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International audience; 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.

BACKGROUND: Onychomycosis is by far the most frequent cause of nail disease. We describe epidemiological and mycological features observed in the Tunis area in Tunisia. MATERIAL AND METHODS: Data were collected from 292 nail samples performed in 255 patients with suspected onychomycosis. RESULTS: Request for samples were made late, on the average 48 months after development of nail disorders. Most of the patients were women (63.5%). One hundred ninety-six samples were positive (67%), 130 from toe nails and 66 from finger nails. Simultaneous infections of both finger and toe nails were found in 22 cases. Associated onychomycosis and skin mycosis was found preferentially in feet onychomycosis. The sensitivities of direct examination and culture depended on the site of the onychomycosis. Cultures were more sensitive for hands where yeasts, particularly Candida albicans, predominated, but the direct examination was more sensitive for feet where dermatophytes, particularly Trichophyton rubrum, predominated. CONCLUSION: Mycological examination is compulsory for confirmation of onychomycosis. It is also recommended before initiating a costly long-term treatment., Introduction : Les onychomycoses semblent représenter un motif de plus en plus fréquent de consultation dans la région de Tunis. Cette étude tente d'en préciser les particularités épidémiologiques et mycologiques.Matériel et méthodes : L'étude a concerné 292 prélèvements d'ongles effectués chez 255 malades suspects d'onychomycoses ayant consulté dans le laboratoire de parasitologie clinique de l'Institut Pasteur de Tunis durant les 5 dernières années.Résultats : Les prélèvements ont concerné une population majoritairement féminine (63,5 p. 100). La demande était souvent tardive, 48 mois en moyenne après l'apparition des lésions. Cent quatre-vingt-seize prélèvements, soit 67 p. 100, se sont révélés positifs, 130 concernaient les ongles des pieds et 66 ceux des mains ; les deux localisations étaient associées à 22 reprises. L'association des onychomycoses avec des mycoses cutanées a été notée surtout avec les onyxis des pieds (40,7 p. 100). Les sensibilités respectives de l'examen direct et de la culture dépendaient de la localisation de l'onyxis. La culture était plus sensible aux mains où prédominaient les levures, particulièrement Candida albicans , alors que l'examen direct était plus sensible aux pieds où prédominaient les dermatophytes, particulièrement Trichophyton rubrum .Conclusion : L'examen mycologique est d'un grand apport pour la confirmation du diagnostic d'une part et l'adaptation de la conduite thérapeutique et prophylactique d'autre part. Il reste indispensable avant d'entreprendre un traitement spécifique long et coûteux.

International audience; AIM: Three forms of cutaneous leishmaniasis (CL) are endemic in Tunisia. The identification of the causative species is useful to complete epidemiological data and to manage the cases. The aim of this study is to assess PCR-RFLP technique in the identification of Leishmania species responsible of CL in Tunisia and to compare the results of this technique to those of isoenzyme analysis. PATIENTS AND METHODS: Sixty-one CL lesions were sampled. Dermal samples were tested by culture on NNN medium and analyzed by PCR-RFLP assay targeting the ITS1 region of ribosomal DNA. Species identification was performed by both iso-enzymatic typing for positive cultures and analysis of restriction profiles after enzymatic digestion by HaeIII of the obtained amplicons. RESULTS: Thirty-eight (62%) samples were positive by culture. The iso-enzymatic typing of 32 isolates identified 3 L. infantum, 23 L. major MON-25 and 6 L. tropica MON-8. Sixty samples were positive by PCR. The PCR-RFLP digestion profiles of the 56 PCR products identified 12 L. infantum, 38 L. major and 6 L. tropica. The results of both techniques were concordant in the 32 strains identified by both techniques. Species identification correlated with the geographical distribution of CL forms endemic in Tunisia. CONCLUSION: Results of PCR-RFLP revealed highly concordant with those of isoenzyme electrophoresis. Thanks to its simplicity, rapidity and ability to be performed directly on biological samples, this technique appears as an interesting alternative for the identification of Leishmania strains responsible of CL in Tunisia.

