Radiologic-pathologic findings of primary osseous adamantinoma with unusual metastasis to the posterior cul-de-sac in pregnancy

Adamantinoma is a rare primary bone malignancy with a predilection for the tibial cortex. Metastases have been reported to the long bones, lung, pleura and spine. We present a 26-year-old pregnant woman with metastatic disease to the posterior cul-de-sac, lungs, liver and retroperitoneum, which collectively have not been previously reported in a single patient to our knowledge.     

Aichi Virus IgG Seroprevalence in Tunisia Parallels Genomic Detection and Clinical Presentation in Children with Gastroenteritis

Aichi virus has been described as a novel causative agent of gastroenteritis in humans. In this study, we report the seroprevalence distribution of Aichi virus in Tunisia. A panel of 1,000 sera was screened by applying an enzyme-linked immunosorbent assay for immunoglobulin G specific for Aichi virus. A considerable prevalence (92%) of antibody to Aichi virus was found across all age groups. The specific anti-Aichi virus antibodies increased with age, from a high rate (68.8%) in children under 10 years old to about 100% in persons more than 60 years old. We found a statistically significant increase in levels of antibody to Aichi virus according to the age of patients. Immunoglobulin M antibodies were detected among five children. A high frequency of Aichi virus monoinfections in hospitalized children with severe gastroenteritis was previously observed in Tunisia. Aichi virus causes diarrhea with dehydration, fever, and vomiting. This work is the first to establish a correlation between the high seroprevalence of specific Aichi virus antibodies, clinical presentation, and a high frequency of isolation of Aichi virus by genomic characterization in stools of children suffering from gastroenteritis. Our data show the importance and emerging character of Aichi virus in the viral etiology of pediatric gastroenteritis.Viral gastroenteritis is a common illness that affects humans worldwide. Rotavirus, calicivirus, adenovirus, and astrovirus have been established as the most important etiologic agents in these clinical diseases (4). Nevertheless, for many nonbacterial gastroenteritis cases, no etiological agent is diagnosed, and it has been hypothesized that other, viral agents are involved. Among these, Aichi virus (AiV) was first recognized in 1989 as the likely cause of oyster-associated gastroenteritis in a Japanese patient (15). This virus is a new member of the family Picornaviridae and is classified in a new genus, Kobuvirus (9, 15). The detection of AiV in stool samples collected from nonbacterial-gastroenteritis outbreaks due to oyster consumption was documented in Asia (14, 16, 19) and in Europe (1, 7). Moreover, this virus was recently identified in oysters implicated in a gastroenteritis outbreak in France (6). The detection of AiV strains has also been reported in fecal specimens from children suffering from gastrointestinal symptoms in several studies in Asian countries (8, 17, 20), in Brazil (7), and in France (1). However, a low incidence (0.9 to 3.1%) of AiV strains was observed in all these surveys in sporadic, as well as epidemic, gastroenteritis. On the other hand, several seroprevalence studies of antibodies to AiV have been conducted in Japan (16), Germany (7), and France (5) showing a high level of seroprevalence (80 to 95%) in adults, which supports widespread exposure to AiV, at least during childhood, and proves that the virus is quite prevalent.In Tunisia, we previously reported the epidemiology and genomic characterization of AiV strains circulating in the pediatric Tunisian population over more than 4 years (12). In this previous prospective survey, contrary to the data in the literature, we showed that AiV was the third most frequently detected agent, after rotavirus and norovirus, in children with sporadic gastroenteritis symptoms. In addition, we observed a high incidence of monoinfections and a relatively high frequency of hospitalizations due to AiV infections, indicating the role of AiV as a causative agent of pediatric diarrhea in our country. Moreover, we previously analyzed sewage and shellfish samples for the presence of AiV from January 2003 to April 2007 (unpublished data), and we performed a comparative analysis of environmental AiV strains with those from clinical cases detected in the same period. AiV was the second most frequent pathogen in sewage, after rotavirus, and a correlation between environmental and human strains was observed. These previous data suggest that AiV plays an important role in pediatric gastroenteritis and environmental contamination in Tunisia.Pursuing our research on AiV epidemiology, in this paper, we report the first seroepidemiological survey of antibodies to AiV in the Tunisian population. One thousand randomly chosen sera from Tunisian individuals were analyzed by an enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G (IgG) specific to AiV. We performed a statistical analysis of IgG antibody levels according to age, and we also looked for AiV-specific immunoglobulin M (IgM) antibodies. We combined the serologic results with clinical and virological data in order to better understand the epidemiology and the role of AiV as a pathogenic agent implicated in gastroenteritis.     

