Hépatites auto-immunes de l’adulte. Expérience d’un service de médecine interne algérien

Aim

To describe the mode of presentation of autoimmune hepatitis (AIH) in a population of patients hospitalized in an Algerian internal medicine department. Patients and methods: The study included 20 consecutives cases of AIH recruited during 9 years (january 2004 to march 2013) on the association of the usual AIH criteria or on the 1999 IAIHG score. Overlap syndrome was defined by the association of AIH and at least two criteria of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC).

Results

Mean age was 41 years, sex ratio of 0.17 (M/F). The disease was revealed by jaundice in 70% of cases and portal hypertension (presence of esophageal varices) was present in 4 cases (20%) at diagnosis. In 60%, both cytolysis and cholestasis were present, a similar rate of cases presented with hypergammaglobulinemia. Autoantibodies were present in 90% of cases. Liver biopsy revealed an interface hepatitis in 94% of cases, signs of PBC were associated in 41% of cases. Treatment was given during at least 2 years, combining prednisone, azathioprine while ursodesoxycholic acid was added in OS. Remission or an incomplete response was reached in 45% of cases, failure rate was 45%.

Conclusion

In our population, diagnosis of AIH remains often delayed; its association with a PBC is not uncommon.     

Estudio de una cohorte de paciente con fibrosis quística y Scedosporium spp.

IntroductionIn recent years an increase in the prevalence of colonization and infection by Scedosporium spp. in patients with cystic fibrosis (CF) has been observed. In this article, we study the frequency of isolation of Scedosporium spp. in an adult CF Unit, analyzing characteristics of the patients and predisposing factors.MethodsA retrospective observational study was conducted in 87 adult CF patients in whom the presence of positive culture for Scedosporium spp. was tested for a 5-year period (January 2012-July 2017). We recorded the following clinical variables: age, sex, body mass index, genotype, presence of pancreatic insufficiency, bacterial colonization, lung function, other complications, exacerbations and treatment, and the modified Bhalla score from the last high-resolution computed tomography. Results were analyzed with IBM SPSS Statistics Version 22.0 software.ResultsScedosporium spp. was isolated in 25.3% of patients. In the bivariate analysis, these patients showed a higher rate of Pseudomonas aeruginosa infection, worse score in the Bhalla classification (highlighting the following items: bronchiectasis, mucus plugs and bronchial generations), a slight decrease in the lung diffusion capacity and more frequently received inhaled antibiotics. In the logistic regression multivariate analysis, only the bronchial generations item was significant.ConclusionScedosporium spp. must be considered an emerging opportunistic pathogen in patients with CF whose clinical involvement, risk factors or need for treatment is unknown.