Prevalence of the protective OAS1 rs10774671-G allele against severe COVID-19 in Moroccans: implications for a North African Neanderthal connection

The clinical presentation of COVID-19 shows high variability among individuals, which is partly due to genetic factors. The OAS1/2/3 cluster has been found to be strongly associated with COVID-19 severity. We examined this locus in the Moroccan population for the occurrence of the critical variant rs10774671 and its respective haplotype blocks. The frequency of single-nucleotide polymorphisms (SNPs) in the cluster of OAS immunity genes in 157 unrelated individuals of Moroccan origin was determined using an in-house exome database. OAS1 exon 6 of 71 SARS-CoV-2-positive individuals with asymptomatic/mild disease and 74 with moderate/severe disease was sequenced by the Sanger method. The genotypic, allelic, and haplotype frequencies of three SNPs were compared between these two groups. Finally, males in our COVID-19 series were genotyped for the Berber-specific marker E-M81. The prevalence of the OAS1 rs10774671-G allele in present-day Moroccans was found to be 40.4%, which is similar to that found in Europeans. However, it was found equally in both the Neanderthal GGG haplotype and the African GAC haplotype, with a frequency of 20% each. These two haplotypes, and hence the rs10774671-G allele, were significantly associated with protection against severe COVID-19 (p = 0.034, p = 0.041, and p = 0.008, respectively). Surprisingly, in men with the Berber-specific uniparental markers, the African haplotype was absent, while the prevalence of the Neanderthal haplotype was similar to that in Europeans. The protective rs10774671-G allele of OAS1 was found only in the Neanderthal haplotype in Berbers, the indigenous people of North Africa, suggesting that this region may have served as a stepping-stone for the passage of hominids to other continents.

Genome sequencing of severe acute respiratory syndrome COVID-19 EF.1 variant strain obtained from a Moroccan patient

Here, we report the identification and coding-complete genome sequence of a severe acute respiratory syndrome COVID-19 (SARS-CoV-2) strain obtained from a Moroccan patient. The detected strain EF.1 belongs to the BQ1.1 subvariant of the BA.5 Omicron variant.

Neutralising antibodies against SARS-CoV-2 give important information on Covid-19 epidemic evolution in Rabat, Morocco, March 2020-February 2021

Background

The SARS-CoV-2 is an extremely contagious and acute viral disease mainly affecting humans.

Objective

To estimate seroprevalence of SARS-CoV-2 neutralizing antibodies (NAbs) for illegible armed force individuals living in Rabat, Morocco.

Method

A convenience sample (N = 2662) was conducted from May 2020 to February 2021. We used the standard neutralization assay to quantify the NAbs titers. A serum was positive when the titer was 1:4. High positive NAbs titers were defined when ≥ 1:32.

Results

Demographic and socioeconomic status did not affect seroprevalence data. An overall seroprevalence of 24,9% was found. Sera from blood donors, young recruits and auto-immune population had lower NAbs titers. However, titers were above 1:16 in 9% of the population with high risk of SARS-CoV-2 exposure. Seropositivity increased over time with values reaching peaks after the epidemic waves (2.4% in May 2020; 16.2% in August 2020; 22.7% in December 2020 and 37% in February 2021).

Conclusion

And increase of NAbs was observed over time and correlated with the post-epidemic waves of COVID-19 in Morocco.

Germline mutations of B-Raf proto-oncogene and pathological implications in prostate cancer: observational study

B-Raf proto-oncogene has been found in a variety of neoplasms. BRAF stimulation can promote tumour proliferation through the activation of the MAP/ERK kinase pathway. This study aimed to determine the germline spectra of BRAF and the association with pathological criteria of prostate tumours.

Methods

Fifty blood samples from men treated with prostate cancer were analyzed for BRAF germline mutations and confirmed by Sanger sequencing, in addition, to establishing the frequencies and clinical correlations of frequent mutations in the BRAF gene for both exon 11 and exon 15. The frequency and distribution of high-frequency mutations were analyzed according to the pathological criteria of the patients.

