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Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.

Introduction: In this multicenter study on subjective cognitive decline (SCD) in community-based and memory clinic settings, we assessed the (1) incidence of Alzheimer's disease (AD) and non-AD dementia and (2) determinants of progression to dementia. Methods: Eleven cohorts provided 2978 participants with SCD and 1391 controls. We estimated dementia incidence and identified risk factors using Cox proportional hazards models. Results: In SCD, incidence of dementia was 17.7 (95% Poisson confidence interval 15.2-20.3)/1000 person-years (AD: 11.5 [9.6-13.7], non-AD: 6.1 [4.7-7.7]), compared with 14.2 (11.3-17.6) in controls (AD: 10.1 [7.7-13.0], non-AD: 4.1 [2.6-6.0]). The risk of dementia was strongly increased in SCD in a memory clinic setting but less so in a community-based setting. In addition, higher age (hazard ratio 1.1 [95% confidence interval 1.1-1.1]), lower Mini–Mental State Examination (0.7 [0.66-0.8]), and apolipoprotein E ε4 (1.8 [1.3-2.5]) increased the risk of dementia. Discussion: SCD can precede both AD and non-AD dementia. Despite their younger age, individuals with SCD in a memory clinic setting have a higher risk of dementia than those in community-based cohorts. © 2018 The Authors

Le but de notre travail est l’etude de la prevalence de l’infection par le parvovirus B19 (PVB19) humain au cours des eruptions febriles de l’enfant. L’etude a concerne 257 enfants âges de 7 mois a 15 ans presentant une eruption febrile non liee a la rougeole ni a la rubeole. Nous avons cherche, par un test immunoenzymatique Elisa, les anticorps specifiques du PVB19 de type IgM et IgG chez ces enfants. La prevalence en IgG et en IgM dans notre population etait de 44 % et de 11,3 % respectivement. Cliniquement, les enfants seropositifs en IgM avaient presente un erytheme infectieux (13/29 cas), une myocardite aigue, une encephalite aigue, une anemie severe chez sept enfants drepanocytaires et sept autres un deficit immunitaire cellulaire. Le taux d’incidence de l’infection par ce virus etait de 11,3 %, et la majorite de ces primo-infections est survenue entre les mois de mai et d’aout. La tranche d’âge la plus touchee est 10–15 ans (21 %). La prevalence des IgG varie et augmente avec l’âge, elle passe de 38,2 % chez l’enfant en âge prescolaire (19 mois–4 ans) a 53,5 % pour les enfants entre quatre ans et demi et neuf ans, pour atteindre 58 % chez l’enfant âge de 10 a 15 ans. Les quatre facteurs de risque de l’infection par le PVB19 sont: la tranche d’âge quatre ans et demi–neuf ans (p = 0,0018), le genre feminin chez l’enfant âge de 19 mois a 4 ans (p = 0,037), les antecedents de transfusions et le deficit immunitaire (respectivement p = 0,022 et p = 0,001). L’etude de la prevalence du PVB19 montre que l’infection s’acquiert tot dans l’enfance, augmente avec l’âge, et sa transmission est favorisee par la vie en collectivite. Du fait de la vaccination generalisee antirougeole et antirubeole, la recherche systematique du PVB19 au cours des fievres eruptives prend toute son importance.

Summary The overall performance of quantitative assays in the detection of anti-Toxoplasma IgG is satisfactory, but discrepancies between assays are not uncommon especially when IgG concentrations are close to the limit of detection of the tests. The purpose of our study was to identify soluble and membrane antigens extracted from Toxoplasma gondii tachyzoites by immunoblot to select the most relevant antigenic bands to be used for qualitative serodiagnosis of acquired toxoplasmosis. We selected five relevant bands (98, 36, 33, 32 and 21 kDa) with soluble antigens and four relevant bands (42, 35, 32 and 30 kDa) with membrane antigens which gave high sensitivity and/or specificity in immunodiagnosis. The association on the same blot of at least three of the five relevant bands in the soluble antigen immunoblot showed the highest sensitivity/specificity (97·4%/99·0%, respectively). Our results indicate that immunoblot using soluble tachyzoite extract with simultaneous detection of at least three of the five bands (98, 36, 33, 32 and 21 kDa) represents a valuable test for serodiagnosis of acquired toxoplasmosis and should be further evaluated as a confirmatory test for sera which give discrepant results in quantitative assays.

Resume Les techniques serologiques communement utilisees dans le diagnostic de la toxoplasmose exposent a des difficultes dans l’interpretation des titres des immunoglobulines G (IgG) a la limite de la detectabilite ou discordants entre les tests utilises. Objectif Le but de ce present travail etait d’evaluer l’apport de l’immunoblot dans la detection des IgG specifiques dans la toxoplasmose acquise de l’immunocompetent et particulierement dans le cas des titres d’IgG douteux ou discordants en enzyme-linked immunosorbent assay (Elisa) et/ou en immunofluorescence indirecte (IFI). Materiel et methodes Nous avons teste trois groupes de serums. Le premier est forme par 87 serums positifs, le deuxieme par 33 serums negatifs et le dernier par 29 serums douteux. Resultats L’analyse des resultats obtenus avec le premier et le deuxieme groupe nous a permis d’identifier les bandes 30 kDa et 32 kDa comme marqueurs de l’infection toxoplasmique. La presence simultanee de ces deux bandes sur un blot a une sensibilite de 91,56 %, une specificite de 96,96 %, une VPP de 98,70 %, une VPN de 74,40 % et un indice de Youden de 0,88. Nos resultats suggerent que la presence de ces deux bandes est un critere fiable pour la confirmation de la presence d’IgG anti-toxoplasmiques dans le serum correspondant. L’immunoblot nous a permis de conclure quant au statut immunitaire de 27 (93,1 %) patients du troisieme groupe ou la serologie etait equivoque ou discordante selon l’Elisa et/ou l’IFI. Conclusion L’immunoblot est d’un apport important dans la detection des titres d’IgG douteux ou discordants.

