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Le diagnostic de l’infection par le SARS-Cov-2 repose sur un ensemble d’arguments cliniques, biologiques et radiologiques. L’infection par le SARS-Cov-2 se manifeste principalement par des signes respiratoires. Parfois, des manifestations extra-respiratoires peuvent être le premier ou le seul symptôme de COVID-19, avant la fièvre ou les signes respiratoires. Les anomalies biologiques pouvant orienter précocement vers une infection par le SARS-CoV-2 sont la lymphopénie, une C Réactive Protéine (CRP) augmentée. Le scanner thoracique semble utile pour identifier des images compatibles avec la COVID-19. Les tests sérologiques pourraient amener une information diagnostique complémentaire aux tests moléculaires par RT-PCR, méthode de choix pour mettre en évidence la présence du virus SARS-CoV-2.

Background HIV infection continues to be a major global public health issue. UNAIDS estimates that 690 000 HIV-related deaths occurred in 2019. In Morocco The number of people living with HIV was estimated at 21,000 in 2018. HIV prevalence in Morocco remains low (around 0.1%) in the general population. It is much higher among female sex workers, men who have sex with men (MSM), people who inject drugs and migrants. In Casablanca the epidemic is concentrated among MSM. The aim of this study was to describe the epidemiologic, clinical and immuno-virological characteristics of people newly diagnosed with HIV infection managed in the Ibn Rochd teaching Hospital of Casablanca. Methods A cross-sectional study was performed including patients newly diagnosed with HIV infection and managed in the infectious diseases department from January 1st, 2017 to June 30, 2018. Data were collected from patient's medical records and were analyzed using SPSS 16. Main outcomes were presented as mean and pourcentages. Results 525 patients newly diagnosed with HIV infection were managed during the 18 months period in the Infectious Diseases Department. The mean age was 36.1 years, with a sex ratio of 1.1. Among them, 43% were single and 61.7% were unemployed. Heterosexual transmission mode represented 65.5% and MSM represented 23%. The seropositivity was discovered through an evocative symptom in 47.8% of all cases. The main clinical symptoms were: weight loss (16.6%) and oral candidiasis (11.2%). The main opportunistic infection was tuberculosis (23%). 36.1% of cases were diagnosed at acquired immunodeficiency syndrome (AIDS) stage. Medians of the first CD4 count and viral load performed were respectively 248/mm3 and 88 174 copies/ml. Conclusions Despite a good antiretroviral coverage, HIV infection is still diagnosed late in our country. The emphasis must be on the promotion of voluntary testing mainly among groups at high risk of infection. Key messages More active offer of HIV testing, by general practitioners, should play a crucial role in the early identification of HIV infections. Strategies such as use of preexposure prophylaxis should be developed to prevent HIV transmission among MSM.

Background: It has been reported that interferon-λ3 (IFNL3)might influence the pathogenesis and clearance of human papillomavirus (HPV) infection. The impact of IFNL3 single-nucleotide polymorphism (SNP) on HPV infection is currently unknown. The aim of this study was to investigate the association between variants in the IFNL3 region and HPV infection in women with human immunodeficiency virus (HIV) infection. Methods: A total of 236 HIV patients, including 65 HPV-negative and 171 HPV DNA-positive women, were enrolled into this study. The IFNL3 rs12979860 polymorphism was genotyped using a predesigned TaqMan SNP genotyping assay. Results: Data showed no significant differences in genotypes or allele frequencies between the HPV DNA-positive and the HPV-negative women (p > 0.05). After dividing the HPV-positive women according to cytology results into patients with abnormal and normal lesions, the genotype and allele distribution of the SNP did not significantly differ between the 2 groups (p > 0.05). Conclusions: Our results showed that the IFNL3 rs12979860 polymorphism is not a major determinant of the susceptibility to HPV infection and their progression to abnormal cervical lesions in women living with HIV.