Results

Frameshift mutations: c.1628_1629insA and c.1624_1625insT with a frequency of (46%) and (18%), respectively, Nonsense mutations: c.1181C>A (p.Ser394Ter) was detected in one patient, missense mutations: c.1226A>G (p.Gln409Arg), c.1270T>C (p.Trp424Arg), c.1270_1271delins2 (p.Trp424Leu), with a frequency of (4%) were detected. There was no significant difference between mutation carriers and non-carriers regarding medical and surgical history, but prostate-specific antigen concentration was significantly different between the two groups.

Conclusion

The results of this study elucidate the presence and involvement of germline mutations in prostate cancer, which could serve as a potential indicator for the diagnosis and therapeutic management of prostate cancer in the population studied.

Coding-Complete Genome Sequences of an Omicron Subvariant (BA.5.2.20) of SARS-CoV-2

Here, we present the complete coding sequences of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains that were recovered from a nasopharyngeal swab from a female patient and the second viral passage in cell culture. After testing, both strains were identified as BA.5.2.20, a subvariant of Omicron.

Mutation status of full RAS and BRAF in 169 Moroccan patients with colorectal cancer

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Background: Morocco has the highest cancer mortality rate in MENA Countries. Colorectal cancer (CRC) is classified as the first digestive cancer and remains a burden in Morocco. According to the data on GLOBOCAN 2020, there were 4324 new CRC patients and 2374 deaths, accounting for 7.3% and 2.8% of all cancers, respectively. Our study aimed to investigate the frequency of the full RAS ( KRAS, NRAS) and BRAF genes in CRC patients from Morocco and their possible associations with clinico-pathological features. Methods: Archived FFPE of 169 CRC patients were screened for KRAS, NRAS and BRAF mutations by Idylla technology. Results: Full RAS mutations were identified in 46.1% (42% in KRAS, 4.1% in NRAS). In KRAS gene, exon 2 mutations accounted for 84.5% (69% in codon 12, 15.5 % in codon 13). Within codon 12, KRAS G12D and G12C were more frequently detected (29.5% and 16.9%, respectively). Detection of KRAS mutations, and particularly G12D and G12C subtypes, are of large significance for CRC patients, have possible therapeutic implications. Within codon 13, the most frequently observed mutation was G13D (15.5 %). Outside exon 2, the mutation rate was 35.1% (8.4% in exon 3 and 26.7% in exon 4). Concurrent KRAS mutations were identified in 8 cases, which suggests that multiple mutations can occur in the same or different codons. In NRAS gene, the mutation rates of exon 2 and 3 were 71.4% and 57.1% respectively. G13V and Q61K were the most common mutations, accounting for 28.6 % of each. Concurrent KRAS mutations were identified in 2 cases. Of the 169 samples, mutations in the BRAF gene at V600E were detected in 3.5%. Combined mutational analysis of KRAS, NRAS and BRAF was able to identify 49.6% of patients with CRC as likely non-responders to anti-EGFR therapy. There was an association between KRAS mutations and age, which were higher in the age group>50 years old (p=0.022). Tumors in the left colon (36.61%) are more likely to harbor mutations in KRAS than the rectum (19.7%) in both sexes. The adenocarcinoma well-differentiated was the most frequent for patients with KRAS mutations (54.9%). No significant clinicopathologic correlations with NRAS and BRAF mutations were identified. Conclusions: Beside established anti-CRC treatment, better understanding of the causality of CRC can be established by combining epidemiology and genetic/epigenetic on CRC etiology in Morocco. This approach may be able to significantly reduce the burden of disease in the country. Moreover, the Moroccan government should develop policy on CRC prevention and public health programs which may serve as a feasible setting to increase public awareness on lifestyle risk factors.

Advanced Non-small Cell Lung Cancer: EGFR Mutation Analysis Using Pyrosequencing and the Fully Automated qPCR-Based IdyllaTM System

BACKGROUND

Epidermal growth factor receptor (EGFR) mutation status is of a major clinical significance in non-small cell lung cancer (NSCLC) management, as it guides therapeutic decision making to target patients for a better response to therapy. This implicates the introduction of EGFR mutation analysis as the standard of care for Moroccan NSCLC patients, which in itself entails the implementation of targeted methods for routine EGFR mutation analysis in our laboratories. In this study, we aimed to present 2 targeted methods for EGFR mutation identification and to determine the prevalence and spectrum of EGFR mutations in NSCLC Moroccan patients.

