A Seropositive Nodular Rheumatoid Polyarthritis without Arthritis: Does It Exist?

The rheumatoid polyarthritis is the most frequent chronic polyarthritis. It affects essentially the woman between 40 and 60 years. Rheumatic subcutaneous nodules and tenosynovitis are usually associated with seropositive symptomatic rheumatoid polyarthritis. It is, however, rare that they constitute the essential clinical expression of the disease. In this case, it makes dispute another exceptional form of rheumatoid arthritis such as rheumatoid nodulosis. A 60-year-old woman was hospitalized for tumefaction of the dorsal face of the right hand evolving two months before. The clinical examination found subcutaneous nodules from which the exploration ended in rheumatoid nodules with tenosynovitis. The evolution after four years was favourable under corticosteroid therapy, methotrexate, and colchicine

Cellulitis in aged persons: a neglected infection in the literature

Cellulitis is a frequent soft tissue and skin infection. The lower limbs are affected in 70 to 80% of cases. Cellulitis in aged persons is not yet well described in literature. A retrospective descriptive study conducted in the Internal Medicine Department of Sahloul hospital in Sousse in Tunisia. It included patients whose age was up to 65 years old admitted into hospital for cellulitis of the legs, the arms or the face. One hundred fifty eight patients with a mean age of 73 years old (range: 65 to 94 years old) were included. Female to male sex ratio was 0.68. Among them, we noted diabetes mellitus in 81 cases (50.6%). The infection was located in the lower limbs in 155 cases (98%), in the face in two cases (1.3%) and in the upper limb in one case (0.7%). Twenty one patients (13.3%) presented with severe cellulitis and one presented with necrotizing fasciitis. All patients received intra venous antibiotic therapy. Surgical treatment was indicated in 14 cases. Cefazolin was prescribed in 77 cases (48%). Favorable evolution was noted in 144 patients (91.1%). Forty four patients (27.8%) received prophylactic antibiotics. Prevention of skin and soft tissue infection is a crucial step to preserve health in aged persons.Keywords: Cellulitis, aged person, diabetes, necrotizing fasciitis, antibiotic, surger

Epidemiological study of bacterial meningitis in Tunisian children, beyond neonatal age, using molecular methods: 2014-2017

Background: Since the 1990s, the epidemiology of bacterial meningitis worldwide has changed thanks to vaccination. In Tunisia, the main causative pathogens were Streptococcus pneumoniae , Neisseria meningitidis and Haemophilus influenzae serotype b (Hib). Only Hib vaccination was available during our study period. Objectives: We performed a laboratory case report based-study of suspected bacterial meningitis in Northern Tunisia from January 2014 to June 2017. Methods: CSF samples obtained from children beyond neonatal age with suspicion of meningitis were tested by two real time PCRs, targeting pneumococcus, meningococcus and Hib, and conventional methods. Results: Using real-time PCR, 63 were positive including ten supplementary cases compared to conventional methods. A general decrease of bacterial meningitis cases was demonstrated comparing to previous data. Pneumococcus was predominant (69.84%) followed by meningococcus (28.57%) and Hib (1.59%). The main serotypes were 14, 19F, 6B and 23F for pneumococcus and serogroup B for meningococcus. Most cases occurred during cold season and children under one year were the most affected by bacterial meningitis. Conclusion: Our study suggests the predominance of pneumococcal cases. It may provide valuable data on meningitis epidemiology before the introduction of pneumococcal vaccine, which may be useful for future evaluation

Emergence and dominance of CTX-M-15 extended spectrum beta-lactamase among Escherichia coli isolates from children

Of forty-seven extended-spectrum cephalosporin-resistant Escherichia coli isolates, collected from children at the Children’s Hospital in 2006 (Tunis, Tunisia), we analyzed 32 isolates that were genotypically different by enterobacterial repetitive intergenic consensus -polymerase chain reaction. For all isolates, the double-disk diffusion test revealed synergy between clavulanate and cefotaxime and/or ceftazidime, suggesting the production of extended-spectrum beta-lactamases. Polymerase chain reaction experiments, performed on plasmid DNA, and sequencing revealed the presence of blaTEM-1B (26 isolates, 81%), blaTEM-34(IRT-6) (3 isolates, 9%), blaSHV-12 (2 isolates, 6%), and blaCTX-M-15 (31 isolates, 97%). Further, the insertion sequence ISEcp1 was found upstream from the blaCTX-M-15 gene in 11 isolates. The bla genes were found alone or in various combinations in a single isolate. blaTEM-1B and blaCTX-M-15 genes were detected in 26 out of the 32 isolates. Three isolates harbored both blaTEM-34(IRT-6) and blaCTX-M-15. blaSHV-12 was identified either alone or with blaCTX-M-15 in a single isolate. Our investigation showed the dominance of CTX-M-type extended-spectrum beta-lactamases, with CTX-M-15 particularly common, and to our best knowledge, this is the first report of the coexistence of CTX-M-15 and IRT-6 in E. coli isolates from children in Tunisia.Fil: Réjiba, Samia. Université Tunis El-Manar; Túnez. Hôpital d’Enfants; TúnezFil: Mercuri, Paola Sandra. Universite de Liege; BélgicaFil: Power, Pablo. Universite de Liege; Bélgica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Kechrid, Amel. Hôpital d’Enfants; Túne

