Recurrence of Cervical Squamous Cell Carcinoma After More Than 4 Years in the Lung: A Rare Case Report

Cervical squamous cell carcinoma (CSCC) is a common gynecological malignancy, typically affecting women of reproductive age. Although the occurrence of late metastatic recurrence in the lung is relatively rare, we present the case of a 52-year-old woman, previously diagnosed and treated for CSCC. After 4 years of disease-free intervals, she presented with respiratory symptoms, including cough, dyspnea, and hemoptysis, with marked asthenia. A computed tomography (CT) scan of the chest revealed a lung mass. Histopathological examination of the lung biopsy confirmed the recurrence of CSCC, specifically in the lung. Immunohistochemistry further supported the origin of the tumor as cervical. The management of such cases necessitates a multidisciplinary approach, considering treatment options such as surgery and chemoradiation. Long-term follow-up and surveillance are vital for the early detection of late recurrences, as they can present several years after the initial diagnosis. This case report highlights the importance of recognizing and appropriately managing cases of late metastatic recurrence of CSCC in the lung. Further studies are needed to deepen our understanding of the underlying mechanisms, refine diagnostic approaches, and optimize treatment strategies for such rare occurrences.

On the Implementation of a Post-Pandemic Deep Learning Algorithm Based on a Hybrid CT-Scan/X-ray Images Classification Applied to Pneumonia Categories

The identification and characterization of lung diseases is one of the most interesting research topics in recent years. They require accurate and rapid diagnosis. Although lung imaging techniques have many advantages for disease diagnosis, the interpretation of medial lung images has always been a major problem for physicians and radiologists due to diagnostic errors. This has encouraged the use of modern artificial intelligence techniques such as deep learning. In this paper, a deep learning architecture based on EfficientNetB7, known as the most advanced architecture among convolutional networks, has been constructed for classification of medical X-ray and CT images of lungs into three classes namely: common pneumonia, coronavirus pneumonia and normal cases. In terms of accuracy, the proposed model is compared with recent pneumonia detection techniques. The results provided robust and consistent features to this system for pneumonia detection with predictive accuracy according to the three classes mentioned above for both imaging modalities: radiography at 99.81% and CT at 99.88%. This work implements an accurate computer-aided system for the analysis of radiographic and CT medical images. The results of the classification are promising and will certainly improve the diagnosis and decision making of lung diseases that keep appearing over time.

Assessment of the Association of Chlamydia e pneumoniae Infection with Lung Cancer in a Moroccan Patients' Cohort

BACKGROUND

Chlamydia pneumoniae (C. pneumoniae) is a respiratory pathogen associated with chronic inflammatory and its detection in human lung cancer suggests its involvement in cancerogenesis. Our study aimed to evaluate the association between C. pneumoniae  infection and Lung Cancer disease in Moroccans patients and control cohorts, through a molecular investigation.

METHODS

The study comprised 42 lung cancer patients and 43 healthy controls. All participants provided demographics, Clinical, and Toxic behaviors datas, and a peripheral blood sample for testing, a Nested Polymerase Chain Reaction (PCR) was performed for C. pneumoniae Deoxyribonucleic acid (DNA) detection. Statistical analysis was performed using IBM®SPSS®software.

RESULTS

Positive Nested PCR results for cases and controls were respectively 33.3% and 4.7%, there by  significant difference between cases and controls   infection was identified (p <0.05). Data analysis also showed that tobacco could act synergically with C. pneumoniae infection as a risk factor of lung cancer. In fact a significant difference between patients and controls was shown for tobacco and alcohol use (p < 0.05).

CONCLUSION

C. pneumoniae infection is potentially associated with primary Lung cancer in the Moroccan population and has combined effects with Tabaco consumption.

Mammary sarcoidosis: A rare case report

Introduction

Sarcoidosis is an inflammatory, systemic, idiopathic disease characterized by multisystem involvement, of which mediastinal and pulmonary involvement is the most frequent. Mammary sarcoidosis is exceptional.

Case presentation

We report the case of a 50-year-old, diagnosed with mediastinal and mammary sarcoidosis. Therapeutic abstention with clinical and radiological surveillance was recommended. The evolution was marked by a clear improvement (clinical and radiological).

Discussion

Mammary sarcoidosis is a rare anatomical and clinical entity which poses a problem of differential diagnosis with other granulomatous diseases and especially with breast carcinoma. The coexistence of systemic manifestations should lead to the discussion of sarcoidosis.

Conclusion

Mammary sarcoidosis involvement is rare and is manifested by a mass with a smooth or spiculated border, requiring the exclusion of malignancy.

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Mammary sarcoidosis is a rare clinical entity.

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The final diagnosis is based on a combination of clinical, biological, radiological, and pathological findings.

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The main differential diagnosis of mammary sarcoidosis is tuberculosis and breast cancer.

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Corticosteroid therapy is the reference treatment for breast sarcoidosis.

Exceptional association of hepatic and pancreatic tuberculosis mimicking metastatic pancreatic neoplasia: A case report and review of the literature

Introduction

Despite the high prevalence of tuberculosis in the world and especially in endemic areas such as Morocco, isolated hepatic and pancreatic tuberculosis and pancreatic tuberculosis remain rare and pose a real diagnostic problem.

Case presentation

We report a case illustrating an exceptional association of pancreatic tuberculosis with hepatic tuberculosis in a 44-year-old immunocompetent woman, in whom the presence of a pancreatic mass on imaging suggested a neoplastic origin. The diagnosis was rectified after bacteriological and pathological study of the CT-guided percutaneous biopsy specimens.

Discussion

The symptomatology of pancreatic and hepatic tuberculosis is unspecific and polymorphic and can mimic any intra-abdominal pathology. Abdominal ultrasound is often the first imaging modality used. The diagnosis of certainty is bacteriological.The treatment of pancreatic and hepatic tuberculosis is identical to the other extrapulmonary tuberculosis. the anti-bacillary drugs are the gold standard. Surgery is reserved for complicated forms.

Conclusion

The diagnosis of hepatic and pancreatic tuberculosis is a challenge for the clinician. The treatment is usually medical and based on antituberculosis treatment; surgery may be necessary in case of complications.