METHODS

A retrospective investigation of a cohort of 340 patients was undertaken to analyze somatic EGFR mutations in exons 18 to 21 using pyrosequencing and the Idylla^TM system.

RESULTS

Of the enrolled patients, 70.9% were males and 29.1% were females. Predominately, 92% of cases had adenocarcinoma, and 53.7% of patients self-reported a history of smoking. Overall, 73 patients (21.7%) harbored an EGFR mutation, the most prevalent of which were the exon 19 deletions (53.4%) followed by exon 21 substitutions (31%). Exon 18 mutations and exon 20 alterations occurred in 8.1% and 6.7% of the positive EGFR mutation cases, respectively. Of the analyzed cases, all of the EGFR-mutated patients had adenocarcinoma. EGFR mutation prevalence was significantly higher in females (females vs males: 38.4% vs 14.5%, P < .001) and non-smokers (non-smokers vs non-smokers: 36% vs 10.3%, P < .001). The featured pyrosequencing and the Idylla^TM system are targeted methods endowed with high sensitivity and specificity as well as other compelling characteristics which make them great options for routine EGFR mutation testing for advanced NSCLC patients.

CONCLUSION

These findings underline the imperious need for implementing quick and efficient targeted methods for routine EGFR mutation testing among NSCLC patients, which is particularly useful in determining patients who are more likely to benefit from targeted therapy.

Prevalence and patterns of mutations in RAS/RAF/MEK/ERK/MAPK signaling pathway in colorectal cancer in North Africa

Background

Our review discuss (i) the findings from analyzed data that have examined KRAS, NRAS and BRAF mutations in patients with colorectal cancer (CRC) in North Africa and to compare its prevalence with that shown in other populations and (ii) the possible role of dietary and lifestyle factors with CRC risk. 

Methods

Using electronic databases, a systematic literature search was performed for the KRAS, NRAS, and BRAF mutations in CRC patients from Morocco, Tunisia, Algeria and Lybia. 

Results

Seventeen studies were identified through electronic searches with six studies conducted in Morocco, eight in Tunisia, two in Algeria, and one in Libya. A total of 1843 CRC patients were included 576 (31.3%) in Morocco, 641 (34.8%) in Tunisia, 592 (32.1%) in Algeria, and 34 (1.8%) in Libya. Overall, the average age of patients was 52.7 years old. Patients were predominantly male (56.6%). The mutation rates of KRAS, NRAS and BRAF were 46.4%, 3.2% and 3.5% of all patients, respectively. A broad range of reported KRAS mutation frequencies have been reported in North Africa countries. The KRAS mutation frequency was 23.9% to 51% in Morocco, 23.1% to 68.2% in Tunisia, 31.4% to 50% in Algeria, and 38.2% in Libya. The G12D was the most frequently identified KRAS exon 2 mutations (31.6%), followed by G12V (25.4%), G13D (15.5%), G12C (10.2%), G12A (6.9%), and G12S (6.4%). G12R, G13V, G13C and G13R are less than 5%. There are important differences among North Africa countries. In Morocco and Tunisia, there is a higher prevalence of G12D mutation in KRAS exon 2 (≈50%). The most frequently mutation type in KRAS exon 3 was Q61L (40%). A59T and Q61E mutations were also found. In KRAS exon 4, the most common mutation was A146T (50%), followed by K117N (33.3%), A146P (8.3%) and A146V (8.3%).

Conclusion

KRAS mutated CRC patients in North Africa have been identified with incidence closer to the European figures. Beside established anti-CRC treatment, better understanding of the causality of CRC can be established by combining epidemiology and genetic/epigenetic on CRC etiology. This approach may be able to significantly reduce the burden of CRC in North Africa.

C-Reactive Protein, Ferritin, and Procalcitonin in 300 Moroccan Patients with COVID 19

BACKGROUND

COVID-19 is a true global pandemic since March 2020, and it is responsible in the majority of patients mild symptoms; however, a small number of patients progress to the severe form with acute respiratory distress syndrome (ARDS) and some of them progress to the very severe form which can be fatal when it comes to multiorgan failure. Thus, it is important to identify as early as possible patients at high risk of progressing to severe forms requiring early and specialized management in order to reduce mortality.