During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmid-mediated CMY-16 β-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6′)-Ib′ enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C 2 of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C 2 , unusual antibiotic resistance genes (e.g., aphA-6 ), and their genetic environments. Further investigation suggested that deletions, acquisition of the IS CR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C 2 plasmid which underwent a remarkable evolution during the epidemic period.

Chronic hepatitis B virus (HBV) infection occurs in association to a deregulation of immune system. Human leukocyte antigen E (HLA-E) is an immune-tolerant nonclassical HLA class I molecule that could be involved in HBV progression. To measure soluble (s) HLA-E in patients with chronic HBV hepatitis (CHB). We tested the potential association of HLA-E*01:01/01:03 AG gene polymorphism to CHB. Our cohort consisted of 93 Tunisian CHB patients (stratified in CHB with high HBV DNA levels and CHB with low HBV DNA levels) and 245 healthy donors. Plasma sHLA-E was determined using enzyme-linked immunosorbent assay (ELISA). Genotyping was performed using polymerase chain reaction sequence-specific primer. No association between HLA-E*01:01/01:03 AG polymorphism and HBV DNA levels in CHB patients was found. G/G genotype is less frequent in CHB patients without significance. sHLA-E is significantly enhanced in CHB patients compared with healthy controls (P = 0.0017). Stratification according to HBV DNA levels showed that CHB patients with low HBV DNA levels have higher sHLA-E levels compared with CHB patients with high HBV DNA levels. CHB patients with G/G genotype have enhanced sHLA-E levels compared with other genotypes (P = 0.037). This significant difference is maintained only for CHB women concerning G/G genotypes (P = 0.042). Finally, we reported enhanced sHLA-E in CHB patients with advanced stages of fibrosis (P = 0.032). We demonstrate, for the first time, the association of sHLA-E to CHB. Owing to the positive correlation of HLA-E*01:01/01:03 AG polymorphism and the association of sHLA-E to advanced fibrosis stages, HLA-E could be a powerful predictor for CHB progression. Further investigations will be required to substantiate HLA-E role as a putative clinical biomarker of CHB.

Aims: The aim of this study was to investigate the genetic relatedness between Candida albicans isolates and to assess their nosocomial origin and the likeliness of cross-transmission between health care workers (HCWs) and hospitalized neonates in a neonatal intensive care unit (NICU). Methods: We retrospectively analysed 82 isolates obtained from 40 neonates and seven isolates from onychomycosis of the fingers of five HCWs in a Tunisian NICU by using pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA (RAPD) analysis with CA1 and CA2 as primers. Results: In RAPD analysis, the discriminatory power (DP) of CA1 and CA2 primers was 0·86 and 0·81, respectively. A higher DP was achieved by combining patterns generated by both primers (0·92), while PFGE karyotyping exhibited the lowest DP (0·62). The RAPD-CA1/CA2 analysis revealed that 65·8% of isolates obtained from neonates derived from a limited number (6) of groups of genetically identical strains, that five temporal clusterings occurred during the study period and that three HCWs’ isolates and 11 isolates obtained from six neonates were identical. Conclusions: These findings argue for the nosocomial transmission of C. albicans in our NICU and for the transfer of strains from HCWs to patients. Significance and Impact of the Study: Identification of relatedness between Candida species obtained from neonates and health care workers by using molecular techniques with high discriminatory power is essential for setting up specific control measures in order to reduce the incidence of nosocomial candidiasis.

Resume L’infection urinaire (IU) de l’enfant est une pathologie grave qui necessite une prise en charge rapide et efficace. Les donnees bacteriologiques et epidemiologiques jouent un role determinant dans la prise en charge du patient. Nous rapportons une etude retrospective qui s’etale du 1er janvier au 31 aout 2009, ayant concerne les enfants hospitalises dans le service de pediatrie du CHU Farhat Hached de Sousse (Tunisie) pour IU. Notre serie a comporte 51 enfants avec un sex-ratio de 0,76, un âge moyen de 32 mois. La majorite des cas etait des pyelonephrites (94,1 %). Une pathologie est associee a l’IU dans 41,2 %. Trois cas de reflux vesico-ureteral ont ete notes. Le diagnostic d’IU a ete confirme par l’examen cytobacteriologique des urines (ECBU). Les enterobacteries etaient isolees dans 96,1 %. Escherichia coli vient au premier rang (80,4 %), suivi de Klebsiella pneumoniae (9,8 %) puis de Proteus mirabilis (5,9 %). E. coli etait resistante a l’amoxicilline dans 78 % des cas, a l’association amoxicilline-acide clavulanique dans 64,8 % des cas, aux cephalosporines de 3e generation (C3G) dans 5 % et au cotrimoxazole dans 51 %. Aucune souche de K. pneumoniae ou de P. mirabilis n’etait resistante aux C3G. L’IU de l’enfant est toujours une indication a la realisation en premiere intention d’un ECBU. Les resultats de cet examen sont tres importants compte tenu de la diversite des bacteries responsables et de la frequence grandissante de la resistance acquise aux antibiotiques.

Candida albicans has become an important cause of nosocomial infections in neonatal intensive care units (NICUs). The aim of the present study was to compare C. albicans strains isolated from neonates (NN) suffering from systemic candidosis and from nurses in order to determine the relatedness between NN and health workers' strains. Thirty-one C. albicans strains were isolated from 18 NN admitted to the NICU of the neonatology service of Farhat Hached Hospital of Sousse, Tunisia and suffering from systemic candidosis, together with five strains recovered from nurses suffering from C. albicans onychomycosis. Two additional strains were tested, one from an adult patient who developed a systemic candidosis and the second from an adult with inguinal intertrigo. All strains were karyotyped by pulsed-field gel electrophoresis (PFGE) with a CHEF-DR II system. Analysis of PFGE patterns yielded by the 38 strains tested led to the identification of three pulsotypes that were designated I, II and III, and consisted of six chromosomal bands with a size ranging from 700 to >2500 kbp. The most widespread was the pulsotype I, which was shared by 17 NN and the five nurses' strains. The identity between NN and nurses' strains is very suggestive of a nosocomial acquisition from health-workers.