Macrophagic activation syndrome revealing disseminated multifocal tuberculosis: A case report of a rare clinical situation

Introduction

Macrophage activation syndrome (MAS) is a rare but serious entity, sometimes triggered by an infectious agent, in particular by certain viruses or mycobacteria. Forms of tuberculosis complicated by MAS frequently occur in immunocompromised subjects. The disease is often disseminated, severe, and has a poor prognosis.

Case presentation

We report a case of MAS complicating disseminated tuberculosis and revealing HIV in a previously healthy young patient.

Discussion & conclusion

The management of macrophage activation syndrome related to tuberculosis is complex and not codified. On the one hand, the immunosuppressive treatment allows to slow down the macrophage activation syndrome and obtain a correction of cytopenia. On the other hand, there is a risk of aggravating tuberculosis by increasing the patient's immunodepression.

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Macrophagic activation syndrome (MAS) represents a rare and serious entity.

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Forms of tuberculosis complicated by MAS frequently occur in immunocompromised subjects.

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The clinical finding is aspecific and the search for medullary hemophagocytosis is part of the work-up.

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The management of MAS related to tuberculosis is complex and not codified.

Vascular thromboses with retroperitoneal fibrosis: a case report

Background

Granulomatosis with polyangiitis is a systemic inflammatory disease characterized by necrotizing vasculitis that affects small- and medium-sized blood vessels. Granulomatous inflammation affects the lungs, ears, nose, and throat, and commonly affects the kidneys, although the retroperitoneal tissue is rarely affected. Several studies have reported an increased risk of venous thromboembolism. Early diagnosis and treatment are of vital importance due to the rapid progression of the disease.

Case presentation

We present the case of a 66-year-old Moroccan man followed for bilateral jugular thrombosis. Cavitary pulmonary nodules and retroperitoneal fibrosis with thrombosis involving several vascular territories were detected on thoracoabdominopelvic computerized tomography scan. Laboratory analyses revealed that the patient was positive for cytoplasmic antineutrophilic antibodies. The diagnosis of granulomatosis with polyangiitis was retained. Treatment with glucocorticoids and immunosuppressive agents resulted in significant clinical and radiological improvement over the following months.

Conclusions

We describe the diagnostic steps and the difficulty of managing this patient. Rare manifestations, such as retroperitoneal fibrosis, have been reported in the literature in association with granulomatosis with polyangiitis, and should not delay the diagnosis and treatment of granulomatosis with polyangiitis owing to its severity.

Intracardiac thrombus in Behçet's disease: a rare case in Morocco

Behçet’s syndrome is a systemic inflammatory disease generally presented with the triad of uveitis, oral and genital ulcers. However, it may present with gastrointestinal, central nervous system, skin and vascular disease manifestations. Intracardiac thrombus is a rare but serious complication of Behçet’s disease. A 16-year-old man with Behçet’s syndrome was hospitalized into our department with a history of cough, fever, chest pain, hemoptysis, and weight loss. Transthoracic echocardiography and chest scan revealed a right ventricular thrombus. After one month of treatment with cyclophosphamide, and corticosteroid the intracardiac thrombus has been resolved.

Simultaneous Association of Pulmonary Tuberculosis and Kaposi's Sarcoma in an Immunocompetent Subject: A Case Report and Literature Review

Kaposi's Sarcoma (KS) occurs as a pathological entity that may be classified into four different types: classic, endemic, epidemic, and iatrogenic. It can arise among HIV-positive subjects or within immunosuppression, yet exceptionally of tuberculous origin. We describe a new case report of an HIV-negative patient, manifesting Kaposi's disease in the course of tuberculosis, with the aim to assess this uncommon disorder and to outline this rare atypical association.

Incidence of adverse reactions caused by first-line anti-tuberculosis drugs and treatment outcome of pulmonary tuberculosis patients in Morocco

PURPOSE

The treatment of tuberculosis is associated with a high incidence of adverse reactions with different degrees of severity. The aim of this study was to determine the incidence of adverse reactions caused by first-line anti-tuberculosis drugs and to evaluate the treatment outcome of TB patients in a large region of Morocco.

METHODS

It is a multi-centric observational cohort study conducted from January 01, 2014 to January 01, 2016. A questionnaire was established for data collection from clinical charts of TB patients. The study was carried out in all the 18 centers located in the Rabat-Salé-Kénitra region of Morocco where tuberculosis is treated. Adverse reactions are evaluated from the start of TB treatment until its end by a specialist clinician. The treatment outcomes are evaluated, and the definitions and classifications of these outcomes are defined according to World Health Organization guidelines.

RESULTS

Among a total number of 2532 patients treated for TB, the average age is 37.3 ± 16.4 years, 10.0% of patients produced adverse reactions. 7.4% of adverse reactions are gastrointestinal, 3.7% are cutaneous, 2.0% are hepatic, 1.14% are articular, 1.07% are immunoallergic, 0.7% are neuropsychiatric, and 0.1% are ocular. The treatment outcome of TB patients is 79.1% rate for successful treatment and 15.6% for unsuccessful treatment.

CONCLUSION

Adverse reactions caused by anti-TB drugs are frequent among patients with TB. These ADRs must be followed up by a closer monitoring during anti-TB treatment period. Treatment success outcome in our study is slightly lower than the success rate target of WHO of at least 85%.

Treatment outcomes of drug resistant tuberculosis patients in Morocco: multi-centric prospective study

Background

Drug resistant tuberculosis is a major public health problem in Morocco and worldwide. Treatment outcome of drug resistant tuberculosis is poor and requires a long period of treatment with many toxic and expensive antituberculosis drugs. The aim of this study is to evaluate treatment outcomes of drug resistant tuberculosis and to determine predictors of poor treatment outcomes in a large region of Morocco.

Methods

It is a multi-centric observational cohort study conducted from January 01, 2014 to January 01, 2016. A questionnaire was established to collect data from clinical charts of patients with confirmed resistant TB. The study was carried out in all the 11 centers located in the Rabat-Salé-Kénitra region of Morocco where drug resistant tuberculosis is treated. Treatment outcomes were reported and the definitions and classifications of these outcomes were defined according to the WHO guidelines. Univariate and multivariate logistic regression were conducted to determine factors associated with poor drug resistant tuberculosis treatment outcomes in Morocco.