International audience; Eumycetoma is a chronic, necrotizing infection of fungal origin that usually occurs on a lower extremity, especially the foot. We describe the first case in Tunisia of eumycetoma of the hand due to Pseudallescheria boydii. Case report. - A 48-year-old agricultural worker presented with a swelling and painless cutaneous nodules of the right hand and wrist that drained spontaneously. No trauma of the hand was noted. Examination of the hand revealed multiple crusted sinus tracts in the palm and on the back of the hand. The right hand appeared swollen and deformed. There was no adenopathy or fever. Radiographic examination showed bone involvement with destruction of the wrist bones. The diagnosis of eumycetoma was confirmed by histological evidence (stained sections) that showed granules containing fungal hyphae and positive culture for P boydii. Initially, treatment with ketoconazole (400 mg daily for 14 months) failed. The patient subsequently received itraconazole (400 mg daily for 18 months) and a marked improvement was obtained. Six years after treatment was stopped, there had been no recurrence, but bone involvement resulted in permanent deformity with wrist ankylosis. (C) 2010 Elsevier Masson SAS. All rights reserved.

Although malaria has been eradicated in Tunisia since 1979, the disease is still a health issue due to the persistence of mosquitoes and coexistence with a potential parasite reservoir in the form of imported cases. From 1999 to 2006, 98 cases of imported malaria were diagnosed at the Pasteur Institute in Tunis where nearly 30% of national cases are recorded. Tunisians accounted for 24.5% of these cases versus 75.5% involving foreigners. The occurrence rate has steadily increased in volunteer workers, businessmen, diplomats and athletes who together accounted for 41.7% of cases in 1995 as compared to only 17.4% in 1980 (p, RÉSUMÉ : Bien qu’éliminé depuis 1979, le paludisme reste d’actualité en Tunisie à cause de la persistance de l’anophélisme et la coexistence d’un réservoir potentiel de plasmodies constitué par les cas importés de la maladie. De 1999 à 2006, 98 cas importés de paludisme ont été diagnostiqués à l’Institut Pasteur de Tunis qui répertorie environ 30 % des cas nationaux. Les tunisiens ont représenté 24,5 % des cas contre 75,5 % d’étrangers. Les coopérants, commerçants, diplomates et sportifs sont de plus en plus concernés, 41,9 % des cas contre seulement 17,4 % entre 1980 et 1995, p

This study presents for the first time the identification of Leishmania infantum zymodeme MON-80 in 6 dogs stemming from Algeria and Tunisia using the method of comparative electrophoresis migration of the parasite iso-enzymes. As this enzymatic variant has been already described in humans with cutaneous and visceral forms of leishmaniasis in south Europe and in the Maghreb (Algeria and Tunisia). these observations reinforce the role of the dog as the principal reservoir host for Leishmania infantum complex., Cette étude présente l’identification, pour la première fois, de Leishmania infantum zymodème MON-80 chez 6 chiens provenant d’Algérie et deTunisie par la méthode de migration électrophorétique comparatives des iso-enzymes parasitaires. Ce variant enzymatique ayant déjà été signalé chez l’homme lors de leishmanioses viscérales et cutanées en Europe du sud et au Maghreb (Algérie et Tunisie), ces résultats viennent renforcer le rôle du chien comme réservoir principal du complexe Leishmania infantum.

This study presents for the first time the identification of Leishmania infantum zymodeme MON-80 in 6 dogs stemming from Algeria and Tunisia using the method of comparative electrophoresis migration of the parasite iso-enzymes. As this enzymatic variant has been already described in humans with cutaneous and visceral forms of leishmaniasis in south Europe and in the Maghreb (Algeria and Tunisia). these observations reinforce the role of the dog as the principal reservoir host for Leishmania infantum complex., Cette étude présente l’identification, pour la première fois, de Leishmania infantum zymodème MON-80 chez 6 chiens provenant d’Algérie et deTunisie par la méthode de migration électrophorétique comparatives des iso-enzymes parasitaires. Ce variant enzymatique ayant déjà été signalé chez l’homme lors de leishmanioses viscérales et cutanées en Europe du sud et au Maghreb (Algérie et Tunisie), ces résultats viennent renforcer le rôle du chien comme réservoir principal du complexe Leishmania infantum.