Cytotoxic chemotherapy suppresses the haematopoietic system, febrile neutropenia is the most serious haematological toxicity associated with the risk of life-threatening infections. We present a retrospective study of 200 episodes of febrile neutropenia in 128 patients treated in department of medical oncology. The aim of this study was to determinate the clinical, therapeutic and evolutive characteristics in patients treated essentially for solid tumors. Among these patients, 72% of them have at least two episodes, the median age was 34 years with extremes six and 75 years. It has been noticed that 26.3% of patients have diabetes, the dominate neoplasm was solid tumors in 79.7%, 65% of patients have received preventive colony-stimulating factors, 83% have received preventive buccal disinfection with antifungic. The median duration of hospitalisation was 12 days, the median delay of febrile neutropenia was 10 days with extremes two and 31 days, median duration of febrile neutropenia was 5.45 days with extremes one and 24 days. Among these cases, 9.45% of them have nadir zero, 68% of patients have clinical documented infections, ORL in 47% of cases. According to the study, 12% of cases have documented microbiological fever, the sites was urinary in 33% of cases, blood in 33% of cases, derm in 30% of cases. The microbe was staphylococcus negative coagulase in 37.5% essentially in blood and derm, the Escherichia coli in 20.8% essentially in urinary and blood. First line antibiotherapy was cefotaxim associated with amikacine in 93.5%, second line antibiotherapy was association of imipenam and amikacine in 82% of cases. Among these cases,7% of them have received anti-staphylococcus, and antifungic treatment in 50% of cases. The thermic defervescence was obtained in median delay of 2.8 days. We have noted nine deaths (22% of cases). Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality and costs. The colony-stimulating have used effectively in a variety of clinical settings to prevent or treat febrile neutropenia and to assist patients receiving dose-intensive chemotherapy.

Resume Objectif Determiner le taux de portage maternel de streptocoque du groupe B a terme et rechercher les eventuels facteurs predictifs de ce portage. Patientes et methodes Un prelevement vaginal et anal ont ete realises de maniere prospective chez 294 parturientes lors de l'entree en salle de travail pour accouchement. Resultats Le taux de portage etait de 12,92 % (38 cas). Aucun des facteurs de risque etudies (âge, niveau d'etude, nulliparite, antecedent d'interruption volontaire de grossesse, de fausse couche spontanee, de grossesse extra-uterine, de mort fœtale in utero, de pyelonephrite gravidique, de menace d'accouchement premature de diabete gestationnel et de grossesse gemellaire) n'etait statistiquement predictif du portage maternel du SGB. Tous les SGB isoles etaient sensibles a la penicilline G. Disucssion et conclusion Il parait souhaitable d'instaurer une politique de depistage systematique a proximite du terme chez toutes les femmes enceintes.

The aim of the study is to evaluate the prevalence of specific antibodies anti-human parvovirus B19 (PVB19) immunoglobulin M (IgM) and IgG in children with fever and rash. This study involved 257 children aged from 7 months to 15 years with febrile rash unrelated to measles and rubella (seronegative for IgM). The sera were examined by immunoenzymatic assay. Detection of antibodies of PVB19 was done by enzyme-linked immunosorbent assay (Elisa). In our study, prevalence of immunoglobulin G (IgG) and IgM were 44 and 11.3%, respectively. Clinically, children with positive IgM serology had submitted an erythema infectiosum (13/29 cases), myocarditis (1 case), encephalitis (1 case), severe sickle cell anemia (7 cases), and immunocompromised (7 cases). The incidence rate of viral infection was 11.3%; most of the cases of PVB19 infection occurred between the months of May and August. Incidence was higher in the 10-15 years age group (21%). The prevalence of IgG antibody varied and increased with age, it rises from 38.2% in preschool children (19 months-4 years) to 53.5% in those aged between 4.5 and 15 years, reaching 58% in the 10-15 years age group. The four risk factors of PVB19 infection are: (1) those aged between 4.5 and 9 years, which is the most affected age group (P = 0.0018); (2) female gender in children aged between 19 months and 4 years (P = 0.037); (3) transfusion and (4) immune deficiency (P = 0.022 and P = 0.001, respectively). The study of the prevalence of PVB19 infection shows that viral infection is acquired early in childhood, increases with age; viral transmission is favored by the community life. Because of the widespread vaccination program against measles and rubella, the systematic search of PVB19 in front of eruptive fevers becomes important.

We present recent data on the bacteriological profile and antibiotic susceptibility of uropathogenic bacteria isolated in children and newborns in our region over the past 2 years.A retrospective study on the positive urine cultures from pediatric and neonatal populations during 2012-2013. Bacteria were identified using conventional methods. Susceptibility testing was performed and interpreted as recommended by the committee of the susceptibility of the French Society of Microbiology (CA-SFM).We collected 1879 non-redundant bacteria with more than 73% Escherichia coli. Children and infants (mean age, 32 months [range, 1 month to 14 years]) accounted for 84% of the bacteria collected and newborns (mean age, 12 days [range, 1 day to 1 month]) 16%. A female predominance was observed in the pediatric population (M:F sex ratio, 3.2), whereas for the neonatal population, the proportions were almost identical in both sexes (M:F sex ratio, 1.1). Most of the positive urine cultures (n=1234) were from the community. Hospitalized patients (n=636) were divided into pediatric (60%) and neonatal units (40%). Five bacterial genera dominated the bacteriological profile: E. coli, Klebsiella sp., Proteus sp., Enterobacter sp., and Enterococcus. The susceptibility of the main BUP antibiotics used for treatment of frequent UTI showed the effectiveness of furadoine, imipenem, fosfomycin, and colistin. Amoxicillin kept constant activity against Enterococcus and Streptococcus agalactiae. The rates of resistance of Enterobacteriaceae to beta-lactam antibiotics were high, especially in the neonatal population. The production of extended-spectrum beta-lactamase (ESBL) was noted in 12.8% of pediatric Enterobacteria vs. 22.6% of the neonatal strains. For community Enterobacteriaceae, the activity of beta-lactam antibiotics was limited with 11.2% resistance to third-generation cephalosporins (C3G), including 8.6% ESBL production.The impact of widespread use of beta-lactam antibiotics in neonatal and pediatric environments is felt. Colistin, imipenem, and fosfomycin are the most frequently used antibiotics active against bacteria responsible for neonatal and pediatric UTI; however, they cannot be used as probabilistic treatment. Nitrofurans seem to be active antibiotics on UTI, but they present limits in their use in neonatal and pediatric populations. Their indication in case of pyelonephritis should be discussed.

