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Objectives. – The prevalence of mycotic infection seems to be higher among diabetic patients than in the non-diabetic population. The aims of this study were to determine the frequency of mycosis and to compare clinical and fungal results. Patients and methods. – This transversal study included 307 type 1 and 2 diabetic patients admitted between January 1998 and January 2000. A dermatologist examined all patients. The mean age was 44 ± 17 years and the duration of diabetes 8 ± 6 years. Patients with suspected lesions underwent mycological examination. Results. – Clinical signs of presumed fungal infection were found in 61% of patients, but mycosis was confirmed only in 30%. Fungal foot infection accounted 38% of the patients, mostly due to dermatophytes (94%). The commonest localizations of dermatophytes were interdigital (60%) followed by onychomycosis (30%). The main fungal agent was Trichophyton rubrum. The main risk factors for fungal infections were the age of patients (P = 0.0003) and duration of diabetes (P < 0.05). Interdigital foot localization of dermatophytes was correlated to age (P < 0.0001) and to the male gender (P < 0.01). The frequency of dermatophytes in nails was higher in type 2 diabetic patients (P < 0.01). Vulvovaginal candidosis and interdigital dermatophytes were more frequent in obese than in non-obese patients. The accuracy and specificity of direct examination were respectively 85% and 79%. Conclusion. – The high frequency of mycosis in diabetic patients at hospital is demonstrated. The main risk factors were age, male gender and obesity.

Resume Chez l’enfant, la sarcoidose est rare et peut revetir des aspects trompeurs. Les auteurs rapportent l’observation d’un enfant âge de 13 ans explore pour une fievre prolongee, un syndrome inflammatoire et des lesions cutanees. L’echographie abdominale a montre une hepatomegalie, des adenopathies mesenteriques et un nodule splenique. Le scanner thoracique a visualise des adenopathies hilaires bilaterales. La biopsie d’une adenopathie inguinale a conclu a une tuberculose caseofolliculaire. L’echec du traitement antituberculeux, la fievre elevee, la negativite de l’intradermoreaction a la tuberculine et les resultats de la biopsie cutanee ont fait suspecter le diagnostic de sarcoidose. Celui-ci a ete conforte par les resultats du lavage broncho-alveolaire, le taux eleve de l’enzyme de conversion de l’angiotensine et le controle de l’examen anatomopathologique. L’evolution sous corticotherapie a forte dose a ete favorable. La sarcoidose, meme si elle est rare chez l’enfant, doit etre evoquee devant une fievre prolongee et un syndrome inflammatoire important.

Summary Background Pemphigus foliaceus is an autoimmune blistering skin disease that partly results from genetic factors, especially human leucocyte antigen (HLA) class II genes. Objectives The aim of the study was to determine the HLA DR/DQ markers of susceptibility and protection in the Tunisian endemic form. Methods Genomic DNA from 90 patients with pemphigus foliaceus recruited from all parts of the country and matched by age, sex and geographical origin with 270 healthy individuals, was genotyped. Results Firstly, when the whole patient population was studied, DRB1*03, DQB1*0302 and DRB1*04 alleles were significantly associated with the disease while a significant decrease of, in particular, DRB1*11 and DQB1*0301 was observed in patients compared with controls. DRB1*0301 was the dominant allele in DR3-positive patients and controls, while DRB1*0402 was found in 42% of DR4-positive patients. Secondly, when the HLA DR/DQ allele distribution was studied after dividing patients according to their geographical origin, the southern group, which consisted exclusively of patients with the endemic form of the disease, showed the same associations as the whole pemphigus foliaceus population, particularly with DRB1*03. In the northern group, only the DRB1*04 and DQB1*0301 alleles were found to be associated. Interestingly, anti-desmoglein 1 antibody-positive healthy controls did not carry susceptibility alleles but, in contrast, most carried negatively associated alleles. Conclusions These observations indicate that a particular genetic background characterizes the Tunisian endemic form of pemphigus foliaceus and that HLA class II genes control the pathogenic properties of the autoimmune response rather than the initial breakage of B-cell tolerance.

To study by flow cytometry (FCM) the ploidy and the cellular cycle of nodular hidradenoma (NH) and hidradenocarcinoma (HC) and to assess the prognostic utility of this technique in such tumors.We studied retrospectively 2 HC and 11 NH one of which was considered as an atypical NH. Monoparametric study by FCM was realized on paraffin-embedded material. The extracted cells were marked by Propidium's lodure and cellular cycle was analyzed by the software Mod-Fit LT.Our study showed eleven 100% diploid profiles, 10 of which had low S-phase varying between 2 and 12%. All of these 11 tumors were NH. S-phase was high (23.79%) in a single case that corresponded to the atypical NH. Two tumors showed aneuploid profiles; these corresponded to the 2 HC.The results of the cytometric study suit perfectly to those of the histopathologic examination. FCM could so help to establish the prognosis of these tumors. But further studies are necessary to determine the value of this technique.

Syringocystadenoma papilliferum (SCAP) is a rare cutaneous adnexal neoplasm with variable clinical appearance and characteristic histology. It arises in about one third of cases within a sebaceous hamartoma (SH) and in this case, multiple other benign adnexal neoplasms may be associated with it. We report the clinical and pathological data of 8 cases of syringocystadenoma papilliferum. The age at the time of the diagnosis varied from 3 to 48 years with an average age of 28 years. Three tumors were localized in the scalp, 2 in the trunk, and 3 others of unusual locations: 1 in the eyelid, 1 in the thigh and 1 in the popliteal fossa. Histopathological examination revealed 3 SCAP occurring within SH. The SCAP observed in the eyelid was associated with an apocrine cystadenoma without features of SH. The four others were not associated with any other lesion.

The prevalence of mycotic infection seems to be higher among diabetic patients than in the non-diabetic population. The aims of this study were to determine the frequency of mycosis and to compare clinical and fungal results.This transversal study included 307 type 1 and 2 diabetic patients admitted between January 1998 and January 2000. A dermatologist examined all patients. The mean age was 44 +/- 17 years and the duration of diabetes 8 +/- 6 years. Patients with suspected lesions underwent mycological examination.Clinical signs of presumed fungal infection were found in 61% of patients, but mycosis was confirmed only in 30%. Fungal foot infection accounted 38% of the patients, mostly due to dermatophytes (94%). The commonest localizations of dermatophytes were interdigital (60%) followed by onychomycosis (30%). The main fungal agent was Trichophyton rubrum. The main risk factors for fungal infections were the age of patients (P = 0.0003) and duration of diabetes (P0.05). Interdigital foot localization of dermatophytes was correlated to age (P0.0001) and to the male gender (P0.01). The frequency of dermatophytes in nails was higher in type 2 diabetic patients (P0.01). Vulvovaginal candidosis and interdigital dermatophytes were more frequent in obese than in non-obese patients. The accuracy and specificity of direct examination were respectively 85% and 79%.The high frequency of mycosis in diabetic patients at hospital is demonstrated. The main risk factors were age, male gender and obesity.