Results

In our study, 101 patients were treated for drug resistant tuberculosis between January 01, 2014 and January 01, 2016. Patients’ age ranged from 9.5 to70 years; 72patients (71.3%) were male and 80 patients (79.2%) were living in urban areas. Thirty two patients were smokers, 74 patients had multidrug-resistant tuberculosis, 25 patients had rifampicin resistance and 2 patients had isoniazid resistance. Treatment outcomes of tuberculosis patients were as follows: 45 patients were cured (44.5%), 9 completed treatment (8.9%), 5 patients died before completing the treatment, 35 patients were lost to follow up (34.6%) and 7 patients had treatment failure. In the multivariate analysis, being a smoker is an independent risk factor for poor treatment outcomes, (p-value = 0.015, OR = 4.355, IC [1.327–14.292]).

Conclusion

Treatment success outcomes occurred in more than half of the cases, which is lower than the World Health Organization target of at least a 75% success rate. A significant number of patients abandoned their treatment before its completion. These dropouts are a serious public health hazard that needs to be addressed urgently.

Tuberculose multifocale compliquée d’un syndrome d’activation macrophagique: à propos de deux cas

Le syndrome d'activation macrophagique (SAM) est une manifestation rare liée à une stimulation inappropriée des macrophages dans la moelle osseuse et les organes lymphoïdes. Il est défini par des critères cliniques, biologiques et cyto-histologiques. Ce syndrome peut être primaire essentiellement chez l'enfant, ou secondaire à diverses affections: hématologiques, infectieuses ainsi qu'à des maladies auto-immunes variées. Le pronostic est sombre, avec une mortalité de près de 50% toutes causes confondues. Le traitement repose sur le traitement spécifique de l'agent causal du SAM et dans certaines indications, sur l'étoposide, les corticostéroïdes et les immunogobulines qui doivent alors être administrés précocement. Le SAM est rarement décrit en association avec la tuberculose, nous rapportons deux observations de deux patientes, l'une immunodéprimée et l'autre immunocompétente présentant une tuberculose multifocale compliquée d'un syndrome d'activation macrophagique. Nous insistons à travers ce travail sur la difficulté du traitement du syndrome d'activation macrophagique associé à une tuberculose, la nécessité de l'évaluation du rapport bénéfice risque, en raison du risque d'immunosuppression lié à l'utilisation des corticoïdes ou des immunosuppresseurs, avec possible aggravation de la tuberculose.

Contribution of Imaging in Diagnosis of Primitive Cyst Hydatid in Unusual Localization: Pleura-A Report of Two Cases

Hydatic disease has always been the most common in countries where large amount of sheep and cattle is raised, but increased travel and immigration have made this condition a serious worldwide public problem. Cyst hydatid may affect all parts of the human body like the heart, the bone marrow, the eye, the brain, the kidney, and the spermatic cord. Humans can become infested by accidentally ingesting the eggs that are passed in the feces from definitive hosts (usually a canid, such as a wolf, fox, or dog). Even in endemic countries, the primitive pleural hydatid cyst is exceptional, and it is very difficult to distinguish from other pleural and parietal cystic masses especially that in majority of cases the immunologic tests are negative. We report two cases of pleural hydatid cyst discovered in two young patients, with a nonspecific clinical presentation. The interest of this paper is to raise the primordial role of imaging in the positive diagnosis of primary pleural hydatid cyst.

Spatiotemporal distribution and predictors of tuberculosis incidence in Morocco

BACKGROUND

Tuberculosis (TB) is a major health problem in Morocco. This study aims at examining trends in TB in Morocco and identifying TB spatial clusters and TB-associated predictors.

METHOD

Country-level surveillance data was exploited. Kendall's correlation test was used to examine trends and an exploratory spatial data analysis was conducted to assess the global and local patterns of spatial autocorrelation in TB rates (Moran's I and local indicator of spatial association [LISA]) at the prefecture/province level. Covariates including living in a prefecture versus living in a province, annual rainfall, annual mean temperature, population density, and AIDS incidence were controlled. An ordinary least squares regression was thus performed and both spatial dependence and heteroscedasticity were assessed.

RESULTS

A decrease in TB incidence rate was seen between 1995 and 2014 (Kendall's tau b = - 0.72; P <  0.0001). However, while the period between 2005 and 2014 (10 last years) was considered, TB rate remained stable and as high as 84 per 100 000 population per year (95% CI: 83.7-84.3). The highest incidence rates were seen in Tanger-Assilah, Fez, Tetouen-M'diq Fnidaq, Inezgane Ait Melleoul, and Casablanca. From 2005 to 2014, while TB incidence rate was stable in Fez (P = 0.500), Tetouen-M'diq Fnidaq (P = 0.300), Casablanca (P = 0.500), Mohammadia (P = 0.146), Al Hoceima (P = 0.364), and Guelmim (P = 0.242), an increase in TB incidence rate was seen in Tanger-Assilah (Kendall's tau = 0.49; P = 0.023) and a decrease in Salé (Kendall's tau b = - 0,54; P = 0.014) and Inezgane-Ait Melloul (Kendall's tau b = - 0,67; P = 0.0023). TB is strongly clustered in space (P-values of Moran's I <  0.01). Two distinct spatial regimes that affect TB spatial clustering were identified (east and west). In the east, both annual rainfall (P = 0.003) and AIDS (P = 0.0002) exert a statistically significant effect on TB rate. In the west, only the living area (prefecture versus province) was associated with TB rate (P = 0.048).

CONCLUSIONS

New information on TB incidence and TB-related predictors was provided to decision-making and to further pertinent research. Association between annual rainfall and TB may be of interest to be explored elsewhere.

[The tree that hides the forest: aspergillosis associated with bronchial carcinoma (about two cases)]

Endobronchial aspergilloma and intracavitary pulmonary aspergilloma may clinically and radiologically mimic a bronchial neoplasia, hence the importance of systematically searching for an association. A confirmed association completely changes the prognosis as well as the therapeutic approach. We here report two cases with two different forms of pulmonary aspergilloma associated with bronchial carcinoma.

