Mucormycoses are serious infections caused by filamentous fungi of the order Mucorales. They occur most often in immunocompromised patients. We report five cases of mucormycosis in patients hospitalized in the Infectious Diseases Department in Sousse – Tunisia between 2000 and 2013. They were 4 males and one female, mean age 60 years. Three patients were diabetic and one patient had acute leukemia. The locations of mucormycosis were rhinocerebral, rhino-orbital, auricular, pulmonary and cutaneous. The Mucorales isolated were Rhizopus arrhizus in 3 cases and Lichteimia in 2 cases. All patients were treated with amphotericin B and 2 patients had, in addition, surgical debridement. Two patients died and 2 kept peripheral facial paralysis.

Background and objectivesQuantitative real time PCR (qPCR) offers rapid diagnosis of rickettsial infections. Thus, successful treatment could be initiated to avoid unfavorable outcome. Our aim was to compare two qPCR assays for Rickettsia detection and to evaluate their contribution in early diagnosis of rickettsial infection in Tunisian patients.Patients and methodsIncluded patients were hospitalized in different hospitals in Tunisia from 2007 to 2012. Serology was performed by microimmunofluorescence assay using R. conorii and R. typhi antigens. Two duplex qPCRs, previously reported, were performed on collected skin biopsies and whole blood samples. The first duplex amplified all Rickettsia species (PanRick) and Rickettsia typhi DNA (Rtt). The second duplex detected spotted fever group Rickettsiae (RC00338) and typhus group Rickettsiae DNA (Rp278).ResultsDiagnosis of rickettsiosis was confirmed in 82 cases (57.7%). Among 44 skin biopsies obtained from patients with confirmed diagnosis, the first duplex was positive in 24 samples (54.5%), with three patients positive by Rtt qPCR. Using the second duplex, positivity was noted in 21 samples (47.7%), with two patients positive by Rp278 qPCR. Among79 whole blood samples obtained from patients with confirmed diagnosis, panRick qPCR was positive in 5 cases (6.3%) among which two were positive by Rtt qPCR. Using the second set of qPCRs, positivity was noted in four cases (5%) with one sample positive by Rp278 qPCR. Positivity rates of the two duplex qPCRs were significantly higher among patients presenting with negative first serum than those with already detectable antibodies.ConclusionsUsing qPCR offers a rapid diagnosis. The PanRick qPCR showed a higher sensitivity. Our study showed that this qPCR could offer a prompt diagnosis at the early stage of the disease. However, its implementation in routine needs cost/effectiveness evaluation.

Urinary tract infections (UTIs) are common. The diagnosis is confirmed by urine culture which is costly and takes at least 24 hours before results are known. The aim of this study was to determine the diagnostic accuracy of dipstick test for the diagnosis of UTI in symptomatic adult patients. We conducted a cross-sectional study in the department of Infectious Diseases, Sousse-Tunisia during a two-year period. We included all patients with clinical signs of UTI. Urine samples were tested for the presence of leukocyte esterase (LE) and nitrites. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of LE and nitrites were calculated against urine culture as gold standard. Four hundred thirty one patients, 139 men (32%) and 292 women (68%) were included. One hundred sixty six patients (39%) had UTI. The most frequently isolated microorganism was Escherichia coli (75%). LE had a high sensitivity (87%) but a low specificity (64%), while nitrites had a high specificity (95%) but a low sensitivity (48%). Combined positive LE and nitrites had a high PPV (85%) and combined negative LE and nitrites had a high NPV (92%), while positive LE combined with negative nitrites had a low PPV (47%) and a low NPV (53%). In conclusion, in adult patients with UTI symptoms, an alternate diagnosis should be considered if the LE is negative, while an early empirical antibiotic therapy against Enterobacteriaceae should be started if the nitrites are positive.

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Invasive fungal rhinosinusitis is a rare infection that occurs primarily in immunocompromised patients. The fungal pathogen Alternaria alternata is rarely associated with rhinosinusitis. We report a case of A. alternata rhinosinusitis in an immunocompetent patient.