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

Aspects épidémiologiques et cliniques de la leishmaniose cutanée à Kairouan-Tunisie et particularités chez l'enfant.

International audienceCutaneous leishmaniasis (CL) remains highly endemic in Tunisia. The governorate of Kairouan (Center) is one of the most affected particularly by zoonotic form due to Leishmania major. The purpose of this study was to describe the epidemiological, clinical and therapeutic features of the disease in this governorate and to identify any particularities in children. Three hundred and ninety cases were registered over 2 years (2012 and 2013). The average age was 29 years one month [± 22.7] (34.6% of patients were under 15 years). The cumulative incidence of CL was equal to 34.4 per 100,000 per year. It was higher in children (39.6 per 100,000 versus 29, p=0.004). Cases were diagnosed especially in autumn and winter (88.3% of cases between October and January, p<0.001). The average delay of consultation was one month and 22 days [± 2.5] after onset of lesions. The average number of lesions per patient was 2.7 [± 2.3] with a mean diameter equal to 2.2 cm. In addition to a higher incidence of the disease, two other features were found in "Children" group which are the presence of similar cases in the neighborhood (27.7% versus 13.4%, p=0.002) and preferential localization in the face (36.4% versus 11%) while the members were more affected in adults (63.5% versus 46.4%) (p<0.001). Meglumine antimoniate was prescribed for most of our patients (93.1%). The intramuscular route was used more than local one, probably because of high proportions of multiple lesions and facial localization.La leishmaniose cutanée (LC) reste fortement endémique en Tunisie. Le gouvernorat de Kairouan (Centre) est l’un des plus concerné particulièrement par la forme zoonotique à Leishmania major. L’objectif de cette étude était de décrire les aspects épidémiologiques, cliniques et thérapeutiques de la maladie dans le gouvernorat de Kairouan et d’identifier les particularités clinico-épidémiologiques chez l’enfant. Trois-cent-quatre-vingt-dix cas ont été colligés sur 2 ans (2012 et 2013) à partir des cas déclarés aux autorités sanitaires régionales. La moyenne d’âge était de 29 ans et un mois [± 22,7] (34,6 % des patients avaient moins de 15 ans). L’incidence cumulée globale de la LC était égale à 34,4/100 000 habitants et par an; plus élevée chez les enfants (39,6 versus 29 pour 100 000, p=0,004). Les cas étaient diagnostiqués surtout à la période automno-hivernale (88,3 % des cas entre octobre et janvier, p<0,001). Le délai moyen de consultation était de un mois et 22 jours [± 2,5] après l’apparition des lésions. Le nombre moyen de lésions par patient était de 2,7 [± 2,3] avec un diamètre égal à 2,2 cm en moyenne. En plus d’une plus forte incidence de la maladie, deux autres particularités ont été relevées dans le groupe « Enfants », à savoir la présence de cas similaires dans l’entourage (27,7 % versus 13,4 %, p=0,002) et une localisation préférentielle au visage (36,4 % versus 11 %) alors que les membres étaient davantage touchés chez l’adulte (63,5 % versus 46,4 %) (p<0,001). L’antimoniate de méglumine (AM) a été prescrit à presque tous nos malades (93,1 %). La voie intra musculaire a été plus utilisée que celle locale en raison probablement des proportions importantes de lésions multiples et de l’atteinte faciale

Rôle du virus Toscana dans les infections neuroméningées en Tunisie

International audienceOBJECTIVES: To detect the presence of Toscana virus (TOSV) circulation in Tunisia and to study its role in viral meningo-encephalitis.PATIENTS AND METHODS: A total of 315 (167 sera and 178 cerobrospinal fluid [CSF]) samples was investigated. These samples are colleted from Tunisian patients with neurological diseases during the period between January 2003 and December 2009. All samples were tested negative for enterovirus, Herpes Simplex virus and West Nile virus. Detection for IgM and IgG specific to TOSV was done by ELISA tests.RESULTS: Specific IgM for TOSV were detected in 10 % of patients with neurological diseases (31 cases). These recent infections were distributed throughout the study period and predominated during summer and automn. Patients were originated, in the majority from the coastal region. IgG were isolated in 22 cases (7 %) corresponding to previous infection.CONCLUSION: This is the first report of TOSV circulating in Tunisia and its frequent implication in neurological diseases. These results incited to include TOSV as one of the viral etiologies to target in the diagnosis of viral meningitis and encephalitis in the country.But de l’étude : Rechercher les témoins de l’éventuelle présence du virus Toscana (TOSV) en Tunisie et étudier son implication dans les infections neuroméningées dans le pays.Patients et méthodes : Au total, 167 prélèvements de sérums et 178 LCR collectés chez 315 patients, hospitalisés pour méningite ou méningo-encéphalite virale, ont été investigués. Ces prélèvements ont été collectés durant la période allant de janvier 2003 à décembre 2009 et ont été préalablement testés négatifs vis-à-vis des entérovirus, virus Herpes Simplex de type 1 et virus West Nile. La recherche des IgM et IgG spécifiques du TOSV a été faite par Elisa indirecte.Résultats : Dix pour cent (n = 31) de ces prélèvements se sont révélés positifs en IgM anti-TOSV ; ces cas sont répartis de façon homogène sur toute la période étudiée. Une infection ancienne a été détectée dans 7 % des cas (n = 22). L’infection neuroméningée à TOSV est plus fréquente chez l’homme (20/11), en période estivo-automnale et en zone côtière.Conclusion : Il s’agit là d’une première étude rapportant la circulation du TOSV en Tunisie et son rôle non négligeable dans les infections neuroméningées. Ces résultats nous incitent à une surveillance régulière avec recherche systématique d’une infection à TOSV devant toute atteinte neurologique. Il serait même intéressant de généraliser la recherche du TOSV à d’autres tableaux cliniques où il a été également impliqué comme le syndrome fébrile aigu ou le syndrome grippal type « grippe d’été »

BAFF is elevated in serum of patients with psoriasis: association with disease activity

International audienc

The State of Hepatitis B and C in the Mediterranean and Balkan Countries: Report from a Summit Conference

The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research