Molecular characterization of mutations associated with resistance to second-line tuberculosis drug among multidrug-resistant tuberculosis patients from high prevalence tuberculosis city in Morocco

BACKGROUND

The emergence of extensively drug-resistant tuberculosis (XDR-TB) has raised public health concern for global TB control. Although multi drug-resistant tuberculosis (MDR- TB) prevalence and associated genetic mutations in Morocco are well documented, scarce information on XDR TB is available. Hence, the evaluation of pre-XDR and XDR prevalence, as well as the mutation status of gyrA, gyrB, rrs, tlyA genes and eis promoter region, associated with resistance to second line drugs, is of great value for better management of M/XDR TB in Morocco.

OBJECTIVES

To evaluate pre-XDR and XDR prevalence, as well as the mutation status of gyrA, gyrB, rrs, tlyA genes and eis promoter region, associated with resistance to second line drug resistance, in 703 clinical isolates from TB patients recruited in Casablanca, and to assess the usefulness of molecular tools in clinical laboratories for better management of M/XDR TB in Morocco.

METHODS

Drug susceptibility testing (DST) was performed by the proportional method for first line drugs, and then the selected MDR isolates were tested for second line drugs (Ofloxacin, Kanamycin, Amikacin and Capreomycin). Along with DST, all samples were subjected to rpoB, katG and p-inhA mutation analysis by PCR and DNA sequencing. MDR isolates as well as 30 pan-susceptible strains were subjected to PCR and DNA sequencing of gyrA, gyrB, rrs, tlyA genes and eis promoter, associated with resistance to fluoroquinolones and injectable drugs.

RESULTS

Among the 703 analysed strains, 12.8% were MDR; Ser531Leu and Ser315Thr being the most common recorded mutations within rpoB and katG genes associated with RIF and INH resistance respectively. Drug susceptibility testing for second line drugs showed that among the 90 MDR strains, 22.2% (20/90) were resistant to OFX, 2.22% (2/90) to KAN, 3.33% (3/90) to AMK and 1.11% (1/90) to CAP. Genotypic analysis revealed that 19 MDR strains harbored mutations in the gyrA gene; the most recorded mutation being Asp91Ala accounting for 47.6% (10/21), and 2 isolates harbored mutations in the promoter region of eis gene. No mutation was found in gyrB, rrs and tlyA genes. Moreover, none of the pan-susceptible isolates displayed mutations in targeted genes.

CONCLUSION

Most of mutations associated with SLD resistance occurred in gyrA gene (codons 90-94) and eis promoter region. These findings highlight the impact of mutations in gyrA on the development of fluroquinolones resistance and provide the first estimates of the proportion of pre-XDR-TB among MDR-TB cases in Morocco.

New variant identified in major susceptibility locus to tuberculosis on chromosomal region 8q12-q13 in Moroccan population: a case control study

Background

Tuberculosis (TB) remains a global health problem. Several studies have implicated genetic host factors in predisposing populations to TB disease. In this study, we have selected NSMAF (Neutral Sphingomyelinase Activation Associated Factor) as a candidate gene to evaluate its level of association with TB disease in a Moroccan population for two reasons: first, this gene is located in a major susceptibility locus on chromosomal region 8q12-q13 in the Moroccan population, closely linked to the CYP7A1 gene, which was previously shown to be associated with TB disease; second, NSMAF has an important role in immune system function.

Methods

We conducted a case-control study including 269 genomic DNA samples extracted from pulmonary TB (PTB) patients and healthy controls (HC). We genotyped three selected SNPs (rs2228505, rs36067275 and rs10505004) using TaqMan® allelic discrimination assays.

Results

Only the rs1050504 C > T genotype was observed to be significantly associated with an increased risk for developing pulmonary TB (41.8% vs 27%, OR 1.95, 95% CI 1.16–3.27; p = 0.01). In contrast, the TT genotype was significantly associated with resistance to PTB (4.1% vs 15.6%, OR 0.23, 95% CI 0.08–0.63; p = 0.002).

Conclusion

Our findings suggest that genetic variations in the NSMAF gene could modulate the risk of PTB development in a Moroccan population. Further functional studies are needed to confirm these findings.

[Initial manifestation and atypical site for metastatic synovial sarcoma in an immunocompetent adult patient: about a case and literature review]

Synovial sarcoma (SS) is a rare tumor. It is characterized by various sites of occurrence but rarely involves the chest. The tumor may be wrongly diagnosed as benign due to its slow growth. Less than 10% of patients present with metastatic cancer. Endobronchial metastases are exceptional. Immunohistochemical examination and cytogenetic analysis allow to distinguish it from other mesenchymal tumors. The presence of SYT-SSX fusion transcript allows the diagnosis. Surgery is used for localized tumors that can be treated with radiation therapy while chemiotherapy is used for metastatic tumors. The average rate of locoregional or metastatic recurrence two years after SS is 50%. We report the case of a 28-year old patient with metastatic SS characterized by its uncommon metastatic site. He presented with endobronchial metastasis revealing his disease, that had evolved for more than 2 years. The SS is life-threatening due to its slow and insidious growth. Prognosis is guarded. This study aimed to emphasize this atypical site for metastatic synovial sarcoma as well as to insist on the role of early diagnosis and treatment.

Low plasma vitamin A concentration is associated with tuberculosis in Moroccan population: a preliminary case control study

BACKGROUND

Vitamin A plays numerous roles in immune system. Its deficiency alters both the innate and adaptive immunity. Previous results reported that the micronutrients deficiency, particularly vitamin A, is observed in patients with tuberculosis. Thus, we aimed in this study to assess vitamin A concentrations in Moroccan patients with tuberculosis to set up a large efficacy study of vitamin A supplementation for TB infected patients. Plasma retinol concentration was measured by HPLC in 44 recently diagnosed TB patients and 40 healthy controls.

RESULTS

We showed that plasma vitamin A is significantly lower in tuberculosis patients as compared to healthy controls (p < 0.0001). Moreover, no significant association was found between vitamin A deficiency and, TB severity and patients' ages.

CONCLUSION

Our study confirms the association between low vitamin A levels and tuberculosis disease.