Previous studies have indicated that neopterin is synthesized in vitro by human monocyte-derived macrophages and dendritic cells upon stimulation with gamma interferon (IFN-γ). Neopterin production under specific conditions in vitro has also been obtained upon stimulation with IFN-α and/or IFN-β. However, it is unknown if any IFN-γ-independent neopterin synthesis is possible in vivo. In the present study we investigated the serum neopterin concentrations in patients affected by the syndrome of Mendelian susceptibility to mycobacterial disease (MSMD). Indeed, this syndrome is characterized by deeply impaired or absent IFN-γ production or function due to severe mutations in molecules involved in IFN-γ/interleukin-12 (IL-12)/IL-23-dependent pathway. Serum neopterin levels were measured by an enzyme-linked immunosorbent assay in 27 patients with MSMD. We found that serum neopterin levels are elevated in the complete absence of IFN-γ activity due either to a complete deficiency of its receptor or to deleterious mutations of IL-12 or its receptor. These data clearly indicate that, as reported from in vitro studies, other stimuli are able to induce neopterin synthesis in vivo. Consequently, neopterin cannot be used as means of diagnosis of MSMD due to IFN-γ-, IL-12-, and IL-23-dependent pathway defects.

To determine the role and importance of beta-haemolytic streptococci in acute pharyngitis and its relative susceptibility to antibiotics, we cultured samples from 143 patients [age range: 3-72 years] who presented over a 5-month period in 2001 at three primary health care centres in Sousse, Tunisia. The cultures yielded 80 beta-haemolytic streptococci [59 group A streptococci and 21 non-group A streptococci]. All strains were susceptible to benzylpenicillin, amoxicillin, chloramphenicol, rifampicin and pristinamycin. Susceptibility was variable in erythromycin, tetracycline, fosfomycin, telithromycin and levofloxacin. Minimum inhibitory concentrations were determined by E-test for penicillin, erythromycin and levofloxacin. Our results confirm that penicillin is still the reference treatment for acute pharyngitis. However, to minimize the potential for complications arising from its use, continued vigilance is required

Resume Objectif. – Explorer une bouffee epidemique d’infections nosocomiales neonatales a Klebsiella pneumoniae producteur de betalactamase a spectre etendu par genotypage. Patients et methodes. – Pendant une periode de 25 jours, une bouffee epidemique nosocomiale a Klebsiella pneumoniae producteur de betalactamase a spectre etendu a interesse 14 nouveau-nes en unite de soins intensifs. Nous avons realise une exploration epidemiologique etayee par la determination du genotype bacterien obtenu par electrophorese en champs pulses. Nous avons teste la sensibilite des souches a 17 antibiotiques. Resultats. – Vingt-et-une souches de Klebsiella pneumoniae producteur de betalactamase a spectre etendu ont ete collectees. Elles se repartissaient en trois groupes genomiques. La cefoxitine, la colistine, l’imipeneme, l’amikacine et les quinolones ont ete actifs sur l’ensemble des souches. Tous les patients infectes sont decedes. La surcharge de travail a ete a l’origine d’une defaillance de l’hygiene du service avec en particulier la contamination de produits de transfusion, principal facteur incrimine dans la survenue de l’epidemie. Conclusion. – Une bouffee epidemique nosocomiale neonatale multiclonale a Klebsiella pneumoniae producteur de betalactamase a spectre etendu a ete rapportee pour laquelle l’insuffisance d’hygiene et le manuportage ont ete incrimines a la suite d’une surcharge de travail.

Resume But de l’etude Le virus de la choriomeningite lymphocytaire (CMLV) est un arenavirus transmis par les rongeurs, virus souvent meconnu d’infection congenitale severe. L’incidence de l’infection durant la grossesse reste imprecise. Le but de notre etude est d’estimer la frequence de l’infection a CMLV chez des femmes enceintes dans un contexte de malformation neurologique fœtale d’origine indeterminee. Materiel et methodes Les prelevements de 160 femmes enceintes obtenus durant trois ans ont ete retrospectivement analyses : 155 serums maternels, 150 liquides amniotiques (LA) et 12 sangs fœtaux (SF). Des anomalies neurologiques congenitales avaient ete diagnostiquees, mais les serologies Torch ainsi que la culture des LA ou SF etaient negatives. Un dosage de l’interferon alpha ete effectue pour tous les LA et SF. Pour realiser les tests serologiques, des cellules L929 ont ete infectees par la souche Armstrong du CMLV. Les anticorps de type IgG et IgM anti-CMLV ont ete recherches par technique d’immunofluorescence en utilisant ces cellules infectees. Resultats Aucune serologie positive n’a ete retrouvee parmi les 317 prelevements etudies y compris ceux ayant un interferon alpha eleve. Conclusion L’atteinte congenitale par le CMLV parait encore rare en France. Neanmoins, a la lumiere de la litterature recente, il faut penser a cet agent teratogene devant toute atteinte congenitale d’origine indeterminee, notamment lors d’une exposition a des rongeurs.