Background In Morocco, of the estimated 29,000 people living with HIV in 2011, only 20% were aware of their HIV status. More than half of diagnoses were at the AIDS stage. We assumed that people who were unaware of their infection had contacts with the healthcare system for HIV indicators that might prompt the healthcare provider to offer a test. The aim was to assess missed opportunities for HIV testing in patients newly diagnosed with HIV who accessed care in Morocco. Methods A cross-sectional study was conducted in 2012–2013 in six Moroccan HIV centers. Participants were aged ≥18, and had sought care within 6 months after their HIV diagnosis. A standardized questionnaire administered during a face-to-face interview collected the patient’s characteristics at HIV diagnosis, HIV testing and medical history. Contacts with care and the occurrence of clinical conditions were assessed during the 3 years prior to HIV diagnosis. Over this period, we assessed whether healthcare providers had offered HIV testing to patients with HIV-related clinical or behavioral conditions. Results We enrolled 650 newly HIV-diagnosed patients (median age: 35, women: 55%, heterosexuals: 81%, diagnosed with AIDS or CD4 3: 63%). During the 3 years prior to the HIV diagnosis, 71% (n = 463) of participants had ≥1 contact with the healthcare system. Of 323 people with HIV-related clinical conditions, 22% did not seek care for them and 9% sought care and were offered an HIV test by a healthcare provider. The remaining 69% were not offered a test and were considered as missed opportunities for HIV testing. Of men who have sex with men, 83% did not address their sexual behavior with their healthcare provider, 11% were not offered HIV testing, while 6% were offered HIV testing after reporting their sexual behavior to their provider. Conclusions Among people who actually sought care during the period of probable infection, many opportunities for HIV testing, based on at-risk behaviors or clinical signs, were missed. This highlights the need to improve the recognition of HIV clinical indicators by physicians, further expand community-based HIV testing by lay providers, and implement self-testing to increase accessibility and privacy.

Human Immunodeficiency Virus (HIV-1) infections are characterized by dysfunctional cellular and humoral antiviral immune responses. The progressive loss of effector functions in chronic viral infection has been associated with the up-regulation of programmed death-1 (PD-1), a negative regulator of activated T cells and Natural Killer cells. In HIV-1 infection, increased levels of PD-1 expression correlate with CD8 + T-cell exhaustion. In vitro, PD-1 blockade using PD-1 antibodies led to an increase in HIV-1 specific CD8 + T and memory B cell proliferation. We aimed to investigate the impact of PDCD1 rs10204525 polymorphism on HIV-1 susceptibility, AIDS development, and treatment response outcomes in HIV-1 infection in a Moroccan population. A total of 214 HIV-1 seropositive and 250 seronegative subjects were enrolled to investigate the association between the between the single-nucleotide polymorphism (SNP) rs10204525 of PDCD1 gene and HIV-1 pathogenesis using a predesigned TaqMan SNP genotyping assay. No significant association was found between rs10204525 and susceptibility to HIV-1 infection and AIDS development (p 0.05). Genotype frequencies were significantly associated with the viral load before ART (p = 0.0105). HIV-1 viral load was significantly higher among subjects with the CC compared to TT genotype (p = 0.0043). In treated subjects, the median of viral load levels was significantly higher in CC and CT groups than TT subjects (p 0.005). However, analysis of the correlation between CD4 + T-cell levels and PDCD1 polymorphism before and after ART showed no significant difference (p 0.05). Our results demonstrated that rs10204525 polymorphism does not affect HIV-1 infection. However, this polymorphism may affect the response to treatment as measured by RNA viral load levels.

