Retroperitoneal Abscess: A Rare Localization of Tubercular Infection

Incidence of tuberculosis infection has considerably increased during the past 20 years due to the HIV pandemic and continues to be one of the most prevalent and deadly infections worldwide. Extrapulmonary tuberculosis lacks specific clinical manifestation and can mimic many diseases. It can invade neighbouring tissue and form a big cyst with manifesting clinical symptoms. We describe a rare case of 31-year-old immunocompetent man affected by a retroperitoneal abscess secondary to tubercular infection. Exploratory laparotomy and histopathological examinations of tissue were required for achieving diagnosis of tuberculosis. No pulmonary or spinal involvement was identified. The patient was successfully treated with standard four-drug antitubercular therapy

Primary resistance to clarithromycin, metronidazole and amoxicillin of Helicobacter pylori isolated from Tunisian patients with peptic ulcers and gastritis: a prospective multicentre study

<p>Abstract</p> <p>Background</p> <p>The frequency of primary resistance to antibiotics in H. pylori isolates is increasing worldwide. In Tunisia, there are limited data regarding the pattern of H. pylori antibiotic primary resistance.</p> <p>Aim</p> <p>To evaluate the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and to detect the mutations involved in clarithromycin resistance.</p> <p>Materials and methods</p> <p>273 strains isolated from adults and children were enrolled. The primary resistance to clarithromycin, metronidazole and amoxicillin was evaluated by means of E-test minimal inhibitory concentration (MIC). The real-time PCR using Scorpion primers was performed in all cases to assess clarithromycin primary resistance and point mutations involved.</p> <p>Results</p> <p>No resistance to amoxicillin was detected. For adults, resistance to clarithromycin and metronidazole was found respectively in 14.6% and 56.8%, and respectively in 18.8% and 25% in children. Overall, the rates of global primary resistance to clarithromycin and metronidazole in Tunisia were respectively determined in 15.4% and 51.3%.</p> <p>By the use of Scorpion PCR, the A2143G was the most frequent point mutation observed (88.1%), followed by the A2142G (11.9%); the A2142C was not found and 18 of 42 patients (42.8%) were infected by both the resistant and the susceptible genotype.</p> <p>The association of clarithromycin resistance with gender was not statistically significant, but metronidazole resistant strains were isolated more frequently in females (67.8%) than in males (32.2%) and the difference was significant. As for gastroduodenal diseases, the difference between strains isolated from patients with peptic ulceration and those with non peptic ulceration was not statistically significant. When about the distribution of resistant strains to clarithromycin and metronidazole between the three Tunisian cities (Tunis, Menzel Bourguiba and Mahdia), the difference was not statistically significant.</p> <p>Conclusion</p> <p>Local data regarding the primary resistance of H. pylori to clarithromycin, metronidazole and amoxicillin and the main genetic mutation involved in clarithromycin resistance in vivo (A2143G) are necessary to prove a clear need for a periodic evaluation of antibiotic consumption and new therapeutic strategies in Tunisia in order to avoid the emergence of resistant strains.</p

Tolllike receptor 4 (TLR4) polymorphisms in Tunisian patients with Crohn's disease: genotype-phenotype correlation

<p>Abstract</p> <p>Background</p> <p>The immune responses to bacterial products through the pattern recognition receptor (PRR) play a pivotal role in pathogenesis of Crohn's disease. A recent study described an association between CD and some gene coding for bacterial receptor like NOD2/CARD15 gene and TLR4. In this study, we sought to determine whether TLR4 gene was associated with Crohn's disease (CD) among the Tunisian population and its correlation with clinical manifestation of the disease.</p> <p>Methods</p> <p>90 patients with CD and 80 healthy individuals are genotyped for the <it>Asp299Gly </it>and <it>Thr399Ile </it>polymorphisms by restriction fragment length polymorphism analysis.</p> <p>Results</p> <p>The allele and genotype frequency of the TLR4 polymorphisms did not differ between patients and controls. The genotype-phenotype correlation permitted to show that the <it>Thr399Ile </it>polymorphism was associated with early onset disease.</p> <p>Conclusion</p> <p>this study reported the absence of association between CD and TLR4 gene in the Tunisian population, but this gene could play a role in clinical expression of the disease.</p