The determination of the accurate immune status of pregnant women is crucial in order to prevent congenital toxoplasmosis. Equivocal results with conventional serological techniques are not uncommon when IgG titers are close to the cut-off value of the test, so that a confirmatory technique is needed. For this purpose, we developed a homemade immunoblot (IB) using soluble extract of Toxoplasma gondii tachyzoites and assessed it by testing 154 positive, 100 negative, and 123 equivocal sera obtained from pregnant women. In order to select the more valuable bands in terms of sensitivity and specificity, we used the Youden Index (YI). The highest YIs were those given by the 32, 36, 98, 21, and 33 bands. The simultaneous presence on the same blot of at least 3 bands showed a much higher YI (0.964) and was adapted as the positivity criterion. The analysis of results showed that our homemade IB correlated well with the commercial LDBIO Toxo II IgG® kit recently recommended as a confirmatory test (96.7% of concordance).

This study is the first one that describes the situation of Legionnaires' disease (LD) in Tunisia, with its clinical and epidemiological characteristics and investigates the risk factors associated with Legionella infections in our country. We conducted a retrospective multicentric study during 5 years (2008-2012) concerning all confirmed LD cases in Tunisia and we investigated risk factors for infection. The total of confirmed LD cases was 14. Incidence was 0.03. Mean age: 53.1, sex ratio (M/F): 2.6. Summer-autumnal peak was noted. Risk factors for infection were: the great humidity at home (n=4), living in community (n=3) and practice ablutions (before prayer) in public places (n=4). Community acquired legionellosis (n=9) and nosocomial (n=2). Pulmonary symptoms (n=11)+/-gastrointestinal (n=6) and/or neurological signs (n=4). Beta lactams therapy failed (n=11). CXR showed bilateral lesions (n=6). Abnormalities in laboratory values were noted: hyponatremia (n=9), high CPK levels (n=9). Diagnosis was confirmed by positive urinary Legionella antigens test (n=10) and by direct immunofluorescence (n=1). Treatment was based on bitherapy (n=10). Five patients died. The incidence of LD appears lower than other countries. Some risk factors, as ablutions, are different from that reported in Western countries and seem to be specific to our society. Given the seriousness of its consequences, it is strongly recommended to improve the national surveillance system up and register LD as notifiable disease.

Resume Objectif Le but de cette etude etait d'identifier le profil bacteriologique des septicemies neonatales et de mieux guider l'antibiotherapie de premiere intention ateriel et methodes Nous rapportons une etude retrospective de 202 cas de septicemies a hemo-culture positive chez des nouveau-nes hospitalises au service de reanimation neonatale de Sousse (Tunisie) durant une periode de trois ans (1991–1993) Resultats Les deux tiers des germes rencontres, tout âge confondu, etaient des bacilles a Gram negatif. Le tiers des germes restants etait represente par les cocci a Gram positif. Dans les septicemies d'origine maternofœtale, les germes etaient Echerichia Coli dans 18,4 % des cas, Streptocoque B dans 14,18 % des cas, et Klebsiella dans 11,3 % des cas. Dans les infections postnatales tardives communautaires, les germes en cause etaient Echerichia coli (28,2 %), Enterobacter (23 %), Klebsiella (10 %) et Proteus (10 %). En revanche, dans les infections postnatales nosocomiales, les germes etaient domines par Klebsiella (45,45 %), Pseudomonas sp. (22,7 %), Enterobacter sp. (13,3 %) Commentaires L'antibiotherapie de premiere intention doit etre adaptee a l'ecologie microbienne de l'unite, ainsi nous proposons l'association ampicilline avec cefotaxime et amikacine dans les infections aternofotales, cefotaxime et amikacine dans les infections postnatales communautaires et amika-cine avec un antibiotique autre que les cephalosporines de troisieme generation tel que l'imipeneme dans les infections postnatales nosocomiales

Resume Sur une periode de trois annees (1992–1994) et a travers l'etude de 7 833 enterobacteries non redondantes isolees de differents produits pathologiques au CHU F. Hached de Sousse, nous avons caracterise 338 souches resistantes aux cephalosporines de troisieme generation. Il s'agit de 166 Klebsiella , 62 Escherichia coli , 47 Salmonella , 43 Enterobacter , 10 Proteus , 6 Citrobacter , 3 Serratia et une Shigella . Parmi ces souches, 93 ont ete isolees a partir d'hemocultures et 9 de liquides cephalorachidiens. Les patients infectes sont essentiellement des nouveau-nes (44 %) et des enfants (23,6 %). L'ofloxacine, l'amikacine et la colimicine se sont averees, in vitro , les plus frequemment actives sur les souches resistantes.

Schizophrenia is a highly disabling chronic mental illness. It is considerded as a neurodeveloppemental illness resulting from the interaction of genetic and environmental factors. Growing evidence supports the major role of prenatal infections and inflammation in the genesis of schizophrenia. The hypothesis including viral infections has been the subject of several studies and the role of parvovirus B19 (PB19) in the onset of the disease has been suggested. However, there is, up till now, no seroepidemiological evidence of his involvement.To determine the prevalence of parvovirus B19 (PB19) in schizophrenic patients and in control subjects and to examine clinical associations between viral prevalence, risk factors of infectious disease and clinical features.We carried out a case-control seroepidemiological study in the Psychiatry department of Farhat-Hached general hospital of Sousse (Tunisia). We recruited108 schizophrenic patients and 108 healthy controls free from any psychotic disorder and matched for age and sex. We collected sociodemographic data, medical history, axis I comorbid disorders and infectious risk factors. We assessed patients for psychopathology and severity of illness using respectively the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions (CGI). For each study participant, blood sample was collected and levels of IgG and IgM anti-PB19 were measured using the ELISA technique.The prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls (73.1% vs 60.2%; P=0.04). There were no statistical differences between the two groups regarding the prevalence of IgM antibodies to PB19. No association was found between viral prevalence and sociodemographic data, risk factors for infection or clinical characteristics. The presence of PB19 antibodies was associated with a lower score on the PANSS negative subscale (P=0.04). No other signficative association were found.In our study, prevalence of IgG antibodies to PB19 was significantly higher in schizophrenic patients than in controls. This finding supports the hypothesis of the involvement of PB19 in schizophrenia. Further studies including both virological and immunological aspects are needed to better clarify the etiopathogenic mechanisms of schizophrenia which would challenge the management of this disease.