Genome characteristics of Bordetella pertussis isolates from Tunisia

The genomic sequence data generated in this work were submitted to the European Nucleotide Archive and are available from the International Nucleotide Sequence Database Collaboration (NCBI/ENA/DDBJ) databases under project accession number PRJEB27412 and run data accession numbers ERS2572942 to ERS2572951.International audienceThe recent increase in pertussis cases observed in some countries may have several causes, including the evolution of Bordetella pertussis populations towards escape of vaccine-induced immunity. Most genomic studies of B. pertussis isolates performed so far are from countries that use acellular vaccines. The objective was to analyse genomic sequences of isolates collected during the 2014 whooping cough epidemic in Tunisia, a country where whole-cell vaccines are used. Ten Tunisian isolates and four vaccine strains were sequenced and compared to 169 isolates from countries where acellular vaccines are used. Phylogenetic analysis showed that Tunisian isolates are diverse, demonstrating a multi-strain 2014 epidemic peak, and are intermixed with those circulating in other world regions, showing inter-country transmission. Consistently, Tunisian isolates have antigen variant composition observed in other world regions. No pertactin-deficient strain was observed. The Tunisian B. pertussis population appears to be largely connected with populations from other countries

Seroprevalence of pertussis among healthcare workers: A cross-sectional study from Tunisia

International audienceThis cross-sectional study aimed to assess pertussis seroprevalence among healthy healthcare workers (HCW) of the Children's Hospital of Tunis, Tunisia. During the study period, 236 blood samples were obtained to determine HCW exposure to pertussis. Concentrations of immunoglobulin G (IgG) to pertussis toxin (PT) were measured using a commercial enzyme-linked immunosorbent assay. Cut-offs values used were 40 and 100 IU/ml, respectively indicative of an infection within the last year and a current/recent infection. Overall, seropositivity rate was 11.4% (95% CI 7.4-15.5) and 2.5% (95% CI 0.5-4.6) of ELISA results were indicative of a current infection. Seroprevalence was significantly most important in nurses (p = 0.03) and in participants aged 21-31y (p = 0.009). Our study confirmed that pertussis is circulating in hospital settings and affecting Tunisian HCW, in close contact with infants. Therefore, a booster dose of acellular pertussis vaccine needs to be considered

Pertussis epidemiology in Tunisian infants and children and characterization of Bordetella pertussis isolates: results of a 9-year surveillance study, 2007 to 2016

International audiencePurpose. Pertussis remains a public health concern in most countries. Our study aimed to prospectively explore the epidemiology of pertussis in the Tunis area of Tunisia between 2007 and 2016, and to characterize the virulence-associated genes of the collected Bordetella pertussis isolates.Methodology. Infants and children hospitalized at the Children’s Hospital of Tunis, Tunisia, between 2007 and 2016 for suspicion of pertussis were enrolled in the study. Culture and real-time PCR (qPCR) assays targeting IS481, IS1001, recA, H-IS1001 and ptxP were used to confirm the pertussis diagnosis. Phenotypic and genotypic characterization of recovered isolates was performed.Results/Key findings. A total of 1844 children were included in the study. Overall, 306 children (16.6 %) with Bordetella infection were confirmed by qPCR. Among them, 265 (86.6 %) were confirmed as having B. pertussis (IS481+, ptxP+, H-IS1001−), 18 (5.9 %) as having Bordetella parapertussis (IS481−, IS1001+) and 11 (3.6 %) as having Bordetella spp. (IS481+, ptxP−, H-IS1001−). No Bordetella holmesii (IS481+, IS1001−, H-IS1001+) was identified. The estimated pertussis incidence in the Tunis area was 134/100 000 in children aged less than 5 years. Two epidemic peaks were observed in 2009 and 2014. Ten B. pertussis isolates were cultured and characterized. Deficiency in pertactin expression was not observed, and genotyping of the isolates revealed a predominant allelic profile: ptxP3-ptxA1-prn2-fim2-1-fim3-2.Conclusion. This study demonstrated that pertussis is still present as a cyclical disease in Tunisia, despite high primo-vaccination coverage with a pertussis whole-cell vaccine. The predominant genotype of Tunisian B. pertussis isolates is similar to isolates circulating in countries using the acellular vaccine