Resume Introduction Depuis l’avenement de la therapie antiretrovirale et l’allongement de l’esperance de vie des patients, la sante mentale est devenue une preoccupation pour les patients vivant avec le VIH (PvVIH) et pour les soignants. Objectif de notre travail : estimer la prevalence des troubles psychiatriques, etudier la nature de ces troubles et identifier les facteurs de risques sociodemographiques et medicaux influencant la sante mentale des PvVIH. Patients et methodes Etude transversale descriptive menee dans le service des Maladies Infectieuses de janvier 2015 an 2015 portant sur les PvVIH, vus a l’hopital de jour et ayant presente des troubles psychiatriques. Les donnees ont ete recueillies sur les fiches d’exploitation et analysees sur Excel. Resultats La prevalence des troubles est de 3,39 %. La moyenne d’âge est de 39,28 ans (24–58 ans). Le sexe feminin predomine (sex-ratio : 0,62). La plupart des patients sont analphabetes ou ayant un niveau d’etudes primaires (63 %), ont un travail (67 %). Douze patients (17 %) ont un antecedent psychiatrique et 42 patients (61 %) ont presente des troubles au cours du suivi. Les troubles psychiatriques sont domines par la depression (87 %) et l’anxiete (29 %). Les sources presumees des troubles sont la precarite materielle (84 %), le divorce (30 %) et la perte du travail (29 %). Le mode de contamination est essentiellement les rapports heterosexuels (87 %). La duree mediane d’infection VIH est de trois ans (un mois-18 ans). La majorite des patients (77 %) sont sous therapie antiretrovirale dont 64 % ont un taux des lymphocytes CD4 Conclusion Les manifestations psychiatriques sont frequentes au cours de l’infection a VIH. Elles sont dominees par la depression et sont responsables de l’echec therapeutique, d’ou la necessite de la collaboration entre psychiatre et infectiologue dans la prise en charge des PvVIH.

Introduction: Women infected with human immunodeficiency virus (HIV) have a higher risk of contracting human papillomavirus (HPV) infections and are more prone to develop cervical cancer. The objective of this study was to determine the prevalence of HPV and its association with risk factors among Moroccan women living with HIV/AIDS. Methodology: We enrolled 251 HIV-infected non-pregnant women in Morocco from February 2013 to September 2016. Sociodemographic, lifestyles, behavioral and clinical data were collected. Polymerase chain reaction followed by sequencing were performed for molecular detection and HPV genotyping in cervical samples, respectively. Results: Abnormal cervical smears were found in 34/246 patients (13.82%). The overall prevalence of HPV was 74.50%. HPV 58 was the most prevalent (39.29%) followed by HPV 18 (10.71%), HPV 70 (8.93%), HPV 33 (7.14%), HPV 6 (6.25%) and other genotypes (< 3%). Overall, high-risk HPV (HR-HPV) types were present in 75% (84/112) of patients and the prevalence of HR-HPV types in samples with abnormal Pap was higher than in normal Pap (55/83, 66.27% vs. 28/83, 33.33%, p < 0.0001). Univariate analyses showed that none of the socio-demographic and behaviors factors was associated with HPV infection. Moreover, Pap results were not affected by HPV status (p = 0.532). Whereas, CD4 T-cell counts above 200/mm3 at enrolment were apparently not protective to HPV infection. We found a high prevalence of HPV infection and HR-HPV types among HIV-positive women that significantly associated with abnormal Pap. Conclusion: Our findings suggest a high prevalence of HPV infection with high-risk types was observed among HIV-positive women warrant to implement a regular screening by Pap smear.

The aim of this work is to study the epidemiology of central neurological system (CNS) diagnosed in the population of people living with HIV in the department of infectious diseases in UHC Ibn Rochd of Casablanca from January 2005 to May 2015. The demographic and clinical profile along with the outcome of these patients were studied. The data were collected from Nadis software. Three hundred and eighty-seven patients were admitted for CNS diagnosis, out of 3496 people living with HIV admitted during this time period, i.e., a prevalence of 11%. The sex ratio (M/F) was 1.27. The average age was 39 years (± 7). Neurological involvement was indicative of HIV infection in 225 cases (68.8%). Neurological disorders were dominated by headache (70%), focal neurological syndrome (35%), and meningeal syndrome (30%). CNS diagnosis noted were CNS tuberculosis (37%), cerebral toxoplasmosis (30%), and cryptococcal meningitis (20%). The median CD4 T-lymphocyte was 184 cells/mm3. Infection with severe immunosuppression was progressive multifocal leucoencephalitis, cryptococcal meningitis, and primary cerebral lymphoma. Lethality was 39%. In the department of infectious diseases of the UHC, 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 detection and management of these patients.