Summary Candida albicans is one of the most medically important fungi because of its high frequency as a commensal and pathogenic microorganism causing superficial as well as invasive infections. Strain typing and delineation of the species are essential for understanding its biology, epidemiology and population structure. A wide range of molecular techniques have been used for this purpose including non-DNA-based methods (multi-locus enzyme electrophoresis), conventional DNA-based methods (electrophoretic karyotyping, random amplified polymorphic DNA, amplified fragment length polymorphism, restriction enzyme analysis with and without hybridization, rep-PCR) and DNA-based methods called exact typing methods because they generate unambiguous and highly reproducible typing data (including microsatellite length polymorphism and multi-locus sequence typing). In this review, the main molecular methods used for C. albicans strain typing are summarized, and their advantages and limitations are discussed with regard to their discriminatory power, reproducibility, cost and ease of performance.

The nosocomial transmission of Candida albicans in neonatal intensive care units (NICUs) is an increasing concern and understanding the route of this transmission is critical for adequate infection control measures. The aim of our study was to assess the likeliness of nosocomial acquisition of C. albicans in the NICU of Farhat Hached hospital in Sousse (Tunisia). We genotyped 82 isolates from 40 neonates and 7 isolates from 5 health care workers (HCWs) with onychomycosis, by using CDC3 microsatellite length polymorphism (MLP) and the high-resolution melting (HRM) analysis. Combined MLP and HRM CD3 analysis led to the delineation of 12 genotypes. Five temporal clustering caused by five genotypes occurred during the study period. Three of these genotypes were isolated in both neonates and HCWs. The first clustering included 28 isolates obtained between January 2003 and May 2004 from 16 neonates and 2 HCWs. The second clustering included three isolates collected in 2004 from three neonates and two HCWs. The third clustering included 11 isolates obtained from 6 neonates and 1 HCW in 2006. The two remaining clustering could not be associated with any HCW's contamination. These results argue for the nosocomial transmission of C. albicans in our NICU. The combined MLP and HRM analysis is a rapid first approach for tracking cross-contamination.

Nosocomial invasive candidiasis (IC) has emerged as a major problem in neonatal intensive care units (NICUs). We investigated herein the temporal clustering of six cases of neonatal IC due toCandida albicansin an NICU. Eighteen isolates obtained from the six neonates and two isolates from two health care workers (HCWs) working at the same unit and suffering from fingers’ onychomycosis were genotyped by electrophoretic karyotyping (EK) and restriction endonuclease analysis of genomic DNA by using Sfi I (PFGE-Sfi I). PFGE-Sfi I was more effective in discriminating between temporally related isolates. It showed that (i) both HCWs had specific strains excluding them as a source of infections in neonates. (ii) Isolates collected from three neonates were identical providing evidence of their clonal origin and the occurrence of a horizontal transmission ofC. albicansin the unit. (iii) The three remaining neonates had specific strains confirming that the IC cases were coincidental. (iv) Microevolution occurred in one catheter-related candidemia case. Our results illustrate the relevance of the molecular approach to investigate suspected outbreaks in hospital surveys and the effectiveness of PFGE-Sfi I for typing of epidemiologically relatedC. albicansisolates.

Resume Campylobacter est actuellement reconnu comme l'un des principaux genres bacteriens responsables de diarrhees. Dans le centre tunisien, au cours de l'annee 1992 et apres l'analyse de 3301 coprocultures, nous avons isole 40 souches de C. jejuni et 3 souches de C. coli . Ces bacteries proviennent de 35 enfants et de 5 adultes. Une predominance automno-hivernale est notee pour l'isolement des souches. Parmi les antibiotiques testes, l'erythromycine est constamment active in vitro . Cet antibiotique a donne le meilleur resultat therapeutique.

The aim of our study was to genotypically characterise isoniazid (INH) and rifampicin (RMP) resistant Mycobacterium tuberculosis isolates in Sousse, Central Tunisia, using DNA sequencing and multispacer sequence typing (MST). The results show that 27/28 (96.4%) and 1/28 (3.6%) INH-resistant isolates yielded respectively the kat G S315T and the inh A - 15C → T mutations. Two-thirds of RMP-resistant isolates yielded the rpo B D516V mutation and one sixth yielded either H526D or S531L mutations. Genotyping analysis revealed the multiclonal spread of drug-resistant isolates in Central Tunisia. Data presented here complete the previously published map of resistant M. tuberculosis isolates and highlight their regional disparity in Tunisia.

Background: Consumption of raw milk and unpasteurized dairy products is common in Tunisia where bovine tuberculosis remains enzootic. We herein investigated the frequency of M. bovis isolation from raw milk. Methods: Three hundred and six milk samples collected from 102 infected cows in different Tunisian regions were analysed. M. bovis isolates were further characterized by spoligotyping and variable number tandem repeat typing. Results: A total of five (4.9 %) M. bovis strains exhibiting three different genotypes were isolated. Conclusion: This study demonstrates that consumers of raw milk or derivatives in Tunisia are at high risk of zoonotic infection with M. bovis. Keywords: Mycobacterium bovis ; Tuberculosis; Raw milk, Zoonosis

The serological tests commonly used for the diagnosis of toxoplasmosis raise the problem of the interpretation of the borderline immunoglobulin G (IgG) levels and discordant results between various tests.The purpose of our study was to evaluate the contribution of the immunoblotting in the detection of specific IgG in acquired toxoplasmosis of immunocompetent patients especially when levels are equivocal or discordant in enzyme-linked immunosorbent assay (Elisa) and indirect fluorescent antigen test (IFAT).[corrected] We tested three groups of sera. The first included 87 positive sera, the second 33 negative sera, and the last one 29 equivocal sera.Results obtained with the first and the second group of sera led us to identify the bands 30kDa and 32kDa as markers of the toxoplasmic infection. The simultaneous presence of both bands showed a sensitivity of 91.5%, a specificity of 96.9%, a VPP of 98.7%, a VPN of 74.4% and a Youden's index of 0.88. Our findings suggest that the presence of these two bands is a reliable criterion for the confirmation of the presence of anti-toxoplasmic IgG in the corresponding serum. The immunoblot allowed us to ascertain serological status of 27 (93.1%) patients from the third group in which results were discrepant or equivocal in Elisa and/or in IFAT.Immunoblot is a useful serological test for detection of very low or equivocal titers.

