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L Jemni

Publications and source records attributed to L Jemni.

At least 19 recordsLinked to original sources
PubMed2005

Clinical and laboratory features of murine typhus in central Tunisia: a report of seven cases.

INTRODUCTION: Murine or endemic typhus, caused by Rickettsia typhi, has been reported in all continents. In the 1970s, no cases of murine typhus were diagnosed in Tunisia. METHODS: The clinico-epidemiological characteristics of seven cases of murine typhus diagnosed at our hospitals since 1993 are reported. Diagnosis was confirmed by indirect fluorescence assay detecting specific R. typhi antibodies. RESULTS: Murine typhus occurred in all ages from 18-80 years during the hot season in rural areas. Clinical features were: sudden onset of fever and absence of eschar in all cases, with maculo-papular rash (five cases), prostration (four cases), meningism (three cases) and pneumonia (four cases). Frequent laboratory findings were moderate thrombopenia (four cases) and elevated transaminases (four cases). Before the results of serology, clinical diagnoses were Mediterranean Spotted Fever (four cases), Q fever (one case), pneumonia (one case), and lymphocytic meningitis (one case). Serology confirmed all diagnoses with cross-reactivity with Rickettsia conorii. CONCLUSION: Murine typhus exists in Tunisia and its prevalence is underestimated. Further, more specific studies are needed to evaluate the true prevalence.

Adolescent↗
PubMed2004

[Infectious endocarditis with negative blood cultures].

Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE). When negative, there are diagnostic and therapeutic problems. The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures. The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia). Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures. An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1). Therefore, in 41 cases (42%), the cause of IE was not determined. Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases. The main complication was cardiac failure (27 cases). The mortality was 14.5%. Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure. Early surgical indications and mortality were the same in both groups. This report confirmed the high frequency of IE with negative blood cultures. Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency. Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors.

Adolescent↗
PubMed2003

Evaluation of clinical diagnosis scores for Boutonneuse fever.

Mediterranean spotted fever (MSF) is endemic in Tunisia. Diagnosis is confirmed retrospectively based on serology. Clinical features are suggestive of diagnosis if the triad (fever, rash, and eschar) is present. Otherwise clinical diagnosis could be difficult. A diagnosis score was already proposed by Raoult et al. The aim of this study was to evaluate this score, considering only clinical parameters, in order to help clinicians in diagnosing MSF before confirmation. We retrospectively analyzed 62 consecutive charts of patients with diagnosis of suspected MSF. Diagnosis confirmation was made by serology (IgG anti-R. conorii exceeding 128 or seroconversion). Epidemiological and clinical features and total score for each patient were reviewed. To validate the clinical score, we calculated sensitivity, specificity and the Youden index for each score in order to establish the ROC curve. SPSS was used for these statistical tests. Area under curve was 0.70 (P = 0.02). The cutoff score with the most predictive value of MSF diagnosis was 18, according to our study (sensitivity 60%, specificity 84,6% and Youden index 0.44). The MSF diagnosis score is a helpful tool to aid the clinician with presumptive management before confirmation. In our study we demonstrated that a score based only on epidemiological and clinical features could be sufficient, but we have to indicate that these results and cutoff score of 18 were from a retrospective study and should be confirmed by a well-designed prospective one.

Animals↗
PubMed1996

[Neurological complications in adults following rabies vaccine prepared from animal brains].

OBJECTIVES: Despite well-known neurological complications, post-exposure semple-type rabies vaccine is still used in Tunisia. We retrospectively studied neurological manifestations following post-exposure rabies vaccine. METHODS: Over a 3-year period, semple-type phenol inactivated lamb nerve tissue vaccine (Pasteur Institute, Tunis) was given to 1392 adults after exposure to rabies. RESULTS: The frequency of neurological complications was 1/200. Seven patients presented complications 4 to 14 days after the first vaccine injection (median 11 days). Central nervous system manifestations occurred in all 7 patients with peripheral neuropathy in 5. Manifestations were meningoradiculitis (n = 3), meningomyeloradiculitis (n = 2), meningomyelitis (n = 1) and myelitis (n = 1). No vaccine-associated death occurred, but one patient suffered persistant paraplegia. CONCLUSION: Semple-type adult animal nerve tissue vaccine produces an unacceptable rate of severe post-vaccinal neurological complications in adults. Human diploid cell rabies vaccine should be used for post-exposure rabies vaccination.

Adolescent↗
PubMed1996

[Pyomyositis in adults in central Tunisia. Apropos of 10 cases].

Ten adult patients treated for pyomyositis between 1988 and 1994 in Sousse's university hospital (Tunisia) were retrospectively reviewed. Due to the non specific symptoms, the diagnosis was often delayed (mean = 17 days) and other primary diagnoses were considered, mainly including synovitis. The muscles around hip and thigh were most commonly involved (ten patients), and Staphylococcus aureus was the most common pathogen (nine patients). Ultrasonography was very helpful in the accurate diagnosis of the infection. Incision, drainage, and antibiotic therapy eradicated the infection in all patients. No residual functional limitations and no residual symptoms were noted. Our study showed that pyomyositis is present in central Tunisia and not associated with HIV infection. Clinical features and prognosis are similar to those previously described in the literature.

Adult↗
PubMed1994

Unusual presentation of gastric dilatation. Dramatic complete atrioventricular block.

We report a case of gastric dilatation in a ventilated 18-year-old woman, which was revealed by the acute onset of hypotension, sinus bradycardia, and complete atrioventricular block. Hypotension and cardiac rhythm disturbances resolved with intravenous injection of atropine, but recurred a few minutes later and required a second bolus of atropine, which had a transient beneficial effect. Only gastric decompression, as soon as gastric distention was recognized, was able to restore normal cardiac rhythm and adequate blood pressure. This case highlights the seriousness of gastric dilatation and argues for the vagal mechanism of cardiac rhythm and conduction troubles complicating gastric dilatation.

Adolescent↗
PubMed1993

[Superior caval syndrome in adults in central Tunisia. Apropos of 26 cases].

We report 26 cases of superior vena cava obstruction (SVC) observed in Sousse University Hospital (TUNISIA). The diagnosis was confirmed by CT scan and/or superior vena cava angiography. The underlying disease was revealed by SVC on 76.9% of cases. Malignant underlying disease was noted on 61.53% of cases. Non malignant causes of SVC was Behçet disease (4 cases) and mediastinal fibrosis (5 cases). SVC revealed Behçet disease in the 4 cases.

Adult↗
PubMed1992

[Kidney carbuncle: diagnostic, bacteriological and therapeutic considerations. Apropos of 11 cases].

Renal carbuncle is a cortical lesion following bacteremia, occurring in patient without any urologic known problems. The analysis of 11 consecutive renal carbuncles showed that one should consider the diagnosis of renal carbuncle in young patients with flank pain, fever, and absence of significant leucocyturia. Our study confirms that renal carbuncle is always caused by staphylococcus aureus and that treatment is based on appropriate antibiotherapy. Isolation of the bacteria was difficult unless ponction of carbuncle under ultrasound control was performed. The usefulness of ultrasonography for the diagnosis of renal carbuncle and for its distinction from other suppurative renal lesions is emphasized.

Adolescent↗