[DRESS syndrome secondary to antituberculosis drugs: about a case]

Drug hypersensitivity syndrome or Drug Rash with Eosinophilia and Systemic Symptoms or DRESS syndrome is a severe and potentially life-threatening toxidermia. It should be suspected in patients developing cutaneous reaction following drug intake. We report the case of a 45-year old patient treated for pulmonary tuberculosis (TPM+) who developed DRESS syndrom induced by antibacillaries.

Association between untreated carious lesions and asthma in adults at Rabat University Hospital, Morocco: a cross sectional study

Background

Depending on risk factors, cumulative risk of developing more dental caries by age has been reported. However, the association between dental caries and asthma is less studied among adults. The aims of this study were to evaluate the severity of untreated carious lesions in a population of asthmatic adults and to evaluate the mediation of socio-economic and oral health behaviour variables.

Methods

The study involved participants with diagnosed asthma (N = 100) and control (N = 100) subjects attending a tertiary hospital. Groups were matched by age and gender. Asthma was the exposure of interest. The outcome measure was the rate of carious lesions. Recorded variables included demographics, socio-economic status, tooth brushing habits and oral health status using WHO criteria. Poisson regression analysis examined the association between asthma and untreated dental caries.

Results

The adjusted model, after the inclusion of individuals’ behaviours regarding oral health, social determinants and asthma, revealed a significant association between the number of untreated carious lesions and asthma (PR = 1.23; 95% CI 1.23–1.58; p < 0.001).

Conclusion

Patients with asthma showed a greater number of untreated carious lesions. Looking forward, better understanding of the association between asthma and oral health may require exploiting the interactions of behavioural, social determinant and biological factors.

A primary intestinal lymphangiectasia hiding the diagnosis of pleural and pericardial tuberculosis: a clinical observation

Primary intestinal lymphangiectasia (Waldmann's disease) is an exudative enteropathy characterized by lymph leakage into the small bowel lumen leading to hypoalbuminemia, hypogammaglobulinemia and lymphopenia (particularly T-cell). The diagnosis is based on viewing the duodenal lymphangiectasia. A 20 years old female patient, treated for a primary intestinal lymphangiectasia, has consulted for anasarca. Etiological work-up reveals pleural and pericardial tuberculosis. The clinical aggravation of an enteropathy, particularly in adulthood, requires a search for a secondary etiology. Tuberculosis should be sought systematically.

Nocardiose pulmonaire sur un terrain immunocompétent: à propos de 2 cas

La nocardiose est une infection rare, mais sévère, causée par des bactéries du genre nocardia, qui appartiennent à l'ordre des actinomycétales. Si elles peuvent toucher l'adulte immunocompétent, les nocardioses restent des pathologies de l'individu fragilisé sur le plan immunitaire. L'atteinte pulmonaire reste la plus fréquente, sa prise en charge correcte est liée au diagnostic qui est souvent retardé par des présentations non spécifiques et des prélèvements non concluants. Nous rapportons ici deux cas de nocardiose chez des patients immunocompétents. Le premier cas est celui d'un homme de 24 ans, avec notion de tabagisme et d'éthylisme, hospitalisé pour des douleurs thoraciques et des hémoptysies de faible abondance, évoluant depuis deux mois, avec apparition d'abcès sous cutanés dorsaux fistulisés. L'exploration radiologique découvre une masse tissulaire médiastino-pulmonaire droite avec lyse costale adjacente et diffusion aux tissus para vertébraux droits. Les prélèvements bactériologiques restent négatifs motivant une biopsie scannoguidée de la lésion qui est revenue en faveur d'infection à nocardiose. Le second cas concerne un homme de 22 ans, aux antécédents de tuberculose pleurale traitée il y a 8 ans puis une rechute de tuberculose en 2011 (abcès médiastinal). Admis pour suspicion de rechute de tuberculose devant une toux chronique avec altération de l'état général et une hépatosplénomégalie. Le scanner thoracique montre des condensations alvéolaires avec pleurésie. Au cours de son hospitalisation, apparition de tuméfactions sous cutanées purulentes dont l'étude bactériologique du pus est revenue en faveur de nocardiose avec une souche résistante à tous les antibiotiques sauf colistine et bactrim. Les auteurs illustrent à travers ces deux observations, les aspects cliniques et radiologiques de nocardiose pulmonaire en mettant le point sur les difficultés diagnostiques et thérapeutiques surtout dans un pays à forte prévalence de tuberculose et très faible incidence de nocardiose.

First line anti-tuberculosis induced hepatotoxicity: incidence and risk factors

In our days, tuberculosis, whet ever its localization, became a curable disease. The cornerstone is a 6 month course of isoniazid, rifampicine and pyrazinamide. All of the three first line antituberculosis drugs may induce hepatic damage which may have negative consequences for treatment outcome. Several risk factors were associated with the development of antituberculosis- drug-induced hepatotoxicity (ATDH). A retrospective study was conducted from July 2014 to March 2015 regarding all therapeutic drug-monitoring requests sent to the Laboratory of Poison Control and Pharmacovigilance Centre of Morocco. 142 patients diagnosed with active tuberculosis were included in study. Plasma peak levels of isoniazid, rifampicin and pyrazinamide were analyzed in plasma samples after 2 to 3 hours of administration of anti-tuberculosis treatment. Logistic regression was used to identify the ATDH risk factors. The incidence of ATDH was found 24.6% (35 patients out of 142). Intergroup differences in the plasma levels were statistically significant for isoniazid (p=0.036). ATDH was found to be associated with combined form of anti-TB drugs (p=0.002, COR=13.1, AOR= 13.5) and plasma concentration of INH superior to 2mg/l (p=0.045, COR=1.3, AOR= 1.4).age, gender, alcohol intake and smoking status were not significantly associated with ATDH. The finding of 24.6% incidence of hepatotoxicity is extremely high. Many factors can be associated with the development of ATDH such as genetic factors, combined forms of treatment and plasma peak levels.