The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.

Tunisia.To assess the clinical usefulness of the commercial Pathozyme-Myco G (Myco G) and Pathozyme TB complex plus (Patho) enzyme-linked immunosorbent assay (ELISA) kits for the rapid diagnosis of active tuberculosis (TB) and to distinguish between active TB and non-TB pulmonary diseases in Tunisian patients.Immunoglobulin G mediated humoral immune response against mycobacterial antigens (38 kDa and lipoarabinomannan, Myco G; 16 and 38 kDa, Patho) was evaluated in a group of active TB patients (128 smear-positive pulmonary and 33 extra-pulmonary samples) and in a control group (107 patients with non-tuberculous lung disease and two with leprosy). Active TB cases were confirmed by Mycobacterium tuberculosis culture from clinical samples.The sensitivity of the Myco G test was 71% in active TB (pulmonary and extra-pulmonary), while the specificity was 100%. The Patho test showed a sensitivity of 43.5% with a specificity of 96.3%. A combination of both tests showed a sensitivity of 81% and a specificity of 96.3%.Both ELISA tests were simple and easy to perform. Their combined use led to an increase in the diagnostic accuracy of active TB and its discrimination from non-TB pulmonary diseases. They could therefore be used as screening tools in poorly equipped laboratories in TB-endemic regions.

Urinary tract infection (UTI) in children is a grave pathology, which requires a fast and effective care. Bacteriological and epidemiological data play a determining role in patient's care. We report a retrospective study, which spreads out from January 1st till August 31st, 2009, having concerned hospitalized children for urinary infection in pediatrics service of Farhat Hached teaching hospital in Sousse. Our series contained 51 children with a sex ratio of 0.76, an average age of 32 months. The majority of cases was pyelonephritis (94.1%). A pathology is associated with the urinary infection in 41.2%. Three cases of vesico-ureteral reflux were noted. The diagnosis of urinary infection was confirmed by cytobacteriological exam of urine (CBEU). Enterobacteriacea were isolated in 96.1%. Escherichia coli remains the most often isolated (80.4%), followed by Klebsiella pneumoniae (9.8%) then by Proteus mirabilis (5.9%). E. coli was resistant to amoxicillin in 78% of cases, to the association amoxicillin-clavulanic acid in 64,8%, to cephalosporins of 3(rd) generation (C3G) in 5% and to cotrimoxazole in 51%. No K. pneumoniae or P. mirabilis strain was resistant to C3G. UTI in children is always an indication for CBEU realization at first intention. The results of this exam are very important considering the diversity of the responsible bacteria and the growing frequency of acquired antibiotic resistance.

Epidemiology of human herpesvirus 8 (HHV8) is still unknown in Tunisia. We aimed to assess the prevalence of HHV8 infection in adults and children from Central-East Tunisia and in patients with high risk of parenteral or sexual infection.We enrolled 553 subjects: 116 blood donors, 100 pregnant women, 100 children, 50 subjects with sexually transmitted infections with positive HIV serology and 50 other without HIV infection, 107 multitransfused patients and 30 kidney transplant patients. Antibodies against HHV8 were tested using a sensitive indirect immunofluorescence assay.The seroprevalence of HHV8 was found to be 13.8% in blood donors, 13% in pregnant women and 12% in children. In healthy adult population, no association was found between HHV8 seropositivity and sex, sociodemographic characteristics, parenteral risk factors or serological markers of hepatitis B. Rates of HHV8 infection were significantly higher in patients having high-risk sexual behavior with or without HIV infection (P10(-4)), in polytransfused patients (P10(-4)) and in patients with kidney transplantation (P=0.001).Our findings suggest that HHV8 infection is widespread in Central-East Tunisia such as in the Mediterranean area. HHV8 infection appears to be acquired early in life, probably through saliva. HHV8 transmission by blood transfusion, subject of controversy in literature, is well established in our study. Early screening of this infection should be considered in populations with high risk of Kaposi's sarcoma in our areas.

The aim of this study is to evaluate the prevalence of seven transfusion-transmitted viruses in polytransfused adults and children comparatively with a group of healthy control subjects. We studied 107 polytransfused patients (59 adults and 48 children) and 160 control subjects (100 blood donors and 60 children). Immunoenzymatic tests were used for detection of HBs antigen (HBs Ag), antibodies against hepatitis C Virus (anti-HCV), and human immunodeficiency virus (anti-HIV), and IgG antibodies against human cytomegalovirus (IgG anti-CMV), human parvovirus B19 (IgG anti-PB19), and hepatitis E virus (IgG anti-HEV). An immunofluorescent assay was performed for the detection of human herpesvirus 8 antibodies (anti-HHV8). Prevalence of HBs Ag, anti-HCV, anti-HIV, IgG anti-CMV, IgG anti-PB19, IgG anti-HEV, and anti-HHV8 in polytransfused group was 8.4, 4.7, 0, 86.9, 60.7, 28.9, and 47.6%, respectively, and 1.8, 0.6, 0, 86.2, 53.1, 10, and 12.5%, respectively, in the control group. The difference in prevalence between the two groups was statistically significant for HBs Ag (P = 0.01), anti-HCV (P = 0.03), IgG anti-HEV (P10(-4)), and IgG anti-HHV8 (P10(-4)). Categorization according to age showed that hepatitis B and C risk was limited in adult polytransfused group. HHV8 infection was higher in polytransfused subjects born before the use of leucocyte-depleted blood components. Our results corroborate literature data on the risk of HEV and HHV8 infection by blood transfusion. Hepatitis B vaccination and improvement in screening tests have an important role in reduction of hepatitis B and C risk in transfusion, especially in young polytransfused persons. However, a residual risk of transmitting viral infections persists, and efforts are needed to improve transfusion safety.