International audience; The epidemiological situation of leishmaniasis in Tunisia is characterised by the co-existence in a very limited territory (165,000 km2, Sahara included), of 4 clinical forms: the infantile visceral leishmaniasis (VL) and 3 cutaneous leishmaniasis (CL) forms (sporadic, zoonotic and chronic). In addition to the useful epidemiological data, identification of the causative parasitic species is essential to determine the geographic distribution of each form and to select appropriate therapeutic procedure and suitable control measures. 226 Leishmania isolates, 135 human's coming from 59 VL cases and 76 CL cases and 91 canine's were identified by the isoenzyme electrophoresis reference technique. Results confirm the endemicity of the 4 forms mentioned above. The sporadic CL, confined to the North of the country is principally caused by L. infantum MON-24 (72.2%). VL which has reached the southern ridge in the central area of Tunisia, in the governorate of Kairouan (36 typed isolates), presents an unusual high proportion of L. infantum MON-24. In fact, this zymodeme, rather dermotropic is responsible for 47.2% of the cases vs 13% in the other regions of the country where L. infantum MON-1 remains predominant with 78.3% of typed isolates, the difference being statistically significant (P < 0.01). A third zymodeme, L. infantum MON-80 is sporadically pointed out during VL or in sporadic CL. Despite the high number of canine isolates (n=91) coming from 6 governorates, only the zymodeme L. infantum MON-1 was identified, letting hypothetic the reservoir of the 2 other zymodemes of the species identified in humans. Those absences may be related to cross infections, with a low sensitivity to L. infantum MON-24 leading to a selection of MON-1 at the time of culture passages. Hence it is important to develop molecular tools of direct identification on initial biological samples without going through cultures. Zoonotic CL remains the predominant cutaneous form in the central and southern area of Tunisia. However L. killicki, agent of the chronic CL, is confirming its presence out of its original focus of Tataouine in the southern-east of the country in both zoonotic CL and VL areas.

The purpose of the study was to obtain more reliable epidemiological data concerning Entamoeba (E.) histolytica infection in Tunisian food handlers using established molecular tools able to differentiate E. histolytica from E. dispar. From 2002 to 2005, 4,266 fresh stools specimens received in the setting of the National program of food handlers' control were analysed by optical microscopy. Twelve (2.8 per thousand) were positive for the presence of four nuclei cysts identified as E. histolytica/E. dispar. Extraction of DNA from the 12 samples, followed by specific amplifications of E. histolytica and E. dispar SSU rDNA, showed that 11 samples (92%) were positive for E. dispar and negative for E. histolytica. Sequencing analysis of 8 PCR products permitted to verify the results obtained with conventional PCR. The remaining sample was negative by PCR amplifying E. histolytica DNA or E. dispar DNA specifically, although it did not show any inhibition. It probably contains protozoan cysts genetically distinct from these two species but morphological similar. Estimation of relative proportions between E. histolytica and E. dispar in cyst carriers showed that all explored individuals harboured the non pathogenic E. dispar strains. This result highlights the need of use in this population of complementary tests that allow specific diagnosis and obviate unnecessary chemotherapy.; Entre 2002 et 2005, 4 266 manipulateurs de denrées alimentaires de la région de Tunis ont bénéficié d’un examen parasitologique des selles dans le cadre du contrôle systématique. Douze (2,8 ‰) étaient porteurs de kystes d’Entamoeba histolytica/dispar. L’extraction d’ADN directement à partir des échantillons de selles positives, suivie respectivement d’une amplification génique de l’ADNr d ’E. histolytica et d’ E. dispar et d’un séquençage des produits d’amplification a permis d’identifier E. dispar chez 11 porteurs de kystes. Aucun manipulateur n’était porteur de l’espèce pathogène E. histolytica. Ces résultats mettent en exergue la nécessité d’examens complémentaires permettant l’identification des espèces E. histolytica et E. dispar et confirment la faible prévalence de l’amibiase dans le nord de la Tunisie.

BACKGROUND: The antenatal diagnosis of congenital toxoplasmosis rests in Tunisia on ultrasonography coupled with biological explorations. Among these explorations the search of Toxoplasma gondii by means of real time PCR in amniotic fluid is the examination of choice. AIM: We report the results of 33 parturients for which the biological examinations allowed to retain the notion of perigravidic or pergravidic toxoplasmic infection. METHODS: They were 13 patients having a seroconversion during the pregnancy, 19 having anti-toxoplasmic IgM with a low or intermediate index of avidity and a patient having presented a symptomatic anteconceptional primary infection. The ADN was extracted by means of the Kit (Qiagen). Genic amplification by PCR TaqMan targeted a portion of 71 pairs of bases of the B 1 gene. RESULTS: The PCR was positive among 9 patients (27.3%). They were a patient having presented a symptomatic toxoplasmosis during the pregnancy, 4 patients having consulted only in the 2nd quarter and for which the index of avidity was intermediate and 4 patients having presented seoconversions of 1st (n=1) of 2nd (n=2) or 3rd trimester. Among these patients, 2 had a medical interruption of pregnancy. The 7 others were put under pyrimethamine sulfadiazine. The neonatal assessment practised at 5 new-born babies was negative in all the cases. The PCR was negative for 24 patients. 18 pregnancies were followed. The neonatal serology was negative. The follow-up of 13 newborn child showed the disappearance of the antitoxoplasmic IgG between the 6th and 12th month.

