative in 23 of them. Two patients without clinical improvement showed no or slight decreases in parasite load (209 versus 202 parasites/mL and 1,765 versus 146 parasites/mL). One patient showed had a relapse seven months after showing a good response to treatment. His parasitemia remained high despite a sharp decrease (5.2 x 10(5) versus 5.9 x 10(3) parasites/mL).

Objective: To assess the Cardiovascular risk factors trend in community based surveys., Method: Two population surveys were conducted in 1996-97 and 2000-01 in the Ariana region among 7608 adults 35-70 years aged. The surveys were based on: 1--a questionnary, 2--an anthropometrical and physical examination, 3--a biological investigation, and 4--an ECG registration for the second cohort., Results: Relative to the first survey, the prevalence of hypertension, diabetes, hypercholesterolemia didn't change significantly while borderline cholesterol increased on both genders, tobacco smoking decreased and ex-smokers increased on men. In both genders, hypertension and diabetes prevalence is low before 50 years but it increased after this age. Risk factors association is common: about 35% have more than two risk factors. This association is more common on women and diabetes-hypertension is the most frequent., Conclusion: These two surveys integrated in a global surveillance program has contributed to assess the CVDs burden and to identify priorities and intervention relevant to epidemiological region context.

The study objective was to assess the prevalence, level of treatment, and control of hypertension in CHDs patients. We conducted a cross-sectional survey on 1109 patients hospitalised for a first episode of MI in the main hospitals of the District of Tunis during the period 1999-2000. Hypertension and control level are defined according to the JNC recommendations. HBP is defined as SBP > = 140 and or DBP > = 90 mm Hg and the use of blood pressure-lowering medication for the indication of hypertension. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variables, medical history and CHDs risk factors. 54.9% men and 72.1% women were hypertensive. The prevalence of hypertension increases with age in both genders. The logistic regression have shown that the age-adjusted odds ratios were statically significant for diabetes, obesity, high cholestrolemia and cigarettes smoking. Only 68.9% of the hypertensive were aware of having hypertension, women were more aware than men (84.6% versus 61.7%, p < 0.001). Awareness increase with age and education level. Among hypertensive, 94.4% were treated but only 41.3% were controlled. The study highlights the problem of the hypertension, and contributes to identify the iceberg of this CHDs risk factor. An effort must be done to involve the health personnel for educating patients, the population for changing their life style and manager for enhancing the availability of drugs. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.