Molecular analysis of HBV genotypes and subgenotypes in the Central-East region of Tunisia

<p>Abstract</p> <p>Background</p> <p>In Tunisia, country of intermediate endemicity for Hepatitis B virus (HBV) infection, most molecular studies on the virus have been carried out in the North of the country and little is known about other regions. The aim of this study was to determine HBV genotype and subgenotypes in Central-East Tunisia. A total of 217 HBs antigen positive patients were enrolled and determination of genotype was investigated in 130 patients with detectable HBV DNA. HBV genotyping methods were: PCR-RFLP on the pre-S region, a PCR using type-specific primers in the S region (TSP-PCR) and partial sequencing in the pre-S region.</p> <p>Results</p> <p>Three genotypes (D, B and A) were detected by the PCR-RFLP method and two (D and A) with the TSP-PCR method, the concordance between the two methods was 93%. Sequencing and phylogenetic analysis of 32 strains, retrieved the same genotype (D and A) for samples with concordant results and genotype D for samples with discordant results. The sequences of discordant genotypes had a restriction site in the pre-S gene which led to erroneous result by the PCR-RFLP method. Thus, prevalence of genotype D and A was 96% and 4%, respectively. Phylogenetic analysis showed the predominance of two subgenotypes D1 (55%) and D7 (41%). Only one strain clustered with D3 subgenotype (3%).</p> <p>Conclusions</p> <p>Predominance of subgenotype D7 appears to occur in northern regions of Africa with transition to subgenotype D1 in the East of the continent. HBV genetic variability may lead to wrong results in rapid genotyping methods and sequence analysis is needed to clarify atypical results.</p

DRESS syndrome : étude de 11 cas et revue de la littérature

Objectif. Analyser les particularités épidémiologiques, cliniques, biologiques et chronologiques du drug rash with eosinophilia and systemic symptoms (DRESS) et préciser les différents médicaments impliqués. Méthodes. Étude rétrospective portant sur toutes les observations du DRESS notifiées à l’unité de pharmacovigilance de Monastir. Résultats. Onze patients âgés en moyenne de 40 ans chez qui l’examen clinique révélait une éruption cutanée fébrile. La biologie objectivait une hyperéosinophilie chez tous les patients, une atteinte hépatique cytolytique chez huit patients et une élévation du taux sérique de la créatinine chez quatre patients. Un syndrome interstitiel pulmonaire a été noté chez deux patients. L’évolution était favorable chez tous les patients. Les tests cutanés médicamenteux se révélaient positifs vis-à-vis de la carbamazépine et le céfotaxime et négatifs vis-à-vis de la sulfasalazine, l’allopurinol et la terbinafine. Conclusion. Les tests cutanés médicamenteux nous ont permis non seulement d’identifier le médicament incriminé mais aussi d’étudier la réactivité croisée et nous soulignons la possibilité de néo-sensibilisation à un médicament non apparenté chimiquement au médicament ayant initialement induit l’épisode du DRESS

Amoxicillin-Induced Hypersensitivity After DRESS To Carbamazepine

The anticonvulsant hypersensitivity syndrome, also known as drug rash eosinophilia and systemic symptoms (DRESS), is a rare but severe form of adverse cutaneous reaction. Several aromatic anticonvulsant drugs, such as carbamazepine (CBZ), phenytoin, or phenobarbital have been frequently associated with the onset of DRESS. Cross-reactivity among the aromatic anticonvulsants frequently occurs (40 to 80% of patients). However, cross reactivity with other drugs such as betalactams have exceptionally been reported. We report a clinical observation describing a DRESS associated with CBZ with a subsequent hypersensitivity to amoxicillin (AMX). A 34-year-old male with a 20-year history of epilepsy was treated with valproic acid and phenobarbital. As he had frequent convulsive fits, CBZ was added. Thirty-four days later, the patient developed hyperthermia (39.5°C), cervical lymphadenopathy, and generalized cutaneous exfoliated maculae and papulae. Biochemical investigation was characterized by a white cell count of (16.1 × 103/μL, 17% eosinophils) and increased levels of aspartate aminotransferase and alanine aminotransferase (50 and 116 IU/L, respectively). CBZ was discontinued. One month later, all the symptoms were progressively relieved. Six weeks after complete recovery, prick and patch skin tests were performed. They were strongly positive at 48-hour reading. About 2 years later, the patient exhibited an extensive pruritic skin rash, 2 days after AMX intake. Laboratory exams showed eosinophilia (7%) but neither elevated liver enzymes nor renal dysfunction. All these symptoms have disappeared 5 days after AMX withdrawal. Intradermal test to AMX was positive but not to other betalactams. Throughout this clinical observation, we report a CBZ-induced DRESS and describe the possibility of cross reactivity between CBZ and AMX. This cross reactivity was observed despite the lack of chemical similarity between both drugs. Keywords: hypersensitivity, amoxicillin, co-sensitization, DRESS, carbamazepine, skin test

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) Probably Induced by Cefotaxime: a Report of Two Cases

We report two cases, one of a 52-year-old man and one of a 32-year-old man, who were treated with cefotaxime. On day 23 and day 28 of the treatment, respectively, the patients manifested clinically with fever, pruriginous skin rash, and facial edema. Blood tests showed marked eosinophilia and atypical lymphocytosis for both patients, and hepatic cytolysis only in the second patient. Cefotaxime was discontinued in both patients; the clinico-biological picture improved gradually and completely disappeared approximately 4 weeks later. Six weeks after complete recovery, both patients underwent intradermal testing which was positive to cefotaxime (2 mg/ml) at the 48-hour reading and negative to benzylpenicillin, amoxicillin, and cefazolin at the 20-minute and 48-hour readings. These clinical pictures suggest drug rash with eosinophilia and systemic symptoms (DRESS) induced by cefotaxime. To the best of our knowledge, only one case of cefotaxime-induced DRESS has been reported in the medical literature. Thus, we add two new cases of cefotaxime-induced DRESS and emphasize the usefulness and safety of intradermal testing in establishing the diagnosis

Les vaccins anti A(H1N1) en Tunisie : efficacité et tolérance

Objectif. Étudier l’efficacité et la tolérance des deux spécialités de vaccins anti grippe A(H1N1) disponibles en Tunisie : Focetria® et Panenza®. Méthodes. Étude épidémiologique prospective réalisée auprès de 601 sujets vaccinés. L’évaluation de l’efficacité s’est basée sur la survenue d’un épisode grippal post vaccinal. L’évaluation de la tolérance a été établie par l’étude d’événements imprévisibles post vaccination. L’imputabilité des événements indésirables a été réalisée selon la méthode de Bégaud et al. Résultats. Les sujets vaccinés par Focetria® étaient plus nombreux que ceux par Panenza®. L’efficacité de ces vaccins serait de 93,6 %. La survenue d’un épisode grippal post vaccin serait indépendante du terrain sous jacent ainsi que du type du vaccin utilisé. Nous avons enregistré 406 événements indésirables (32,4 %) avec un haut degré d’imputabilité (I3). Les événements indésirables sont plus fréquents chez les sujets vaccinés par Focetria® que ceux par Panenza® (p = 0,009). L’évolution des effets indésirables était favorable dans la majorité des cas. Conclusion. Les deux vaccins utilisés en Tunisie demeurent assez efficaces pour lutter contre la pandémie de la grippe A(H1N1) et bien tolérés et ce indépendamment des caractéristiques démographiques et pathologiques des sujets vaccinés ainsi que de la nature du vaccin utilisé