METHODS

Our five-month retrospective study (May 2020 - October 2020) included 300 SARS-CoV-2 patients confirmed by RT-PCR and hospitalized in the Infectious and Tropical Diseases Center (CMIT), and in the Intensive Care Unit of the Military Hospital of instructions Mohamed V of Rabat (Morocco). Our objective was to compare the levels of C-reactive protein (CRP), ferritin, and procalcitonin (PCT) according to the clinical state and prog-nosis of patients.

RESULTS

In our series of results, very significantly elevated levels of C-reactive protein, ferritin, and procalcitonin were associated with severe and very severe forms of COVID-19 disease as well as a poor prognosis.

CONCLUSIONS

In the absence of international recommendations, the validation of clinical-biological scores involving different biological parameters in COVID-19 patients would allow a standardization of practices, a correct prescription of biological analyses and a risk stratification allowing to palliate the lack of medical resources and thus to reduce mortality.

Prevalence of specific and recurrent/founder pathogenic variants in BRCA genes in breast and ovarian cancer in North Africa

Background

Elucidation of specific and recurrent/founder pathogenic variants (PVs) in BRCA (BRCA1 and BRCA2) genes can make the genetic testing, for breast cancer (BC) and/or ovarian cancer (OC), affordable for developing nations.

Methods

To establish the knowledge about BRCA PVs and to determine the prevalence of the specific and recurrent/founder variants in BRCA genes in BC and/or OC women in North Africa, a systematic review was conducted in Morocco, Algeria, and Tunisia.

Results

Search of the databases yielded 25 relevant references, including eleven studies in Morocco, five in Algeria, and nine in Tunisia. Overall, 15 studies investigated both BRCA1 and BRCA2 genes, four studies examined the entire coding region of the BRCA1 gene, and six studies in which the analysis was limited to a few BRCA1 and/or BRCA2 exons. Overall, 76 PVs (44 in BRCA1 and32 in BRCA2) were identified in 196 BC and/or OC patients (129 BRCA1 and 67 BRCA2 carriers). Eighteen of the 76 (23.7%) PVs [10/44 (22.7%) in BRCA1 and 8/32 (25%) in BRCA2] were reported for the first time and considered to be novel PVs. Among those identified as unlikely to be of North African origin, the BRCA1 c.68_69del and BRCA1 c.5266dupC Jewish founder alleles and PVs that have been reported as recurrent/founder variants in European populations (ex: BRCA1 c.181T>G, BRCA1 c1016dupA). The most well characterized PVs are four in BRCA1 gene [c.211dupA (14.7%), c.798_799detTT (14%), c.5266dup (8.5%), c.5309G>T (7.8%), c.3279delC (4.7%)] and one in BRCA2 [c.1310_1313detAAGA (38.9%)]. The c.211dupA and c.5309G>T PVs were identified as specific founder variants in Tunisia and Morocco, accounting for 35.2% (19/54) and 20.4% (10/49) of total established BRCA1 PVs, respectively. c.798_799delTT variant was identified in 14% (18/129) of all BRCA1 North African carriers, suggesting a founder allele. A broad spectrum of recurrent variants including BRCA1 3279delC, BRCA1 c.5266dup and BRCA2 c.1310_1313detAAGA was detected in 42 patients. BRCA1 founder variants explain around 36.4% (47/129) of BC and outnumber BRCA2 founder variants by a ratio of ≈3:1.

Conclusions

Testing BC and/or OC patients for the panel of specific and recurrent/founder PVs might be the most cost-effective molecular diagnosis strategy.

Genome Sequences of the Delta Variant (B.1.617.2) and the Kappa Variant (B.1.617.1) Detected in Morocco

Here, we report the identification and coding-complete genome sequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains obtained from patients with COVID-19. The strains identified belong to variant of concern B.1.617.2 and variant of interest B.1.617.1.

Complete Genome Sequence of a SARS-CoV-2 Strain Sampled in Morocco in May 2020, Obtained Using Sanger Sequencing

The complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain was obtained. The strain was isolated from a nasopharyngeal swab specimen from a female patient in Rabat, Morocco, with coronavirus disease 2019 (COVID-19). This strain belongs to clade 20A and has 12 mutations and 8 amino acid substitutions compared to the reference strain Wuhan/Hu-1/2019.