[Tuberculous cheilitis revealing pulmonary tuberculosis]

La tuberculose de la cavité buccale reste rare. Elle admet un polymorphisme clinique et pose avant tout un problème de diagnostic. Nous rapportons le cas d'un homme de 42 ans présentant une chéilite tuberculeuse. L’intérêt de cette présentation est d’attirer l’attention sur la tuberculose que l’on peut retrouver de façon exceptionnelle dans certaines localisations, comme la lèvre buccale.

[Myocardial tuberculoma: unusual location of tuberculosis: a new observation and review of the literature]

Nous rapportons l'observation d'un patient de 50 ans présentant une masse tumorale du ventricule gauche évoluant dans un contexte d'altération de l’état général et de fièvre. Cette masse a été objectivée par l’échocardiographie réalisée pour l'exploration d'une cardiomégalie radiologique. L'aspect en imagerie par résonance magnétique était évocateur d'un tuberculome intra myocardique. A travers notre observation, nous proposons une revue de la littérature sur cette localisation inhabituelle de la tuberculose.

Un mode révélateur original de la sarcoïdose: syndrome de sweet

Le syndrome de Sweet est une dermatose neutrophilique, le plus souvent idiopathique. L'association d'un syndrome de Sweet et d'une sarcoïdose est rare. Nous rapportons le cas clinique d'un syndrome de Sweet révélant une sarcoïdose.

[Pulmonary tuberculosis mortality risk factors]

La tuberculose est une maladie infectieuse transmissible provoquée par myco-bacterium tuberculosis (bacille de Koch ou BK). Elle représente, selon les estimations del'Organisation Mondiale de la Santé (OMS), l'une des pathologies infectieuses causant le plus de décès au niveau mondial avec plus de 1 million de décès par an. Pour déterminer les facteurs de risque de mortalité au cours de la tuberculose pulmonaire à microscopie positive nous avons mené une étude rétrospective portant sur tous les cas de tuberculose pulmonaire à microscopie positive et qui étaient décédés au cours de leur hospitalisation. Cette étude a colligé 1803 cas de tuberculose sur une période de 2 ans et demi dont 46 sont décédés. La prévalence de décès est de 2,55%. La population se répartit en 32 hommes et 14 femmes. L’âge moyen était de 53ans ± 17 ans. Le tabagisme était retrouvé chez la moitié des cas. Une comorbidité était retrouvée dans 43%, avec 17% de diabète. Le délai de diagnostic avait une médiane de 60 jours avec percentile (30j; 105j). La symptomatologie clinique était dominée par la toux, la dyspnée et les expectorations soit respectivement: 97,8%, 69,6% et 67,4% des cas. Sur le plan radiologique les lésions étaient diffuses et bilatérales dans 76,1% des cas. Tous les patients étaient mis sous SRHZ. 11% avaient présenté une toxicité aux antibacillaires (de type hépatiques dans 3 cas et neurologiques dans 2 cas). Le délai médian de décès était de 8,5 jours (5j; 17j). Les causes de décès retrouvées étaient: Une hépatite fulminante (3 cas), une décompensation acido-cétosique (3 cas), un SDRA (2 cas), des hémoptysies foudroyantes (2 cas), et respectivement un cas secondaire à une décompensation de BPCO, une décompensation cardiaque, une hypoglycémie et un tableau d'anasarque. Cette étude suggère que le terrain, le retard diagnostique et les effets secondaires du traitement sont les principaux facteurs de risque de mortalité chez les patients hospitalisés pour tuberculose pulmonaire.

[Pulmonary tuberculosis and tobacco: about 100 cases]

Le tabagisme et la tuberculose sont deux enjeux majeurs de santé publique au niveau mondial, en particulier dans les pays émergents. Pour déterminer les particularités cliniques, radiologiques, bactériologiques et thérapeutiques de la tuberculose pulmonaire chez les sujets tabagiques nous avons mené une étude prospective au service de phtisiologie de l'hôpital Moulay Youssef sur une période de 10 mois, portant sur 100 nouveaux cas de tuberculose pulmonaire, répartis en 2 groupes, 50 patients tabagiques: Groupe A et 50 patients non tabagiques: Groupe B. Tous nos patients étaient de sexe masculin, l’âge moyen était de 41 ans ± 12 chez le groupe A et de 36 ans ± 16 chez le groupe B. Le délai de consultation était plus long chez les tabagiques, la médiane était de 60j (30; 98) contre 40j (30; 60), la symptomatologie clinique était variable chez les deux groupes, dominée par les expectorations chez les tabagiques 96% contre 60%. Les lésions radiologiques étaient similaires chez les deux groupes ainsi que la charge bacillaire. Tous les patients ont été mis sous traitement antituberculeux. Après un mois du traitement, la Bacilloscopie était négative chez 50% du groupe A contre 66% chez le groupe B. la régression des lésions radiologiques était similaire chez les deux groupes. Le retard diagnostique et le retard de négativation des frottis sont les principales particularités de la tuberculose pulmonaire du sujet tabagique. Le sevrage tabagique doit faire partie intégrante de la prise en charge des patients atteints de tuberculose.

[Hypothermia due to anti-tuberculosis drugs: first case]

Hypothermia - an adverse reaction of drug use potentially severe - requires an early diagnosis and an adapted management. We report the first case, to our knowledge of hypothermia due to anti-tuberculosis drugs.

Tracheobronchopathia osteochondroplastica associated with skin cancer: a case report and review of the literature

BACKGROUND

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder of unknown cause affecting the large airways. It is characterized by the accumulation of bony and cartilaginous nodules in the tracheal and bronchial mucosa. Approximately 300 cases of tracheobronchopathia osteochondroplastica have been reported since Wilks first identified it in 1857. Tomography and computed tomography scanning (CT) can be suggestive but final verification requires biopsy. Neoplastic disorders are, among others, blamed in etiology. We describe here, for the first time, a case of TO associated with skin cancer.

CASE PRESENTATION

A 40-year-old man with a scalp cancer was admitted for further evaluation of an occasional dry cough. Her medical history was otherwise unremarkable, and physical examination showed no abnormalities.The chest CT scan demonstrated multiple nodular densities in the trachea and proximal bronchi. The fiberoptic bronchoscopy showed multiple nodules in the trachea suggesting a malignant infiltration.Microscopic examination of the biopsy material revealed fragments of normal cartilage and bone formation with normal mucosa which confirmed the diagnosis of TO.Patient underwent surgery for scalp cancer. For TO, case has followed up. At twelve-month follow up, scalp tumor did not recur and cough ceased.

