Tunisian Toxoplasma gondii strains genotyping by the use of AK69 marker

<p>Abstract</p> <p>Background</p> <p>Clinical manifestation due to infection by <it>Toxoplasma gondii </it>is closely linked to the infecting strain of the parasite. Several genetic markers are available to determinate its genotype but few of them are able to discriminate between the three predominant lineages, namely types I, II and III. The number of markers decreases when atypical, recombinant/mixed genotypes need to be identified.</p> <p>Findings</p> <p>In our study, the contribution of sequence polymorphisms in the AK69 gene as typing markers for <it>T. gondii </it>was investigated for the first time in an epidemiological study. The coding region of the marker was amplified, sequenced and aligned for different <it>Toxoplasma </it>strains. The identified nucleotide polymorphism at 12 positions was able to highly discriminate between the different congenital toxoplasmosis Tunisian strains. Moreover the high detection sensitivity level of the marker enabled unambiguous identification of mixed/recombinant genotypes directly.</p> <p>Conclusion</p> <p>It can be, thus, very useful for direct typing in areas where such genotypes are frequently encountered, mainly in the African continent.</p

Toxoplasma gondii infection and toxoplasmosis in North Africa: a review

Toxoplasmosis is an important zoonosis caused by an obligate intracellular parasitic protozoan, Toxoplasma gondii. The disease is distributed worldwide and can affect all warm-blooded vertebrates, including humans. The present review aimed to collect, compile and summarize the data on the prevalence of T. gondii infection in humans and animals in the five North African countries (Morocco, Algeria, Tunisia, Libya and Egypt). Published data from national and international databases were used. Distribution patterns and risk factors for T. gondii infection are discussed, focusing on biotic and abiotic factors. This review is a comprehensive epidemiological analysis of T. gondii infection in North Africa and will therefore be a useful tool for researchers. It can also be used to propose or enhance appropriate national toxoplasmosis control programs

Spatio-temporal analysis of the grombalia aquifer dynamics--northern east of Tunisia

International audienceAquifer maps are key tools for water resources management, and allow to characterize awater table distribution and variability. The Grombalia plain in the northeast part of Tunisia was studied to identify the origin of groundwater recharge and to specify the type of recharge in the whole study area. It aims to investigate the impact of recharge schemes on the piezometric evolution of the water table. Furthermore, the purpose is to investigate the origin and dominant factor of the recharge. The methodology of this work includes two methods of analysis of the dynamics of the piezometric heads of this aquifer, namely the interpretation of piezometric maps for an evaluation of the spatial evolution and the study of piezometric sections. Both methods allow to distinguish between the different types of recharge, show which recharge sources is the most important in supplying the groundwater. In addition, they permit to analyze in detail the piezometric evolution and the impact of the various hydraulic structures on the piezometry. Without forgetting the naturel recharge coming directly from the soil surface and depending on the permeability, there is another natural recharge which comes from flooding areas. In Grombalia groundwater, this natural recharge occurs mainly at Wadi Ejjorf, Wadi Sidi Toumi and Wadi Ejdida sites. This recharge is accented for rainy years and mainly after flooding events. This study shows the picks at all the recharge sites between 1999 and 2009. However, an overexploitation of the aquifer was observed in Soliman-Fondok Jedid, Boucharray, Bou Argoub, which presented local depression zones. The used methodologies are very important tool to choose the best recharge site and allow to adjust the hydrodynamic models. In fact, there is an urgent need for assessing various aspects of ground water resources through a process of systematic data collection, analysis and synthesis

Nodular glomerulosclerosis in patients' without history of diabetes mellitus: a case report

INTRODUCTION: Diabetic nephropathy can occur during the course of both type1 and type 2 diabetes mellitus. The characteristic lesions are diffuse or nodular (Kimmelsteil-Wilson) diabetic glomerulosclerosis. The reported cases represent unusual presentations of diabetes mellitus. CASE PRESENTATION: We report the case of a 49-year-old man without prior history of diabetes mellitus who presented with rapidly progressive renal failure and whose renal biopsy revealed nodular (Kimmelsteil-Wilson) glomerulosclerosis lesions characteristic of diabetes. CONCLUSION: Renal manifestations of diabetes mellitus may antedate other more common presenting symptoms of this disease and we critically review the literature on this subject

PLA2R antibody, PLA2R rs4664308 polymorphism and PLA2R mRNA levels in Tunisian patients with primary membranous nephritis.