Study of Clinical and Biological Characteristics of Moroccan Covid-19 Patients With and Without Olfactory and/or Gustatory Dysfunction

Background

The epidemic of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), presents a significant and urgent threat to global health. This alarming viral infection, declared as pandemic by the WHO in February 2020, has resulted millions of infected patients and thousands of deaths around the world. In Morocco, despite the efforts made by the authorities, the SARS-CoV-2 continues to spread and constitutes a burden of morbidity and mortality. The objective of this study is to describe clinical characteristics of COVID-19 Moroccan patients and to establish the relationship between specific clinical symptoms, namely ageusia and/or anosmia, with these characteristics.

Methods

We performed a descriptive, non-interventional cross-sectional study analyzing data from 108 patients admitted to the VINCI clinic, Casablanca (Morocco). The database includes 39 parameters including epidemiological characteristics, anthropometric measurements and biological analyzes.

Results

The average of age of the patients was 43.80 ± 15.75 years with a sex ratio of 1:1. The mean body mass index of the patients was 25.54 ± 4.63 Kg/m². The majority of patients had, at least, one comorbidity and among 75% symptomatic patients, about 50% had, at least, three symptoms namely, fever (40.7%), cough (39.8%), myalgia (28.7%), and anosmia and/or ageusia (20.4%). From biological analyzes, we noticed lymphopenia and an elevated protein C reactive and lactate dehydrogenases levels in 24.1, 36.1, and 35.2% of patients, respectively. A disturbance in liver function markers was observed in 15.7% of cases. For the other hemostasis parameters, high levels of prothrombin and platelets were reported in 14.6 and 14.8% of patients, respectively. Comparisons related to the presence of anosmia and/or ageusia did not show any difference for demographic and anthropometric characteristics, while a possibility of a significant difference was revealed for certain biological parameters, particularly the levels of lymphocytes, D-dimer and troponin.

Conclusion

This study provides significant findings that will be used not only to supplement previous studies carried out in Morocco in order to resume the epidemiological situation in comparison with other countries, but also to improve the quality of the diagnosis of COVID-19 patients by identifying all the symptoms of the disease and better understanding its clinical outcomes.

Relapsing fever in a Moroccan man

Tick-borne relapsing fever is a zoonosis caused by spirochetes of the genus Borrelia, transmitted by hematophagous ticks. This life-threatening condition is still misdiagnosed. We report a case of tick-borne relapsing fever in a 54 year-old man in Morocco with a history of hiking, who was hospitalized for an isolated fever. On admission, the clinical examination showed no specific signs. The laboratory assessment showed inflammatory syndrome with disturbance of the liver function. The blood culture was sterile. Serology was negative for HIV and Lyme disease, as were all the rest of the paraclinical tests. The patient's course was marked by spontaneous resolution of the fever and then, seven days later, the onset of a new episode of fever. Malaria was suspected and a blood sample was sent to the parasitology department. The thick smear and blood smear stained with May-Grünwald Giemsa showed the presence of spirochetes. Tick-borne relapsing fever was diagnosed and the patient responded favorably to treatment by cycline drugs. This disease is poorly known and should be considered in cases of presence of intermittent fever without a specific clinical-laboratory picture, according to epidemiological context. The diagnosis is confirmed by the presence of spirochetes on thick smear and blood or cerebrospinal fluid smear stained with MGG.

[Granulomatous spondylodiscitis: due mainly to tuberculosis but lymphoma cannot be excluded]

Les douleurs lombaires relèvent d'étiologies multiples dont le diagnostic peut être source de grandes difficultés. Le lymphome rachidien primitif est rare et son diagnostic nécessite une biopsie souvent scanoguidée. Un homme de 30 ans, était hospitalisé pour lombalgies inflammatoires évoluant dans un contexte d'altération de l'état général avec à l'examen des douleurs à la palpation des apophyses épineux L2L3, sans syndrome tumoral périphérique. Le bilan biologique montrait un syndrome inflammatoire. Le bilan morphologique était en faveur d'une spondylodiscite. La première biopsie montrait une ostéite granulomateuse. L'aggravation clinique et radiologique sous anti bacillaire a mené à reconsidérer le diagnostic et la deuxième biopsie confirme le diagnostic du lymphome. Le diagnostic de tuberculose osseuse en particulier vertébrale nécessite une confirmation bactériologique et ou histologique pour ne pas méconnaître un lymphome osseux primitif.