Resume Objectifs Rapporter la prevalence de la meningite tuberculeuse confirmee et decrire les aspects cliniques, paracliniques et evolutifs. Patients et methode Etude retrospective portant sur 52 patients hospitalises entre janvier 2011 et decembre 2014 dans le service de maladies infectieuses pour une meningite tuberculeuse confirmee. Resultats La prevalence de la meningite tuberculeuse etait de 10 %. L’âge moyen etait de 32 ans et le sex-ratio de 1. Les facteurs de risque retrouves etaient un bas niveau economique (90 %), l’infection a VIH (27 %) et le contage tuberculeux (17 %). L’installation de la symptomatologie avant l’hospitalisation etait progressive (84 %). Les signes cliniques dominant etaient la fievre (84 %), les cephalees (75 %), le syndrome meninge (73 %) et les troubles de la conscience (53 %). Les anomalies de l’imagerie cerebrale dominant etaient l’hydrocephalie (25 %) et les tuberculomes (21 %). Les anomalies du liquide cephalorachidien etaient une hyperproteinorachie (98 %), une hypoglycorachie (83 %) et une lymphocytose (65 %). La culture du liquide cephalorachidien sur milieu de Lowenstein etait positive (84 %) et la PCR positive dans 92 % des cas (12/13). Tous les patients avaient recu un traitement antituberculeux associe a la corticotherapie dans 82 % des cas. L’evolution etait favorable dans 69 % des cas. Conclusion La meningite tuberculeuse est une pathologie extremement heterogene dans sa presentation clinique et radiologique. Le meilleur outil diagnostique semble etre la recherche de BK par methode de PCR.

Resume Objectifs Rapporter les cas de cryptococcose neuromeningee (CNM) et decrire les aspects cliniques, paracliniques, therapeutiques et evolutifs. Patients et methodes Etude retrospective portant sur 43 patients VIH positif hospitalises du 1 er janvier 2010 au 30 juin 2015 dans le service des maladies infectieuses du centre hospitalo-universitaire Ibn Rochd de Casablanca pour CNM. Resultats Durant la periode d’etude, 43 cas de CNM ont ete diagnostiques, soit une frequence moyenne de 1,4 %. L’âge moyen etait de 39 ± 8,5 ans et le sex-ratio de 1,38. La moyenne des CD4 etait de 70 cellules/mm 3 . La CNM etait revelatrice de l’infection a VIH (77 %). Le delai moyen de la symptomatologie avant l’hospitalisation etait de 15 ± 8 jours. Le signe clinique dominant etait les cephalees (77 %). Les anomalies du liquide cephalorachidien (LCR) etaient une hypoglycorachie (67 %), une hyperproteinorachie (65 %) et une lymphocytose (63 %). La recherche de Cryptococcus neoformans a l’examen direct a l’encre de Chine etait positive (86 %) et apres culture sur milieu de Sabouraud additionne de chloramphenicol dans tous les cas. Les patients etaient traites par monotherapie avec l’amphotericine B (42 %) ou le fluconazole (28 %) et la bitherapie associant amphotericine B au fluconazole (28 %). L’evolution etait mortelle dans 60 % des cas. Conclusion Cette etude montre que la cryptococcose neuromeningee reste une infection opportuniste severe chez les patients infectes par le VIH avec une lourde mortalite.

Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease.

Summary Introduction Nationally, no data on the association between human immunodeficiency virus infection and diabetes have been published. Objectives To review the epidemiological, clinical and therapeutic data and evaluate the experience of people living with HIV and suffering from diabetes. Methods Our study population was composed of 190 outpatients (87 males and 103 females) attending the Infectious Diseases department of the University Hospital Center of Casablanca (Ibn Rochd). Using the computerized medical records, we identified patients with HIV-Diabetes and collected their epidemiological, clinical and therapeutic data. At the enrollment date of each patient, we measured anthropometric parameters (weight, height, waist circumference, hip circumference, and arm circumference). We also asked each patient, about the impression on their bodies’ appearance and the degree of concern with regard to the diabetes. Results The population of patients with HIV, the prevalence of diabetes was 10.5%, among the patients taking an antiretroviral therapy, the prevalence was 13.5%. Diabetes has been diagnosed in 113 patients before the discovery of their HIV infection. At time of recruitment, 111 of them were under antiretroviral therapy for a mean period of 3.1 years. Zidovudine was the most prescribed drug followed by lamivudine. Type 2 diabetes was diagnosed in 144 patients. Eighty-seven patients feel conscious about their body appearance which makes them feel bad about the way they look. Metformin was prescribed in 46 cases. The majority of patients (73.1%) considered diabetes as a second health problem. Only 46 patients were well balanced. Conclusion The multidisciplinary consultation and patient education should enable an appropriate management of diabetes in HIV infected patients.