: Journée d’études:Littérature tunisienne et révolution

La troisième table ronde, « Écrire et éditer depuis 2011 », a réuni Azza Filali et Abdelaziz Belkhodja autour de la modératrice Elisabeth Daldoul. Dans une intervention toute en poésie, l’écrivaine Azza Filali a défendu le droit de la littérature à rester en retrait, en décalage par rapport aux faits. L’écriture n’a pas pour mission d’expliquer le réel, mais de le transfigurer en captant l’essence de l’événement. C’est ce qui garantit sa liberté à l’égard des idées et des hommes. La liberté d’expression n’a donc pas véritablement modifié la façon d’écrire de l’écrivaine, l’imaginaire étant, selon elle, toujours libre. Abdelaziz Belkhodja, écrivain et éditeur (éditions Appolonia), a insisté sur le rôle croissant de l’écrit de façon plus large depuis 2011. Il a joué un rôle fédérateur par le biais d’internet ; le besoin de se réapproprier l’histoire et de réécrire les bases politiques et constitutionnelles a entrainé un retour aux textes fondamentaux. La révolution tunisienne a fait renaître la nécessité de l’écrit, sous des formes et des structures nouvelles. Les débats ont permis de poursuivre cette réflexion sur l’écrit et ses lecteurs. Selon Azza Filali, les bouleversements politiques n’ont pas provoqué un regain de la lecture et les formats et médias actuels font perdre à l’écrit sa dignité. D’autres ont soutenu qu’il fallait considérer la lecture dans ses nouvelles pratiques qui se rattachent à des textes plus courts. Enfin, la salle et les intervenants ont débattu du rôle des réseaux culturels étatiques et de l’enseignement dans le développement d’une lecture comme forme d’interaction et de socialisation

Rôle de la cellule épithéliale dans l’homéostasie intestinale et les maladies inflammatoires chroniques de l’intestin

La maladie de Crohn (MC) et la rectocolite hémorragique (RCH) sont les principales maladies inflammatoires chroniques de l’intestin (MICI), dont l’étiopathogénie est actuellement mal définie. Au cours de ces maladies, la participation de la cellule épithéliale dans l’installation et la pérennisation de l’inflammation intestinale est de plus en plus impliquée. En effet, l’épithélium intestinal, situé à l’interface entre le milieu intérieur tissulaire et la lumière intestinale, est le pivot des mécanismes de l’homéostasie de la barrière intestinale. Cet épithélium peut être schématiquement considérée comme constitué de trois « barrières » distinctes : une barrière physique, une barrière chimique et une barrière immunitaire. Cette fonction de barrière peut être altérée par différents mécanismes physiopathologiques, comme dans les MICI. Le rôle de la cellule épithéliale dans l’homéostasie intestinale et son implication dans les MICI sont analysés dans cette revue

Y a-t-il intérêt à doser les métabolites de l’azathioprine chez les malades ayant une maladie inflammatoire chronique de l’intestin ?

Objectif. Chercher s’il y a une relation entre les concentrations de 6-thioguanine nucléotide et des 6-méthyl mercaptopurine et l’efficacité clinique et les effets indésirables à travers une population de patients atteints de maladie inflammatoire chronique de l’intestin. Méthodes. Nous incluons des patients atteins de la maladie de Crohn ou de rectocolite hémorragique (RCH) traités par l’azathioprine pendant une durée minimale de 12 mois. Pour chaque patient, un dosage des métabolites a été réalisé. Résultats. Nous avons inclus 43 patients atteints de maladie de Crohn et 7 de RCH. L’azathioprine a été indiquée pour une cortico-dépendance dans 23 cas, pour prévenir les récidives post-opératoires dans 10 cas, pour maintenir une rémission clinique obtenue par un traitement médical chez 17 patients. Conclusion. Notre travail confirme la relation entre la concentration de la 6TGN et la survenue d’une myélo-toxicité

Association between CTLA-4 Gene Promoter (49 A/G) in Exon 1 Polymorphisms and Inflammatory Bowel Disease in the Tunisian Population