BackgroundPrimary membranous nephritis (PMN) is an autoimmune disease induced by the deposit of antibodies (Ab) to the phospholipase receptor A2 receptor (PLA2R) on podocytes. In this context, we aimed to assess the relationships between anti-PLA2R Ab, PLA2R rs4664308 SNP, PLA2R mRNA levels and PMN susceptibility and outcome.MethodsSixty-eight PMN patients, 30 systemic lupus erythematosus (SLE) patients with secondary MN and 30 healthy control subjects served for anti-PLA2R Ab measurement by ELISA and PLA2R rs4664308 SNP genotyping by a commercial real-time PCR. Twenty patients with tubulo-interstitial nephritis (TIN) were used as controls for renal PLA2R mRNA quantification in PMN patients from kidney biopsies. PLA2R mRNA quantification was carried-out by real-time PCR after RNA extraction.ResultsForty-three (63.2%) PMN patients received initial therapy consisting of alternating monthly cycles of corticosteroids and cyclophosphamide. Twelve (17.6%) patients had resistant PMN to initial therapy and were consecutively treated by cyclosporine or tacrolimus. Anti-PLA2R Ab were positive in 54 (79.4%) PMN patients, while all SLE patients and controls were negative, pConclusionAnti-PLA2R Ab and renal PLA2R mRNA could be useful markers for PMN outcome predicting. The PLA2R rs6446308 SNP is associated with PMN susceptibility in Tunisians

Renal amyloidosis in ankylosing spondylitis: A monocentric study and review of literature

Secondary renal amyloidosis (RA) is the most common type of renal involvement in ankylosing spondylitis (AS). We assessed the epidemiologic and clinico-biological profile of AS patients with RA, to analyze treatment modalities and prognostic aspects, and to determine predictive factors of RA during AS. This was a retrospective study including 13 cases of RA among 212 cases who presented with AS, during the period from 1978 to 2006. The median age of the patients at the time of diagnosing AS was 47 years (range: 19–67). There were 11 males and two females. RA onset was diagnosed after a mean follow-up of 144.6 months (range: 10–505) from the AS diagnosis. We noted erosive peripheral arthritis, lumbar stiffness with bamboo spine, and coxitis in 23.1%, 76.9%, and 30.8% of cases, respectively. Nephrotic syndrome was found in eight patients (61.5%). At the time of diagnosing RA, six patients had renal failure. Amyloid deposits were histologically proven by salivary gland biopsy in six cases (46.1%) and by renal biopsy in seven cases (53.8%). Four patients received a long-course treatment with colchicine but with a good outcome only in two cases. In our series, AS was more severe among patients with RA. Four predictive factors of RA were identified: smoking (P = 0.04), erosive peripheral arthritis (P = 0.002), bamboo spine (P = 0.001), and biologic indicators of inflammation (P = 0.0001). High erythrocyte sedimentation rate was identified as the only independent risk factor of RA during AS (P = 0.0001). Renal function as well as urinalysis should be monitored at regular intervals to detect early renal involvement during AS

Facteurs pronostiques de l’atteinte rénale au cours du Purpura Rhumatoïde de l’adulte au Centre Hospitalier et Universitaire de Tunis / Pronostic factors of Henoch Schönlein nephritis in Tunis university hospital: Pronostic factors of Henoch Schönlein nephritis in Tunis university hospital

Context and objective. IgA vasculitis is a leukocytoclastic vasculitis with IgA deposits characterized by the association of cutaneous, articular and digestive involvements. Renal involvement worsens the pronostic of the disease. The main objective of this work was to identify the risk factors of end-stage renal failure in Tunisian adults with IgA vasculitis.&nbsp;Methods. From 1975 to 2017, patients with IgA vasculitis and nephritis were studied retrospectively. All the patients benefited from a renal biopsy classified histologically according to Pillebout.&nbsp;Results. Thirty-four adult patients (mean age at nephritis onset: 39 ± 17.6y) mainly men, were included. Risk factors for progression to end stage renal disease were: edema (p=0.002), oligoanuria (p=0.003), initial renal impairment (p=0.001), anemia (p=0.010), hyperuricemia (p=0.015), class IV (p=0.018), crescents (p=0.018) and interstitial fibrosis (p=0.017).&nbsp;Conclusion. The outcome of renal involvement during IgA vasculitis is relatively poor. Renal involvement conditions the long-term prognosis of the disease. The identification of clinical, biological and histological risk factors of end stage renal failure would improve its management. Contexte et objectif. Le purpura rhumatoïde est une vascularite leucocytoclasique à dépôts d’IgA caractérisée par l’association de signes cutanés, articulaires et digestifs. L’atteinte rénale fait la gravité de la maladie. Le principal objectif de ce travail était d’identifier les facteurs prédictifs de la maladie rénale chronique stade 5 chez des patients ayant un Purpura Rhumatoïde avec atteinte rénale.&nbsp;Méthodes. Nous avons étudié de façon rétrospective les observations de patients ayant présenté un purpura rhumatoïde avec atteinte rénale colligés de 1975 à 2017. Les lésions histologiques ont été classées selon la classification de Pillebout.&nbsp;Résultats. Nous avons colligé 34 patients adultes atteints de Purpura Rhumatoïde avec atteinte rénale. L’âge moyen des patients était de 39 ± 17,6 ans avec une prédominance masculine. Les facteurs prédictifs de la Maladie Rénale Chronique stade 5 étaient : les œdèmes (p=0,002), l’oligoanurie (p=0,003), l’insuffisance rénale initiale (p=0,001), l’anémie (p=0,010), l’hyperuricémie (p=0,015), la classe histologique IV (p=0,018), les croissants (p=0,009) et la fibrose interstitielle (p=0,017).&nbsp;Conclusion. L’atteinte rénale au cours du Purpura Rhumatoïde conditionne le pronostic à long terme. Sa recherche doit être systématique afin de prévenir ou de ralentir l’évolution vers la maladie rénale chronique stade 5