Cryptococcosis is a cosmopolitan fungal serious condition due to an encapsulated yeast Cryptococcus neoformans. This is the systemic fungal infection the most common in HIV infection. This yeast is present in the environment and its main entrance in the body is the respiratory tract. Its gravity is linked to its tropism for the central nervous system. It generally affects subjects with severe deficit of cellular immunity and in particular, patients living with HIV. The diagnosis of neuromeningeal cryptococcosis is based on the detection of encapsulated yeasts at microscopic examination of cerebrospinal fluid, the detection of capsular polysaccharide antigen in serum or cerebrospinal fluid, but especially on the culture. A staging is always essential. The prognosis is severe. The control of intracranial hypertension is a major element of prognosis.

Background Human papillomavirus (HPV) is the most common sexually transmitted agent worldwide. HPV is the main causative agent for cervical cancer. The HPV oncoprotein E6 binds to the tumor suppressor gene product p53, promoting its degradation; the Arg allele of TP53 R72P polymorphism binds more ardently with HPV E6 than the Pro variant. Here, we investigated whether TP53 R72P gene variant, rs104252, was associated with susceptibility to HPV infection in women with human immunodeficiency virus (HIV). Methods We analyzed 200 HPV-positive and 68 uninfected women with HIV. Genomic DNA was isolated from cervical swab. The TP53 R72P polymorphism was genotyped by PCR-RFLP. Unconditional logistic regression was used to assess the association between polymorphism and the clinical, lifestyle, and behavioral data. Results The genotype and allele frequencies of rs104252 variant did not differ between women without or with HPV infection (P > 0.05). Moreover, the p53 polymorphism was not associated with cervical cytology. In contrast, when we analyzed according to behavior factors, the P72P genotype was more frequent among HPV-positive smoker women. However, no significant relationship was found between alcohol, contraceptive use, and number of partners with TP53 R72P genotype distributions among HPV-positive cases (P > 0.05). Conclusions The R72 variant of p53 R72P is not associated with HPV infection and progression of lesions. There was no association between this variant and behavior factors in HPV-positive cases. The P72P genotype may be more frequent among HPV-positive smoker women.

The aim of this work is to study the epidemiology of central neurological system (CNS) diagnosed in the population of people living with HIV in the department of infectious diseases in UHC Ibn Rochd of Casablanca from January 2005 to May 2015. The demographic and clinical profile along with the outcome of these patients were studied. The data were collected from Nadis software. Three hundred and eighty-seven patients were admitted for CNS diagnosis, out of 3496 people living with HIV admitted during this time period, i.e., a prevalence of 11%. The sex ratio (M/F) was 1.27. The average age was 39 years (± 7). Neurological involvement was indicative of HIV infection in 225 cases (68.8%). Neurological disorders were dominated by headache (70%), focal neurological syndrome (35%), and meningeal syndrome (30%). CNS diagnosis noted were CNS tuberculosis (37%), cerebral toxoplasmosis (30%), and cryptococcal meningitis (20%). The median CD4 T-lymphocyte was 184 cells/mmL'objectif de ce travail est d'étudier l'épidémiologie des manifestations neurologiques centrales (MNC) des patients vivant avec le VIH (PvVIH) suivis dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca entre janvier 2005 et mai 2015. La source des données était le logiciel Nadis. Trois cent quatre-vingt-sept patients ont été hospitalisés pour une MNC sur 3 496 PvVIH, soit une prévalence de 11 %. Le sex-ratio (H/F) était de 1,27. L'âge moyen des patients était de 39 ans (± 7). L'atteinte neurologique était révélatrice de l'infection à VIH dans 266 cas (69 %). Les troubles neurologiques étaient dominés par les céphalées (70 %), le syndrome neurologique focal (35 %) et le syndrome méningé (35 %). Les étiologies étaient dominées par la méningoencéphalite tuberculeuse (37 %), la toxoplasmose cérébrale (30 %) et la cryptococcose neuroméningée (CNM) (20 %). La médiane des lymphocytes T CD4 était de 184 cellules/mm