When to initiate highly active antiretroviral therapy in low-resource settings: the Moroccan experience

BACKGROUND: The aim of this study was to assess the cost-effectiveness of HIV treatment alternatives - with and without highly active antiretroviral therapy (HAART) - within alternative strata based on the CD4+ T-cell count at the initiation of treatment in a low-resource setting. METHODS: A retrospective observational study was conducted following 286 HIV-positive individuals admitted to the principal teaching hospital in Casablanca, Morocco, between 1995 and 2002. Patients were stratified by CD4+ T-cell count and regression models were fitted to determine risk of opportunistic infection. Data on healthcare resource use were derived from patient records and were evaluated from the hospital perspective. RESULTS: HAART led to a significant reduction in the number of HIV-related opportunistic infections (P<0.0001), extended survival (61.3 versus 55.2 months; P<0.0001) and reduced hospital stays (P<0.0001) in comparison with care in the absence of HAART. When medical care and drug costs were considered together, HAART was more costly than providing treatment for opportunistic infections. The incremental cost-effectiveness ratio was lower than gross domestic product (GDP) per capita for patients starting HAART with a CD4+ T-cell count <200 cells/mm3, but this increased to nearly three times GDP per capita when HAART was initiated at CD4+ T-cell counts above this threshold. CONCLUSIONS: HAART is more cost-effective than treating HIV-related opportunistic infections and, contrary to conclusions drawn in developed countries, HAART is more cost-effective when the CD4+ T-cell count drops to <200 cells/mm3.     

Molecular epidemiology of human astrovirus and adenovirus serotypes 40/41 strains related to acute diarrhea in Tunisian children

Human astrovirus (AstV) and adenovirus types 40 and 41 (AdV 40/41) are responsible for epidemic and endemic acute gastroenteritis in children and adults. The present study was designed to evaluate the prevalence and genetic diversity of enteric viruses in children in Tunisia. A total of 788 fecal samples were collected during a 4‐year period in the region of Monastir, from children under 12 years old, hospitalized or presenting in dispensaries with symptoms of acute gastroenteritis. AstV and AdV40/41 were detected by immunoenzymatic methods and confirmed by PCR/RT‐PCR and sequence analysis. Phylogenetic analyses were performed for nucleotide homology with reference strains. AstV and AdV40/41 were characterized as a causative agent in 28 (3.6%) and 18 (2.3%) of the fecal samples, respectively. Phylogenetic analysis showed that the AstVs belonged to the serotypes 3 (n = 4; 14.3%) and 1 (n = 24; 85.7%), and the enteric AdVs to the serotypes 40 (n = 1; 5.6%) and 41 (n = 17; 94.4%). This is the first report that describes the molecular epidemiology of AstV and AdV40/41 in Tunisian children. Their respective detection rate was very low, far below that of rotavirus and norovirus. The genetic diversity among these two viruses is relatively limited and varies depending on the area. J. Med. Virol. 81:1895–1902, 2009. © 2009 Wiley‐Liss, Inc.     

Molecular detection of genogroup I sapovirus in Tunisian children suffering from acute gastroenteritis

This study investigated the prevalence of sapovirus infections in children with acute gastroenteritis in Monastir region, Tunisia, from January 2003 to April 2007. Sapovirus was characterized by sequence and phylogenetic analyses of the partial polymerase gene. From 788 fecal specimens tested, 6 (0.8%) were positive for sapovirus, of these, 4 (66.7%) were monoinfections. All sapovirus positive samples were detected in outpatient, contrary to norovirus which was significantly more frequent in hospitalized children than in outpatients (14.5 vs. 9.5%, P = 0.03). The mean age of children with sapovirus infections was 11 ± 5.56 months (range 6–19 months). Sapovirus isolates were detected in March and between September and December 2003. Fever, vomiting, abdominal pain, and dehydration were not observed in patients with sapovirus infections. Analysis of nucleotide and amino acid sequences revealed that all 6 Tunisian sapovirus strains clustered in the GGI/1 genotype and strains were identical in the region sequenced, sharing 90.2% nucleotide identity with the reference strain Sapporo/82/JP (U65427). This represents the first finding of sapovirus infections in North Africa and especially in Tunisia. The data indicate that, contrary to norovirus which can cause severe diarrhea and is an important etiologic agent in hospitalized cases, sapovirus causes mild gastroenteritis in Tunisian children.     

Sigmoid lipoma as an exceptional cause of intussusception and bowel obstruction in adults: A case report and review of literature

Acute intestinal intussusception in adults is a rare condition, most often secondary to an organic lesion (tumor or inflammation), representing 1%-5% of intestinal obstructions. Pure colic intussusception on lipoma rectal causing bowel obstruction is an exceptional situation. A 60-year-old man presented to the emergency department for acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. Colonic lipomas of the recto-sigmoid region represent a very rare condition and a subsequent etiology for intussusception and bowel obstruction in adults. However, it should be considered in the differential diagnosis of such situations.