Neuropathie périphérique sous Infliximab: étude d’une observation

Les traitements Anti TNF alpha sont de prescription de plus en plus large. Des événements secondaires multiples ont été rapportés ses dernières années, en particulier les neuropathies périphériques. Nous rapportons un cas de neuropathie axonale survenant trois mois après le début d’un traitement par Infliximab. Il s’agit d’une patiente âgée de 60 ans, suivie pour réctocolite hémorragique résistant au traitement et ayant nécessité un traitement par Infliximab. Trois mois après, la patiente présente un tableau de neuropathie axonale sensitive. Le bilan étiologique restait négatif et la réduction des doses s’est accompagnée d’une amélioration de la symptomatologie. Le délai entre l’instauration du traitement à base d’Infliximab et l’apparition des manifestations cliniques de même que l’amélioration après réduction des doses plaident en faveur de la responsabilité de l’Infliximab dans la survenue de la neuropathie sensitive. La prise en charge n’est pas standardisée et doit être discuté au cas par cas.

Pulmonary hypertension and von Recklinghausen's disease: association and therapeutic difficulties

The neurofibromatosis type 1 (NF1) or Von Recklinghausen's disease is a genetic disorder. The café-au-lait spots and neurofibromas are the most common manifestations. Respiratory symptoms are rare in this disease, described as neurofibromas, infiltrative lesions, cysts, bubbles or emphysema. Pulmonary hypertension is rarely reported. It is due to the plexiform lesions in pulmonary arterioles or to parenchymal lung lesions reducing the vascular bed. We report a case of idiopathic precapillary pulmonary hypertension in a young patient with Von Recklinghausen's disease.

Tuberculose hepatique nodulaire: complication inhabituelle au cours de la maladie de Wilson

La tuberculose hépatique nodulaire est rare. Nous rapportons une forme pseudo-tumorale dont le tableau clinico-biologique et radiologique initial était aspécifique. Il s'agit d'un jeune marocain suivi pour maladie de Wilson et présentant une fièvre au long cours. L'imagerie met en évidence une lésion nodulaire hépatique non spécifique. L'examen anatomo-pathologique au cours d'une biopsie écho guidée du nodule hépatique permit de porter le diagnostic. L’évolution clinique est favorable sous traitement spécifique.

[Pulmonary nocardiosis and sarcoidosis]

Infectious complications are rarely observed in the course of sarcoidosis. Only small series or cases reports of infection are described in sarcoidosis. Corticosteroids-induced immune suppression, pulmonary fibrosis and T-CD4 lymphopenia, are often present. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection with a marked tendency towards remissions and exacerbations. We report a case of pulmonary nocardiosis in a patient with sarcoidosis followed for pulmonary fibrosis receiving corticosteroids. During the investigation of pyrexia and dyspnea, evidence of Nocardia spp. infection was found in the bronchial secretions. Six months of trimethoprim/sulfamethoxazole therapy ensured further resolution of this pleuropulmonary infection. Pulmonary nocardiosis is exceptional in sarcoidosis and mainly occur, in patients receiving corticosteroids, and with CD4+ T-lymphocytopenia. Sarcoidosis by itself does not appear to be a risk factor of opportunistic infection.

Pandemic influenza A(H1N1)2009 in Morocco: experience of the Mohammed V Military Teaching Hospital, Rabat, 12 June to 24 December 2009

Binary file ES_Abstracts_Final_ECDC.txt matches

Pandemic influenza A(H1N1)2009 in Morocco: experience of the Mohammed V Military Teaching Hospital, Rabat, 12 June to 24 December 2009

On 12 June 2009, Morocco was the first country in North Africa to report a laboratory-confirmed case of influenza A(H1N1)2009 virus infection. This study describes the epidemiological and clinical characteristics of 240 laboratory-confirmed cases among 594 outpatients with influenza-like illness at the Mohammed V Military Teaching Hospital, Rabat, from 12 June to 24 December 2009. Real-time reverse transcription-PCR was used to confirm the infection. The epidemic peaked in weeks 47 to 49 (16 November to 6 December 2009). The mean age of cases was 23 years (standard deviation: 14 years). Cough was the most common symptom in 200 cases (83%), followed by fever (≥38 °C) in 195 (81%). Diarrhoea or vomiting was reported in 12 (5%) patients. None of the cases developed any complications and no deaths occurred during the study period.