Congenital asplenia is a rare life-threatening condition, often presenting with sepsis caused by encapsulated pathogens. It may arise as part of situs abnormalities or result from an unrelated specific defect of spleen development. Isolated congenital asplenia is a very rare condition. We report a case of asplenia revealed by severe sepsis and multi-organ failure in a previously healthy 25-year-old male how had never undergone any surgical procedures. Blood cultures grew Streptococcus oralis four days after admission. Computed tomography revealed pneumonia and asplenia. The patient was finally diagnosed as Streptococcal sepsis revealing isolated congenital asplenia. Cephalosporin and levofloxacin were administered and the patient died following cardiopulmonary arrests. No family history for this condition was reported. Clinicians should pay attention to the congenital asplenia in Streptococcal disease, particularly in the event of overwhelming sepsis. In affected individuals, the use of appropriate antibiotic prophylaxis and immunisations could save lives.

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.

Introduction La diffusion des bacilles a gram negatif (BGN) multiresistants est une menace grandissante en particulier au cours des infections urinaires. L’objectif de cette etude etait d’evaluer le profil de resistance des BGN uropathogenes isoles chez les patients hospitalises dans un service des maladies infectieuses (SMI) Materiels et methodes Ont ete inclus dans cette etude retrospective tous les patients ayant eu un ECBU positif a BGN en cours d’hospitalisation dans le SMI entre janvier 2015 et decembre 2017. Les doublons ont ete elimines. Le recueil des donnees a ete fait a partir des dossiers medicaux. Resultats Un total de 233 dossiers ont ete retenus. L’âge moyen etait de 51,2 ans, avec un sex-ratio H/F de 0,56. Le BGN etait d’origine communautaire (89 %) ou acquis en milieu de soins (11 %). Les germes etaient Escherichia coli (54,5 %), Klebsiella pneumoniae (24,4 %), Entercoccus faecalis (10 %), Enterobacter cloacae (3,8 %), Acinetobacter baumanii (3,4 %), Proteus mirabilis (2,1 %) et le Pseudomonas aeruginosa (1,8 %). Quarante-cinq pour cent des BGN etaient multiresistants, 34 % produisaient une β-lactamase a spectre elargi et 7 % une carbapenemases. La resistance a l’amoxicilline a ete detectee dans 82 %, a l’amoxicilline/acide clavulanique dans 47 %, a la ciprofloxacine dans 42 %, aux C3G dans 30 %, a la gentamicine dans 26 % et a l’imipeneme dans 8 % des cas. Conclusion L’emergence des souches des BGN multiresistantes est de plus en plus importante dans notre structure. Nos resultats confirment que les fluoroquinolones et l’association amoxicilline/acide clavulanique ne peuvent plus etre des antibiotiques de premier choix dans les infections urinaires. Ces donnees locales sont essentielles pour adapter les referentiels locaux.