A 9-year old girl with a history of diabetes mellitus type 1, presented with visual loss of the left eye. The right eye examination was unremarkable. Slit-lamp examination revealed few small and fine keratic precipitates. We noted 2+ flare in the vitreous. There was no choroiditis, papillitis or retinal vasculitis. No aetiology was found. The patient was treated by topical and systemic corticosteroids without any improvement. Celiac disease was discovered by the presence of celiac antibodies in the work-up of joint pain and diabetes mellitus type 1. Antiendomysium antibodies and anti-transglutaminase antibodies were both positive. A small bowel biopsy confirmed celiac disease. A gluten free diet was set up and corticosteroids were tapered off. Recovery of the uveitis was obvious during gluten free diet and normalized within two months.

The study was conducted to investigate the prevalence and risk factors for hepatitis E virus (HEV) infection in Tunisian pregnant women.A total of 404 pregnant women were enrolled. Data were collected through a standard questionnaire which covered sociodemographic characteristics and risk factors. Blood samples were collected and were tested for HEV IgM and IgG antibodies, IgG against hepatitis A (anti-HAV IgG), hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). Risk factors were analyzed using univariate and multivariate logistic regression models.Prevalence of anti-HEV IgG, anti-HEV IgM, anti-HAV IgG, HBs Ag and anti-HCV was 12.1 %, 0 %, 97 %, 3 % and 0,5 %, respectively. In multivariate analysis age (30 years) and the number of persons per room (2) in the house were independent factors predicting HEV infection. History of agricultural work, kind of water, sewage treatment, use detergent to wash vegetables, contact with animals and parenteral risk factors were not correlated with the presence of anti-HEV IgG.The important seropositive rate among pregnant women is compatible with endemicity of HEV in Tunisia. Hepatitis E should be considered in the diagnosis of acute hepatitis during pregnancy. Our result suggests that infection occurs sporadically by person-to-person transmission route but further investigations are needed to determine the natural reservoir of infection.

Lymphocytic choriomeningitis virus (LCMV), a rodent-borne arenavirus, is an uncommonly recognized cause of severe congenital viral infection. The incidence of this infection during pregnancy is still unknown. Our study aimed to evaluate LCMV infection frequency in pregnancy with fetal neurological abnormalities of unknown etiology.Samples obtained during three years from 160 pregnant women were retrospectively analysed: 155 maternal sera, 150 amniotic fluids (AF) and 12 fetal sera (FS). Congenital neurological anomalies were diagnosed but TORCH and culture investigations were negatives. Serological analysis was performed with L929 cells infected with the Armstrong strain of LCMV. IgG and IgM antibodies against CMLV were researched by immunofluorescence assay using these infected cells. Interferon alpha was also assayed for AF and FS.No positive serology was found in any of the 317 samples investigated even when interferon alpha was detected.This result confirms the rarity of LCMV infection in France. Nevertheless, at the light of the recent literature, this teratogenic pathogen should be considered in pregnancy with unexplained congenital malformation, especially after rodent exposure.

Candida albicans has become an important cause of nosocomial infections in neonatal intensive care units (NICUs). The aim of the present study was to compare C. albicans strains isolated from neonates (NN) suffering from systemic candidosis and from nurses in order to determine the relatedness between NN and health workers' strains. Thirty-one C. albicans strains were isolated from 18 NN admitted to the NICU of the neonatology service of Farhat Hached Hospital of Sousse, Tunisia and suffering from systemic candidosis, together with five strains recovered from nurses suffering from C. albicans onychomycosis. Two additional strains were tested, one from an adult patient who developed a systemic candidosis and the second from an adult with inguinal intertrigo. All strains were karyotyped by pulsed-field gel electrophoresis (PFGE) with a CHEF-DR II system. Analysis of PFGE patterns yielded by the 38 strains tested led to the identification of three pulsotypes that were designated I, II and III, and consisted of six chromosomal bands with a size ranging from 700 to2500 kbp. The most widespread was the pulsotype I, which was shared by 17 NN and the five nurses' strains. The identity between NN and nurses' strains is very suggestive of a nosocomial acquisition from health-workers.

The aim of this study was to determine the antimicrobial activity of amoxicillin-clavulanic acid against Escherichia coli urinary strains, especially those resistant to amoxicillin, and to analyze the results according to the susceptibility testing methods.This prospective study was made from April to May 2008, on 301 E. coli strains isolated from urine samples. The susceptibility to antibiotics was studied by agar disk diffusion according to French Society of Microbiology Antibiogram Committee recommendations. MIC were determined with the E-test.According to the antibiogram, 59.8% of strains were resistant to amoxicillin, 33.2% to amoxicillin-clavulanic acid, 1.7% to cefotaxim, 8.3% to nalidixic acid, 6.6% to ofloxacin, 4.7% to ciprofloxacin, 4.7% to gentamicin and 38.1% to cotrimoxazole. After determining the MIC of E. coli strains resistant to amoxicillin and susceptible to amoxicillin-clavulanic acid, 37.5% (n=30) remained susceptible, 61.25% (n=55) were of intermediate susceptibility and only one strain (1.25%) was resistant. Among E. coli strains resistant to amoxicillin and intermediately susceptible to amoxicillin-clavulanic acid, 83.3% (n=55) remained intermediately susceptible, 13.7% (n=9) became susceptible and two strains (3%) were resistant.The susceptibility testing methods, especially for amoxicillin-clavulanic acid, must be standardized to avoid the discrepancies noted between standard antibiograms and an accurate determination of MIC.