CONCLUSION

TO is a rare, benign disease that should be kept in mind especially in patients with tracheal irregularities in their chest imaging. Association with malignant tumors is reported.In patients with malignancy, TO can easily be misdiagnosed if it is not known as a diagnosis possibility of malignant invasion of the trachea. Therefore, it is important to be aware of this possibility, in order to prevent unnecessary treatments to patients.

Genetic diversity of TLR2, TLR4, and VDR loci and pulmonary tuberculosis in Moroccan patients

Introduction: Toll-like receptors (TLRs) 2, 4, and the vitamin D receptor (VDR) are central components of the innate and adaptive immunity against Mycobacterium tuberculosis (Mtb). TLR2, TLR4, and VDR polymorphisms were previously associated with tuberculosis (TB) and were here investigated as candidates for pulmonary TB (PTB) susceptibility in a Moroccan population group. Methodology: Genomic DNA from 343 PTB patients and 203 healthy controls were analyzed for 12 single nucleotide polymorphisms (SNPs) located in TLR2, TLR4, and VDR genes using polymerase chain reaction-based restriction fragment length polymorphism and TaqMan SNP genotyping assays. Results: The TLR2 +597 CT genotype was associated with protection against PTB (corrected p [pc] = 0.04; odds ratio (OR) = 0.65; 95% confidence interval (CI) = 0.45 - 0.94), and the TLR4 +7263 C allele was significantly associated with PTB susceptibility (pc = 0.04; OR = 1.63; CI = 1.06 - 2.57). The VDR [f,b,a,T] haplotype was found to confer protection (pc < 0.00001; OR = 0.18; CI = 0.09 - 0.35), while the TLR2 [-16934T,+597C,+1349T] haplotype seemed to be at risk (p = 0.03; OR = 1.52; CI = 1.01 - 2.30), but  statistical significance was not reached. Finally, cross-analysis between polymorphisms of the three studied genes revealed significant interaction between TLR2 +597 and TLR4 +4434 SNPs towards protection against PTB (pc = 0.036), suggesting that the functionally relevant TLR4 +4434 SNP may act synergistically with TLR2 SNPs. Conclusions: TLR2 and TLR4 interaction and a specific VDR haplotype influence protection against PTB in Moroccans patients.

Treatment default amongst patients with tuberculosis in urban Morocco: predicting and explaining default and post-default sputum smear and drug susceptibility results

Setting

Public tuberculosis (TB) clinics in urban Morocco.

Objective

Explore risk factors for TB treatment default and develop a prediction tool. Assess consequences of default, specifically risk for transmission or development of drug resistance.

Design

Case-control study comparing patients who defaulted from TB treatment and patients who completed it using quantitative methods and open-ended questions. Results were interpreted in light of health professionals’ perspectives from a parallel study. A predictive model and simple tool to identify patients at high risk of default were developed. Sputum from cases with pulmonary TB was collected for smear and drug susceptibility testing.

Results

91 cases and 186 controls enrolled. Independent risk factors for default included current smoking, retreatment, work interference with adherence, daily directly observed therapy, side effects, quick symptom resolution, and not knowing one’s treatment duration. Age >50 years, never smoking, and having friends who knew one’s diagnosis were protective. A simple scoring tool incorporating these factors was 82.4% sensitive and 87.6% specific for predicting default in this population. Clinicians and patients described additional contributors to default and suggested locally-relevant intervention targets. Among 89 cases with pulmonary TB, 71% had sputum that was smear positive for TB. Drug resistance was rare.

Conclusion

The causes of default from TB treatment were explored through synthesis of qualitative and quantitative data from patients and health professionals. A scoring tool with high sensitivity and specificity to predict default was developed. Prospective evaluation of this tool coupled with targeted interventions based on our findings is warranted. Of note, the risk of TB transmission from patients who default treatment to others is likely to be high. The commonly-feared risk of drug resistance, though, may be low; a larger study is required to confirm these findings.

Postmenopausal breast tuberculosis - report of 4 cases

BACKGROUND

Breast tuberculosis is an uncommon disease even in countries where the incidence of tuberculosis is high.

CASE REPORT

This is a case series concerning 4 postmenopausal breast tuberculosis cases encountered in Moulay Youssef Hospital between January 2007 and December 2010. Breast tuberculosis represents 0.25% of all hospitalized tuberculosis patients in our department. The mean age of our patients was 62.5 ± 5.8 years. Clinical findings were heterogeneous; 1 case was multifocal tuberculosis, and another case was coexistent tuberculosis and malignancy of the breast. Mammography and ultrasonography findings were suspicious for malignancy in all 4 cases. Fine needle aspiration was negative in 3 cases. The diagnosis was made in all patients by histological examination of biopsy specimens, which revealed typical tuberculous lesions. Anti-tuberculosis therapy formed the mainstay of treatment.

CONCLUSION

The clinical and radiological features of mammary tuberculosis can be very confusing and easily mistaken for breast cancer. Symptoms suggestive of tuberculosis warrant a biopsy to exclude possible cancer.

L’intérêt de l’accoutumance aux antituberculeux majeurs

Les réactions d’ hypersensibilité aux antituberculeux sont relativement rares et graves par leur caractère imprévisible, elles conduisent généralement à l'arrêt ou au changement thérapeutique. Nous rapportons un cas d'hypersensibilité à trois antibacillaires majeurs (Isoniazide, Pyrazinamide, Ethombutol). Une accoutumance orale à ces trois médicaments a été réalisée permettant à la patiente de bénéficier d'un traitement antibacillaire optimal.

[An unusual cause of hemoptysis: a leech]

We report an exceptional case of hemoptysis observed in a 71-year-old woman with an uneventful past history. After 48 hours of admission, the patient spontaneously expelled a leech from the nose. The parasite was examined in parasitology laboratory, which confirmed the hemiptera. The infestation of the airway by a leech is not uncommon; however, this diagnosis is rarely mentioned. The clinical symptoms are variable depending on location and the diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

Qualitative study of perceived causes of tuberculosis treatment default among health care workers in Morocco

SETTING

In Morocco, tuberculosis (TB) treatment default is increasing in some urban areas.