Epidemiological, clinical and parasitological data concerning canine leishmaniasis were collected in two Tunisian populations of dogs, different in breed and life style: 23 rural dogs and 26 dogs of European breeds. All were symptomatic and lived in the north of Tunisia where human visceral and cutaneous leishmaniasis caused by Leishmania infantum are endemic. Leishmaniasis has been confirmed in all dogs by serology or/and by parasitic identification. Significant differences concerning age and symptoms suggest a higher susceptibility to infection in European imported breeds. In fact individuals of this population were significantly younger; 81% were less than 5 years old whereas 57% of the autochthonous rural dogs were more than 5 years old with 31% of them being older than 9 (p = 0.014). In spite of their young age, 75% of imported breeds presented an affection of their general state with more frequent cutaneous symptoms than the rural dogs (96% versus 69%, p = 0.02). Isoenzyme typing of 31 strains, obtained from the two populations, from different sites (blood, lymph nodes, spleen) has only identified the zymodeme Leishmania infantum MON-1. This stresses the need of more investigations to determine reservoirs of the other enzymatic variants identified in humans in Tunisia and Mediterranean basin.

The incidence of adult visceral leishmaniasis in Tunisia has increased in recent years. As a result the epidemiological profile of the disease in our country is now closer to those observed in other Mediterranean countries. Most of the increase involves adults not infected by human immunodeficiency virus (HIV) although 56% of patients presented concurrent disease. In comparison with pediatric visceral leishmaniasis, adult disease is characterized by inconsistence occurrence of some major symptoms such as fever and spleen enlargement. For this reason the clinical disease syndrome may be incomplete and diagnosis may be difficult. Laboratory tests are essential for definitive diagnosis. Although no test is specific, some findings are highly useful, e.g, elevated g-globulins which was observed in 94% of patients in our series. Standard serology is less sensitive in adults with 18% of false negatives in our series probably as a result of immunodeficiency in some patients.

This study reports on the evaluation of two L. infantum specific DNA probes for the diagnosis of canine leishmaniasis. The probes presented very satisfying performances in terms of specificity (100%) and predictive value of the positive result (100%). However, their sensitivity (35.3%) and the clinical complexity of canine infections render their use difficult in epidemiological surveys of visceral leishmaniasis aiming at measuring the prevalence of the dog infection by L. infantum. The sensitivity of these tools has improved (66.7%) when dogs presenting patent leishmaniasis were considered. Such probes constitute appropriate tools to confirm suspected cases of leishmaniasis. Unlike the classical parasitological and serological tools, this kind of tools allows a concomitant detection and identification of the causative agent. Therefore, despite their low sensitivity, these probes can still be of importance in epidemiological investigations.

Iso-enzymatic characterization of 19 Leishmania strains isolated from Tunisian dogs revealed that all correspond to Leishmania infantum MON-1. This confirms the role of dog as a reservoir of the commonest zymodeme responsible for human visceral leishmaniasis in the Mediterranean basin. However, and in spite of the high number of identifications, many zymodemes, mainly the dermotropic ones as Leishmania infantum MON-24, frequently reported in humans, had never been isolated from dogs. The study of their cultural characteristics may contribute to explain the particular iso-enzymatic profile of dogs strains., Dix-neuf souches de leishmanies, isolées chez des chiens originaires de différentes régions de la Tunisie, ont été typées par électrophorèse des iso-enzymes. Toutes se sont révélé correspondre à Leishmania infantum MON-1, confirmant la prédominance de ce zymodème chez cet animal. L’absence, aussi bien dans cette série que dans celles d’autres pays méditerranéens, de certains zymodèmes dermotropes, fréquemment rencontrés chez l’homme, pose le problème de leur réservoir. La multiplication des isolements chez les hôtes potentiels et l’étude de la cinétique en culture des différents zymodèmes pourraient apporter d’éventuelles réponses.