Osteite frontale post-sinusitique: Etude rétrospective à propos de 31 cas

Objective : Post-sinusitic frontal osteitis is defined as an extension of frontal sinus infection to the adjacent bony structures. It is an emergency that should rapidly be diagnosed and treated. The aim of this study is to analyze epidemiologic, clinical and paraclinical features, and to review different therapeutic modalities of this disease.Materials and methods : We carry a retrospective study about 31 patients diagnosed and treated between 1996 and 2010. All patients underwent complete ENT and neurological examination, biological investigations, sino-nasal and cerebral CT scan. Antibiotherapy was administrated intravenously. Surgical drainage of the frontal sinus was performed eitherby trephination, by osteoplastic flap confection, or by Lemoyne drain placement. Endonasal drainage consisted of middle meatotomy with anterior ethmoidectomy. Frontal sinus cranialisation was performed with coronal approach. Evolution was assessed on clinical, biological and radiological criteria.Results : Mean age was 24,4 years (8-62 years) and sex-ratio 4,16. Frontal headache (10 cases) and intracranial hypertension signs (8 cases) were the most frequent functional symptoms. Frontal tumefaction was noted in 9 patients, associated in 5 cases with orbital tumefaction of the internal eye angle. Rhinological signs were essentially purulent rhinorrhea(9 cases) and nasal obstruction (5 cases). Nasal endoscopy showed purulent secretions at themiddlemeatus in 12 cases. CT scan revealed a typical aspect of frontal osteitis with bony lysis. A sub-periostal abscess was associated in 7 patients. Intracranial extension was noted in 15 cases and orbital extension in 7 cases. Bacteriological examination was positivein 8 cases. Most frequent bacteria were streptococcus and staphylococcus aureus (3 cases each). Antibiotic therapy was initially administrated in all cases. Concerning initial surgical treatment, 9 patients underwent frontaldrainage and 2 others orbital drainage. On the other hand, 4 patients underwent only sub-periostal abscess drainage. This one was associated with cranialisation in another case. For patients having endocranial complications, empyema drainage was realized in 14 cases, associed in 6 of them with cranialisation. Cerebral abscess drainage was performedin one other patient. Clinical and radiological evolution was favourable in 24 patients (77,4%). The seven other patients were reoperated because of persistence or aggravation of clinical symptoms. Later evolution was favourable.Conclusion : Post-sinusitic frontal osteitis a rare and serious affection. Diagnosis, based on clinical and radiological features, should be early made. Adequate treatment have to be instituted to prevent life-threatening complications.Keywords : osteitis, frontal sinus, sinusitis, computed tomography, drainage, cranialisatio

Healed Lesions of Human Cutaneous Leishmaniasis Caused By Leishmania major Do Not Shelter Persistent Residual Parasites

In human cutaneous leishmaniasis (HCL) caused by Leishmania (L.) major, the cutaneous lesions heal spontaneously and induce a Th1-type immunity that confers solid protection against reinfection. The same holds true for the experimental leishmaniasis induced by L. major in C57BL/6 mice where residual parasites persist after spontaneous clinical cure and induce sustainable memory immune responses and resistance to reinfection. Whether residual parasites also persist in scars of cured HCL caused by L. major is still unknown. Cutaneous scars from 53 volunteers with healed HCL caused by L. major were biopsied and the tissue sample homogenates were analyzed for residual parasites by four methods: i) microscope detection of amastigotes, ii) parasite culture by inoculation on biphasic medium, iii) inoculation of tissue exctracts to the footpad of BALB/c mice, an inbred strain highly susceptible to L. major, and iv) amplification of parasite kDNA by a highly sensitive real-time PCR (RT-PCR). Our results show that the scars of healed lesions of HCL caused by L. major do not contain detectable residual parasites, suggesting that this form likely induces a sterile cure at least within the scars. This feature contrasts with other Leishmania species causing chronic, diffuse, or recidivating forms of leishmaniasis where parasites do persist in healed lesions. The possibility that alternative mechanisms to parasite persistence are needed to boost and maintain long-term immunity to L. major, should be taken into consideration in vaccine development against L. major infection

First report of naturally infected Sergentomyia minuta with Leishmania major in Tunisia

International audienceBackground: Many sand fly species are implicated in the transmission cycle of Leishmania parasites around the world. Incriminating new sand flies species, as vectors of Leishmania is crucial to understanding the parasite-vector transmission cycle in different areas in Tunisia and surrounding countries. Findings: Seventy-four unfed females belonging to the genera Sergentomyia and Phlebotomus were collected in South Tunisia between June and November 2014, using sticky papers. PCR-RFLP (Restriction Fragment Length Polymorphism) analysis of the internal transcribed spacer 1 (ITS1) was used for Leishmania parasites detection and identification. Leishmania (L.) major (Yakimoff & Shokkor, 1914) was identified within two Sergentomyia (S.) minuta (Rondani, 1843) and one Phlebotomus papatasi (Scopoli, 1786). Conclusion: This is the first report of L. major identified from S. minuta in Tunisia. This novel finding enhances the understanding of the transmission cycle of L. major parasites of cutaneous leishmaniasis in an endemic area in South Tunisia