Introduction Le paludisme est une endemie parasitaire frequente dans le monde. Il constitue un probleme majeur de sante publique aussi bien pour les pays d’endemie, que pour les pays de zones non endemiques, du fait du paludisme d’importation. Materiels et methodes C’est une etude retrospective, descriptive et analytique de 554 cas de paludisme d’importation, traites et suivis durant 6 ans (janvier 2010–decembre 2016), dans les differentes structures sanitaires du secteur medical liberal et public. Resultats Cinq cents cinquante-quatre cas ont ete traites pour paludisme d’importation. L’âge moyen etait de 34,7 ans. Ils etaient de sexe masculin dans 86 %. 98 % avaient sejourne en Afrique de l’ouest et dans 2 % a l’Asie de sud-est. La chimioprophylaxie a ete prise chez seulement 9 %. Le delai moyen entre le debut des symptomes et le traitement etait de 4 jours (0 a 15 jours). La parasitemie etait positive chez 100 % de nos patients avec des variances entre 0,1 % et 20 %, et l’espece plasmodiale la plus frequente etait le Falciparum (99 %) et le Vivax (1 %). Les signes cliniques etaient essentiellement : triade (fievre–frissons–sueurs) et arthro-myalgies 100 %, vomissements (32 %), ictere (15 %), signes neurologiques (2 %), splenomegalie (4 %) et hepatomegalie (3 %). Sur le plan biologique 74 % presentaient une thrombopenie, une anemie dans 56 % et une lymphopenie dans 59 %. L’atteinte hepatique etait retrouvee chez 26 % et 8 % presentaient une insuffisance renale. Plusieurs molecules antipaludiques ont ete utilisees comme traitement : artemether-lumefantrine (68 %) et son association avec artesunate dans 21 % et les quinines (10 %), associees au traitement symptomatique. Cinq cents quarante-cinq malades ont bien evolue avec 11 cas de rechutes. Conclusion L’augmentation du paludisme importe est une situation alarmante. La mise en route de moyens de prevention constitue une urgence, d’ou l’interet de l’optimisation de la formation medicale continue en medecine de voyage, la minimisation du cout des antipaludeens et leurs remboursements.

To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients.Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus.The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mmNeuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.

Cytomegalovirus (CMV) disease is a serious condition due to reactivation of previously latent infection or newly acquired infection, it occurs frequently in immunocompromised patients by HIV infection. Even it is actually uncommon in the developed nations with the widespread use of highly active antiretroviral therapy (HAART), CMV disease continues to be among the most common opportunistic infections in patient living with HIV (PLWH) in developing countries. Its severity is linked to its tropism for retina and central nervous system (CNS). It generally affects patients with major deficit in cellular immunity. It’s also an important HIV cofactor that promotes the virus progression and influences morbidity and mortality in PLWH by maintaining immunity dysregulation as well as a chronic systemic inflammation. Retinitis is the major reported CMV disease in PLWH, followed by gastro-intestinal and CNS involvements, rarely lung can be also affected. Diagnosis is achieved by clinical examination; the gold standard is polymerase chain reaction (PCR) in blood and tissue samples. Unless an earlier and effective management, prognosis of CMV disease will be unfavorable. The standard treatment is based on the administration of systemic antiviral drugs. Maintenance treatment is strongly indicated in CMV retinitis to prevent relapses; whereas its indication is discussed in the other organ involvements.

Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease.

Cryptococcosis is a cosmopolitan fungal serious condition due to an encapsulated yeast Cryptococcus neoformans. This is the systemic fungal infection the most common in HIV infection. This yeast is present in the environment and its main entrance in the body is the respiratory tract. Its gravity is linked to its tropism for the central nervous system. It generally affects subjects with severe deficit of cellular immunity and in particular, patients living with HIV. The diagnosis of neuromeningeal cryptococcosis is based on the detection of encapsulated yeasts at microscopic examination of cerebrospinal fluid, the detection of capsular polysaccharide antigen in serum or cerebrospinal fluid, but especially on the culture. A staging is always essential. The prognosis is severe. The control of intracranial hypertension is a major element of prognosis.

In Moroccan patients, predisposition to Behcet'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.

Resume La maladie de Behcet (MB) est une vascularite multisystemique caracterisee par l’association d’une aphtose buccogenitale a des manifestations systemiques diverses dont les plus importantes sont oculaires, nerveuses et vasculaires. L’association de la MB et de l’infection VIH/sida est rare. Le role du VIH dans la pathogenie de la MB est mal elucide. Nous rapportons l’observation d’un patient âge de 28 ans infecte par le VIH1 et qui a developpe une MB compliquee d’une thrombose veineuse profonde et d’une thrombose du sinus lateral gauche. Cette association rare pose des problemes therapeutiques et etiopathogeniques.