Risk factors and consequences of delayed graft function

The impact of delayed graft function (DGF) on the outcome of renal transplantation remains controversial. We analyzed the risk factors for DGF and its impact on graft and patient survival. A total of 354 renal transplants performed between June 1986 and April 2000 were analyzed. Variables analyzed included donor and recipient age, method and duration of renal replacement therapy, HLA mismatch, cold and warm ischemia times, biopsy-confirmed acute rejection, length of stay in the hospital, serum creatinine at the end of first hospitalization as well as graft and patient survival at one, three, five and ten years. The study patients were divided into two groups: patients with DGF (G1) and those without DGF (G2). DGF occurred in 50 patients (14.1%), and it was seen more frequently in patients transplanted from deceased donors (60% vs. 40%, P <0.0001). The cause of DGF was acute tubular necrosis, seen in 98% of the cases. Univariate analysis showed a statistically significant difference between the two groups G1 and G2 in the following parameters: average duration on dialysis (52.3 vs. 36.4 months, P = 0.006), HLA mismatch (44.9% vs. 32.11% P = 0.015), donor age (35.9 vs. 40.2 years, P = 0.026), cold ischemia time (23 vs. 18.2 h, P = 0.0016), warm ischemia time (41.9 vs. 38.6 mn, P = 0.046), length of stay in the hospital during first hospitalization (54.7 vs. 33.2 days, P <0.0001), serum creatinine at the end of first hospitalization (140 vs. 112 μmol/L, P <0.0001) and at three months following transplantation (159 vs. 119 μmol/L, P = 0.0002). Multivariate analysis revealed the following independent risk factors for DGF: deceased donor (RR = 13.2, P <0.0001) and cold ischemia time (RR = 1.17, P = 0.008). The graft survival at one, three, five and ten years was 100%, 93%, 88.3% and 78.3% in G1 versus 100%, 95.9% 92.8% and 82.3% in G2; there was no statistically significant difference. The patient survival at one, three, five and ten years was 100%, 91.3%, 83.6% and 74.4% in G1 versus 100%, 95.9%, 94% and 82.6% in G2 with a statistically significant difference (P = 0.04). Prolonged cold ischemia time and transplantation of kidneys from deceased donors were the main risk factors for DGF in our study. Also, DGF significantly affected patient survival but had no influence on graft survival

Molecular Investigation of Distal Renal Tubular Acidosis in Tunisia, Evidence for Founder Mutations

International audienceBackground: Distal renal tubular acidosis (dRTA) is a rare genetic disease caused by mutations in different genes involved in the secretion of H+ ions in the intercalated cells of the collecting duct. Both autosomal dominant and recessive forms have been described; the latter is also associated with sensorineural hearing loss. Methods: Twenty-two Tunisian families were analyzed for mutations in the ATP6V1B1 and ATP6V0A4 genes by direct sequencing. Dating of the founder mutations was performed. Results: Two founder mutations in the ATP6V1B1 gene were found in 16/27 dRTA cases. The p.Ile386Hisfs*56 founder mutation was estimated to be older than 2400 years and no correlations were found with deafness. For the remaining patients, two mutations in the ATP6V0A4 gene, one of them being novel, were found in three Tunisian cases. The presence of a heterozygous missense mutation p.T30I, of the ATP6V1B1 gene, was identified in six patients, while no mutations of the second gene were detected. No deleterious mutations of either ATP6V1B1 or ATP6V0A were found for the two probands. Conclusion: Our study gives evidence of phenotypic and genotypic heterogeneity of dRTA in the Tunisian population. Five different mutations were found, two of them were due to a founder effect, and screening of these mutations could provide a rapid and valuable tool for diagnosis of dRTA