[Nodular liver lesions with fever in a Moroccan man: hepatic brucelloma]

Hepatic brucelloma is an exceptional localization in brucellosis. The purpose of this report is to describe an uncommon case involving a 42-year-old man hospitalized for febrile hepatic cytolysis. Diagnosis was established based on positive rose bengal test results, positive blood culture, hypoechogenic masses on ultrasound, and hypodense enhancing masses on CT scan. Hepatic brucelloma is a focal suppurative lesion occurring after undetected acute brucellosis or undertreated brucellosis. Diagnosis is based on the association of imaging showing characteristic features (hepatic calcifications) and on positive blood culture and serology. First-line treatment should consist of doxycyclin and rifampicin for 2 to 12 months. If medical treatment fails, surgical drainage should be performed.

[Primary gastric lymphoma: a retrospective series of 35 cases]

BACKGROUND

Primary gastric non Hodgkin's lymphoma (PGNHL) is the most common site of extranodal malignant lymphoma. It is a rare subtype of malignancy, for which no consensus exists about treatment.

AIM

The purpose of This paper was to assess the managemnt of PGNHL.

METHODS

Between January 1992 and December 2001, 35 patients were retrospectively evaluated.

RESULTS

Of the 35 patients, with a mean age of 44 years old Signs and symptoms are unspecific. 20 (57.1%) were in stage IE/IIE1. 15 patients (42.8%) were in stage IIE2,IIIE,IVE. These patients were treated with primary surgery with or without chemotherapy (11; 31.4%); primary chemotherapy (CT) alone with surgery in one patient (21; 60%) and three patients with gastric MALT lymphoma were treated by Helicobacter pylori eradication. The 5 year survival rates of the 35 patients are 62, 86%. There was no significant difference in the 5 year survival rate between the patients with low grade lymphoma and the patients with large grade lymphoma (75% versus 60%, P = 0.467). The 5-year survival rates for stage I/IIE1 and IIE2/III/IV patients were 80%, 53.3% respectively (p < 0.144). Of the 11 primary surgical groups with or without chemotherapy, the 5 year survival rate is 90.9%. Of the 21 patients who received CT, alone or combined with surgery, the survival rate is 52.4%. There was significant difference between the two groups (P = 0.05). Of the 3 patients with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma with only oral anti-Helicobacter pylori regimen remained disease-free after a median follow-up of two years.

CONCLUSIONS

This study suggested that primary surgical resection may be important factor predicting the long-term survival of patients with primary gastric NHL. H. pylori eradication therapy was an effective first-line treatment for patients with gastric MALT lymphoma.

[Hodgkin's disease presenting with spinal cord compression]

INTRODUCTION

Hematological neoplasms may be complicated by signs of neurological compression. Most cases reported in the literature have described advanced-stage non-Hodgkin lymphomas. We report a case of spinal cord compression revealing an isolated vertebral localization of Hodgkin lymphoma.

CASE REPORT

Magnetic resonance imaging of the thoracic spine in a 54-year-old man who presented with spastic paraplegia revealed a vertebral and extradural mass. After laminectomy, histology and immunohistochemistry showed Hodgkin's disease. Post-operative staging did not reveal any other localization. The patient responded favorably after decompressive surgery and ABVD regimen.

CONCLUSION

Spinal cord compression is a rare complication of Hodgkin's disease, occurring in only 5p.cent of cases, usually in the setting of progressive, advanced disease. As the initial symptom of Hodgkin's disease, it is extremely rare, with only a few cases reported in the literature. Significant results may be obtained with decompressive surgery and chemotherapy when the disease is promptly diagnosed. Spinal cord compression by primary Hodgkin's disease is a very infrequent situation. We urge this diagnosis be considered in all patients presenting with spinal cord compression attributed to malignancy.

Hyperplasie angiolymphoïde à éosinophiles

INTRODUCTION

Angiolymphoid hyperplasia with eosinophilia is a rare affection.