Resume Objectif – Nous rapportons la resistance a 11 antibiotiques de 156 souches de Staphylococcus aureus isolees a partir d'infections communautaires et de 189 isolees d'infections hospitalieres durant deux periodes au centre hospitalo-universitaire Ibn Rochd de Casablanca. Materiel et methodes – La resistance a la methicilline a ete detectee par screening en milieu gelose additionne de 6 mg/L d'oxacilline. La resistance aux autres antibiotiques a ete determinee par la technique de diffusion selon les normes NCCLS. Resultats – La resistance a la methicilline etait de 1,9% et de 45% chez S. aureus isole des infections communautaires et des infections hospitalieres respectivement. Les SARM sont multiresistants (gentamicine 84,7%, cotrimoxazole 51,2%, erythromycine 44,7%, acide fucidique 45,9%, ciprofloxacine 83,5%), et ont ete frequemment retrouvees dans les services de chirurgie (46,2%) durant la premiere periode et dans les unites de soins intensif (61%) durant la seconde periode. Les souches sont le plus souvent isolees a partir des hemocultures (34,1%), du pus (34,6%) et des pelevements bronchiques (27,1%).

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.

Behçet's disease is a multisystemic vasculitis characterized by the association of recurrent oral and genital ulcers with systemic involvements, particularly ocular, nervous and vascular manifestations. The association of Behçet's disease and aids/HIV infection is rare. The role of HIV infection in the pathomechanism of both diseases is unclear. We report a 28-year-old HIV-positive patient who presented Behçet's disease complicated by deep vein thrombosis and left lateral sinus thrombosis. This rare association raises questions about the etiopathogenic process and therapeutic management.

Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor discovered in the USA in 2001. It is currently the treatment of choice for patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus. Its antiretroviral efficacy and good tolerance are responsible for the higher frequency of prescriptions compared with other nucleoside analogs. However, it can induce acute renal toxicity causing impairment of the proximal tubular function of the kidney. This is highly dependent on factors such as associated co-prescription didanosine or a protease inhibitor "boosted" with ritonavir, preexisting renal insufficiency, low body weight, or presence of associated diabetes. In contrast, long-term renal toxicity remains highly debated. Some studies describe a decrease in estimated glomerular filtration rate during prolonged treatment with TDF. Others reported renal safety even during prolonged use. The differences between patients enrolled in the different studies, the measured parameters and their interpretation could explain these discrepancies. We describe a case of a patient infected with HIV, who presented with Fanconi syndrome with acute renal failure six months after starting antiretroviral treatment including tenofovir.

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.

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.

Introduction – objectifs Plusieurs milliers de migrants originaires de pays d’Afrique Subsaharienne transitent par le Maroc avant de tenter de passer en Europe. L’objectif de notre travail etait d’etudier les aspects epidemiologiques des pathologies infectieuses dans la population des migrants subsahariens. Materiels et methodes Etude retrospective descriptive sur 4 ans incluant tous les patients originaires des pays subsahariens ayant ete pris en charge dans le service de maladies infectieuses pour une infection virale, bacterienne, parasitaire ou mycosique. Resultats Nous avons collige 129 patients. La moyenne d’âge etait de 32,6 ans [16,78] avec une predominance masculine (70H/59F). Les patients etaient principalement d’origines ivoirienne dans 33 cas (25,58 %), congolaise dans 19 cas (14,72 %), Guineenne dans 16 cas (12,40 %), beninoise dans 13 cas (10,07 %), malienne dans 11 cas (8,52 %). Soixante patients etait en situation de sejour irreguliere (46,5 %). L’infection a VIH etait la plus frequente avec 63 cas (48,83 %) dont 29 (46 %) etait au stade C, suivie de 48 cas (37,20 %) de paludisme, quatorze cas (10,85 %) de tuberculose, neuf cas de HVB (10 %) dont 4 cas coinfection HIV/HVC. Dans les autres cas il s’agissait de : leishmaniose viscerale (1cas), meningite bacterienne (1 cas), fievre typhoide (1cas), pneumopathie bacterienne (1cas). Un suivi medical regulier est assure que chez 18 patients dont 17 pour infection a VIH et 1 pour hepatite B chronique. Nous avons enregistre 10 de deces lies a l’infection a VIH. Conclusion Les infections restent les principales pathologies chez les migrants subsahariens. Actuellement l’acces au titre de sejour facilite par les autorites marocaines permet d’ameliorer les conditions socioeconomiques des migrants et par consequent ameliorer l’acces aux soins.