<b>Background/Aim:</b> To investigate the possible association between the polymorphism of the <i> CTLA-4 </i> exon 1 &#x002B;49 A/G and susceptibility to Crohn&#x2032;s disease (CD) and ulcerative colitis (UC) in the Tunisian population. <b> Methods:</b> The &#x002B;49 A/G dimorphism was analyzed in 119 patients with CD, 65 patients with UC, and 100 controls by the polymerase chain reaction-restriction fragment length polymorphism method. <b> Results:</b> Significantly higher frequencies of the <i> CTLA-4 </i> &#x002B;49A allele and A/A homozygous individuals were observed in patients with CD when compared with controls (pc = 0.0023 and pc = 0.0003, respectively). Analysis of <i> CTLA-4</i> A/G polymorphism with respect to sex in CD showed a significant difference in A/A genotypes between female patients and controls (pc = 0.0001 and pc = 0.038, respectively). There were no differences in the subgroups of patients with CD. <b> Conclusions:</b> Forty-nine A alleles and AA genotype are associated with CD susceptibility in Tunisians. Other genes involved in the T-cell regulation remain strong candidates for IBD susceptibility and require further investigation

The rhizome of the multidrug-resistant Enterobacter aerogenes genome reveals how new "killer bugs" are created because of a sympatric lifestyle.

International audienceHere, we sequenced the 5,419,609 bp circular genome of an Enterobacter aerogenes clinical isolate that killed a patient and was resistant to almost all current antibiotics (except gentamicin) commonly used to treat Enterobacterial infections, including colistin. Genomic and phylogenetic analyses explain the discrepancies of this bacterium and show that its core genome originates from another genus, Klebsiella. Atypical characteristics of this bacterium (i.e., motility, presence of ornithine decarboxylase, and lack of urease activity) are attributed to genomic mosaicism, by acquisition of additional genes, such as the complete 60,582 bp flagellar assembly operon acquired "en bloc" from the genus Serratia. The genealogic tree of the 162,202 bp multidrug-resistant conjugative plasmid shows that it is a chimera of transposons and integrative conjugative elements from various bacterial origins, resembling a rhizome. Moreover, we demonstrate biologically that a G53S mutation in the pmrA gene results in colistin resistance. E. aerogenes has a large RNA population comprising 8 rRNA operons and 87 cognate tRNAs that have the ability to translate transferred genes that use different codons, as exemplified by the significantly different codon usage between genes from the core genome and the "mobilome." On the basis of our findings, the evolution of this bacterium to become a "killer bug" with new genomic repertoires was from three criteria that are "opportunity, power, and usage" to indicate a sympatric lifestyle: "opportunity" to meet other bacteria and exchange foreign sequences since this bacteria was similar to sympatric bacteria; "power" to integrate these foreign sequences such as the acquisition of several mobile genetic elements (plasmids, integrative conjugative element, prophages, transposons, flagellar assembly system, etc.) found in his genome; and "usage" to have the ability to translate these sequences including those from rare codons to serve as a translator of foreign languages

Association of Fas/Apo1 gene promoter (-670 A/G) polymorphism in Tunisian patients with IBD

AIM: To detect a possible association between the polymorphism of the (-670 A/G) Fas/Apo1 gene promoter and susceptibility to Crohn’s disease (CD) and ulcerative colitis (UC) in the Tunisian population. METHODS: The (-670 A/G) Fas polymorphism was analyzed in 105 patients with CD, 59 patients with UC, and 100 controls using the polymerase chain reaction restriction fragment length polymorphism method. RESULTS: Significantly lower frequencies of the Fas -670 A allele and A/A homozygous individuals were observed in CD and UC patients when compared with controls. Analysis of (-670 A/G) Fas polymorphism with respect to sex in CD and UC showed a significant difference in A/A genotypes between female patients and controls (P corrected = 0.004 in CD patients and P corrected = 0.02 in UC patients, respectively). Analysis also showed a statistically significant association between genotype AA of the (-670 A/G) polymorphism and the ileum localization of the lesions (P corrected = 0.048) and between genotype GG and the colon localization (P corrected = 0.009). The analysis of inflammatory bowel disease patients according to clinical behavior revealed no difference. CONCLUSION: Fas-670 polymorphism was associated with the development of CD and UC in the Tunisian population