CASE REPORT

A 36 years-old woman presented an angiolymphoid hyperplasia with eosinophilia manifesting by erythematous nodular lesions on the face and the forearms, severe neuropathy, visual loss and eosinophilia. Corticosteroids, immunosuppressive drugs and interferon-alpha were unsuccessful.

DISCUSSION

Angiolymphoid hyperplasia with eosinophilia is a dermatological disease with possible systemic features. Differential diagnosis with Kimura disease is based on clinical presentation and histological findings. Etiopathology remains unknown and the treatment is not codified.

Acquired ichthyosis disclosing non-Hodgkin's malignant lymphoma

When ichthyosis occurs in adulthood, it may signify internal disease, especially malignant hemopathy. A 49-year-old man was admitted to hospital with diarrhea, fever, weight loss and abdominal pain. Physical examination showed generalized ichthyosis with palmoplantar hyperkeratosis and multiple inguinal lymph nodes. Laboratory investigations showed severe pancytopenia. Ultrasonography and CT scan demonstrated intraabdominal lymph node enlargement. Osteomedullary biopsy and open abdominal lymph node biopsy revealed an anaplastic large cell lymphoma. The lymph node involvement subsequently became worse and more severe, and the patient's general condition deteriorated. He died before receiving chemotherapy.

[Acquired ichthyosis revealing hepatic and lymph node tuberculosis]

INTRODUCTION

Acquired ichthyosis is an uncommon disease usually associated with different systemic diseases. Its characteristic clinical sign is symmetrical scaling of the skin. We report a case of acquired ichthyosis revealing hepatic and lymph node tuberculosis.

CASE

A 41-year-old man was admitted to our hospital with weight loss and generalized acquired ichthyosis. Ultrasonography and computer tomography showed enlargement of abdominal lymph nodes. Lymph node and liver biopsy samples were taken during exploratory laparotomy and revealed multiple lymphoepitheliomas with Langhans-type giant cells and central caseous necrosis. The skin lesions resolved progressively after 5 months of antituberculous therapy.

DISCUSSION

Ichthyosis occurring in adulthood is often a sign of internal disease, especially malignant conditions. It has also been associated with autoimmune and infectious diseases, sarcoidosis and drugs. It is only rarely reported among patients with tuberculosis but it is possible that the ichthyosis in this case was due to weight loss and deterioration of the patient's general condition.

[Non-Hodgkin's lymphoma and hepatitis C virus infection]

INTRODUCTION

The authors report four cases of non Hodgkin's lymphomas (NHL) among patients infected by the hepatitis C virus (HCV). They discuss the epidemiological, physiopathological and clinical features of this association.

CURRENT KNOWLEDGE AND KEY POINTS

The role of the HCV in the development of B-cell NHL is probable but the reported frequency of the association with HCV infection is variable especially in different countries. Most of the reported cases are low-grade NHL with frequent extranodal involvement.

FUTURE PROSPECTS AND PROJECTS

New studies will improve the understanding of the physiopathological mechanisms that might explain the occurrence of NHL in the course of HCV infection. The recent evidence that the antiviral treatment is effective in splenic lymphoma with villous lymphocytes leads to reconsider the relationship between HCV and NHL and to think about new therapeutic possibilities.

[Digestive malacoplakia]

INTRODUCTION

Malacoplakia, a chronic granulomatous disease, rarely involves the digestive tube and, when it does, takes on a pseudotumoral aspect.

OBSERVATION

A 37 year-old man was hospitalized for chronic diarrhea that had progressed over 15 years. He exhibited an edematous-ascitic syndrome and bilateral pleurisy together with, biologically, a malabsorption syndrome. The endoscopic examinations (fibroscopy and colonoscopy) revealed polypoid tumor-like formations. An image of tumoral stenosis of the sigmoid-colic junction was revealed on barite lavage. Histological examination of the surgical sample (wide left colectomy of one third of the transverse) was suggestive of malacoplakia (histiocytes with characteristic Michaelis-Gutmann bodies).

DISCUSSION

Malacoplakia is an inflammatory disease predominantly affecting the urogenital tract. Other organs can be involved. Its clinical symptomatology is highly disparate. The interest of this disease is in its pathogenesis, on which, in fact, its treatment is based.