OBJECTIVE

To provide a detailed description of factors that contribute to patient default and solutions from the point of view of health care professionals who participate in TB care.

DESIGN

In-depth interviews were conducted with 62 physicians and nurses at nine regional public pulmonary clinics and local health clinics.

RESULTS

Participants had a median of 24 years of experience in health care. Treatment default was seen as a result of multilevel factors related to the patient (lack of means, being a migrant worker, distance to treatment site, poor understanding of treatment, drug use, mental illness), medical team (high patient load, low motivation, lack of resources for tracking defaulters), treatment organization (poor communication between treatment sites, no systematic strategy for patient education or tracking, incomplete record keeping), and health care system and society. Tailored recommendations for low- and higher-cost interventions are provided.

CONCLUSIONS

Interventions to enhance TB treatment completion should take into account the local context and multilevel factors that contribute to default. Qualitative studies involving health care workers directly involved in TB care can be powerful tools to identify contributing factors and define strategies to help reduce treatment default.

The MCP-1 (CCL2) -2518 GG genotype is associated with protection against pulmonary tuberculosis in Moroccan patients

INTRODUCTION

Both monocyte chemoattractant protein-1 (MCP-1), also designated officially as chemokine (C-C motif) ligand 2 (CCL2), and interleukin-12 p40 (IL-12 p40) molecules, encoded by polymorphic genes, are central components of the immune response to infection by Mycobacterium tuberculosis (Mtb). Their genetic diversity has previously been associated with the outcome of tuberculosis (TB) infection. We investigated whether the MCP-1 -2518 A/G and the IL-12B (p40) +1188 A/C polymorphisms influence susceptibility to or resistance against pulmonary tuberculosis (PTB) in a Moroccan population group.

METHODOLOGY

Genomic DNA from 337 patients along with 204 healthy controls were genotyped for the above-mentioned genetic variations using polymerase chain reaction-based restriction fragment length polymorphism assay.

RESULTS

We found a higher prevalence of homozygous MCP-1 -2518 G allele in healthy individuals than in patients (pc = 0.04; odds ratio  = 0.35; 95% confidence interval  = 0.13 - 0.86), suggesting a potential protective effect, whereas analysis of IL-12B +1188 variation failed to reveal any such association.

CONCLUSION

Our results are in agreement with recent findings in Ghanaian patients, complying with the known genetic admixture of the Moroccan population.

[Pulmonary alveolar microlithiasis: report of four cases]

INTRODUCTION

Pulmonary alveolar microlithiasis is a rare disease characterised by the formation and deposition of calcium phosphate microliths in the lung. It is an autosomal recessive disorder, for which mutation in the SLC34A2 gene was recently found to be responsible for the disease.

OBSERVATIONS

We report on four cases of pulmonary alveolar microlithiasis. Three patients were asymptomatic. The diagnosis was made after histological confirmation in three patients. The outcome was marked by the death of one patient.

CONCLUSION

Pulmonary alveolar microlithiasis is a rare disease. Diagnosis is made with high-resolution computed tomography, which exhibits the calcic character and distribution of the lesions, thus avoiding the need to perform lung biopsy. We suggest that a literature review be performed.

Sarcoïdose et insuffisance rénale: à propos de deux cas

Renal involvement in sarcoidosis is rare and more often related to calcium metabolism disorders or granulomatous interstitial nephritis, glomerulonephritis is exceptional. The two cases of renal failure reported in this article illustrate the gravity of this complication, whose treatment remains difficult.

[Congenital esophagobronchial fistula in an adult. Case report]

Congenital esophagobronchial fistulae are uncommon anomalies generally discovered during the neonatal period due to overt symptoms. Rarely symptoms are discrete, leading to discovery in adulthood; exceptionally the patients are totally symptom free or present minimal signs such as coughing at ingestion of fluids. Less than 200 adult cases have been reported in the literature. We report a new case of this type II congenital esophagobronchial fistula. A 59-year-old woman was hospitalized for exploration of cough at ingestion of fluids. The radiographic work-up reveal dilatation of the left bronchial tree and suspected esophagobronchial fistula. An esophago-gastro-duodenal barium study demonstrated a fistula between the mid esophagus and the left posterobasal bronchus. Fistulectomy and left lower lobectomy were performed. Outcome was favorable. The diagnosis of adult esophagobronchial fistula should be entertained in patients with an uneventful history who present localized bronchial dilatation associated with cough induced by fluid ingestion.

[The pseudoalveolar form of sarcoïdosis: a diagnostic pitfall]

BACKGROUND

Sarcoïdosis is a benign systemic granulomatosis whose aetiology remains unknown. Lung is the most frequently involved organ. The pseudoalveolar form of this disease is known to have an acute onset and is quite uncommon. Therefore, diagnosing such a rare variety of sarcoidosis is rather often challenging.

OBSERVATIONS

In the present article, the authors report two cases of pseudoalveolar sarcoidosis. The patients, both young adults, showed no suggestive signs of sarcoidosis at first presentation. This resulted in a considerable delay to diagnosis and to the corticosteroid therapy.

CONCLUSION

The authors emphasize the rarity of the pseudoalveolar form of sarcoidosis. They insist on its roentgenographic characteristics and demonstrate the functional benefits allowed by the precocious medical management. They also propose a current review of the literature.

[Pulmonary leptospirosis. Two cases]

Leptospirosis is a systemic infection transmitted to man by a variety of animals. Classical manifestations include fever, liver and renal involvement, meningoencephalitis and hemorrhage. Pulmonary involvement is less common, generally expressed by hemoptysis and bilateral reticulonodular infiltration on the chest x-ray. Pulmonary disease is one of the principal causes of mortality. We report the cases of two patients aged 22 and 32 years who were hospitalized for moderately abundant hemopysis and fever. The diagnosis of leptospirosis with pulmonary involvement, strongly suggested by the classical extrapulmonary signs and was confirmed later. The patients were given antibiotics (amoxicillin, cycline). Clinical, biological and radiological outcome was favorable.