Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithorax. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed preoperatively in 30 of the 40 cases. Posterolateral thoracotomy was performed in all patients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed 15 lobectomies, 10 wedge resections, 16 decortications, and in one patient simple drainage of a voluminous pleuropulmonary and hepatic purulent hydatic collection. The postoperative course was uneventful in 26 cases, but 14 patients had complications, from which 3 patients died. The therapeutic approach depends on ultrasonographic findings. We believe ultrasonography to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and is sufficient if the biliary tract is safe. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.

Summary The β2 integrin CD11b/CD18 (CR3) is a major adhesion receptor of neutrophils, normally utilized to fend off infections. This receptor contributes, however, to multiple forms of non‐infectious inflammatory injury when dysregulated as shown in gene knock‐outs and through the use of blocking monoclonal antibodies. The major ligand recognition site of CR3 has been mapped to the A‐domain in the CD11b subunit (CD11bA). The recombinant form of this domain exhibits a ligand binding profile similar to that of the holoreceptor. To assess the potential anti‐inflammatory activity of CD11bA as a competitive antagonist of CR3 in vivo, we assessed its effects on a developed animal model of traumatic skeletal muscle injury in the rat. Recombinant soluble rat CD11bA‐domain fused to glutathione‐S‐transferase (GST) was administered intravenously in a single dose at 1 mg/kg to nine groups of Wistar rats, five in each group, 30 min before inducing traumatic skeletal muscle injury. Control animals received either a function‐blocking anti‐CD11b/CD18 monoclonal antibody (1 mg/kg), non‐functional mutant forms of the CD11bA (D140GS/AGA, T209/A, D242/A), recombinant GST or buffer alone. In control animals, the wounded muscle showed oedema, erythrocyte extravasation and myonecrosis both within and outside the immediate wounded area (5–10 mm zone) and influx of neutrophils was detected 30 min post‐wound, followed by a second wave 3 hr later. Wild‐type CD11bA‐ or anti‐CD11b monoclonal antibody (mAb)‐treated rats showed a comparable and significant decrease in the number of infiltrating PMN (78 + 4%, n = 70 and 86 ± 2%, n = 50, respectively) and preservation of the muscular fibres outside the immediate zone of necrosis (75 + 4%, n = 70, 84 ± 1%, n = 50, respectively), compared to controls. These data demonstrate that CD11bA can be an effective tissue‐preserving agent in acute inflammatory muscular injury.

The lung may be infested by a great number of parasites. Hydatidosis is the most frequent parasitic lung disease. Diagnosis of lung hydatidosis is usually easy on chest radiography, ultrasonography, and CT scan, and immunodiagnosis may help in dubious cases. Surgery is necessary in most cases, but it must be conservative. Complex forms, such as disseminated disease and secondary lung hydatidosis (metastatic or bronchogenic) are difficult to treat and may be considered malignant. Medical treatment may be helpful in complex forms, in poor surgical risk patients, and in cases of preoperative spillage of hydatic fluid. Prevention programs are necessary in endemic areas, and research must be directed toward vaccination against the parasite. Other parasitic diseases are reported less frequently in the literature, and the majority of published articles are either case reports or only report a small number of cases. Clinical presentation is variable according to the great variety of parasites that may involve the lungs.

This study evaluated the occurrence of extended-spectrum β-lactamases (ESBL) and associated resistance genes, integrons, and plasmid types as well as the genetic relatedness of enterobacterial isolates in the wastewater treatment plant (WWTP) of La Charguia, Tunis City (Tunisia). One-hundred water samples were collected at different points of the sewage treatment process during 2017–2019. Antimicrobial susceptibility was conducted by disc-diffusion method. blaCTX-M, blaTEM and blaSHV genes as well as those encoding non-β-lactam resistance, the plasmid types, occurrence of class1 integrons and phylogenetic groups of Escherichia coli isolates were determined by PCR/sequencing. Genomic relatedness was determined by MLST for selected isolates. Fifty-seven ESBL-producer isolates were recovered (47 E. coli, eight Klebsiella pneumoniae, one of the Citrobacter freundii complex and one of the Enterobacter cloacae complex). CTX-M-15 was the most frequently detected ESBL, followed by CTX-M-27, CTX-M-55 and SHV-12. One E. coli isolate harboured the mcr-1 gene. The following phylogroups/STs were identified among ESBL-producing E. coli isolates: B2/ST131 (subclade-C1), A/ST3221, A/ST8900, D/ST69, D/ST2142, D/ST38, B1/ST2460 and B1/ST6448. High number of isolates harboured the class 1 integrons with various gene cassette arrays as well as IncP-1 and IncFIB plasmids. Our findings confirm the importance of WWTPs as hotspot collectors of ESBL-producing Enterobacteriaceae with high likelihood spread to human and natural environment.

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