Rhumatismes inflammatoires chroniques et COVID-19

Introduction

Toute personne est susceptible de contracter l’infection à la COVID-19 à l’instar des patients atteints de rhumatismes inflammatoires chroniques (RIC). Cette étude a pour objectif de déterminer la prévalence de l’infection à la COVID-19 chez cette population de patients, déterminer leur taux de vaccination et étudier le maintien thérapeutique pendant la pandémie de COVID-19.

Patients et méthodes

Les patients atteints de RIC suivis dans notre Service de rhumatologie ont été invités à remplir un questionnaire portant sur la présence de symptômes COVID-19, sur les résultats des tests diagnostiques, les modifications de traitements durant la période de confinement et leur statut vaccinal anti-COVID-19. Les réponses au questionnaire ont été rapportées à l’aide de statistiques descriptives.

Résultats

Sur 304 questionnaires, nous avons obtenu 271 réponses provenant de 150 patients atteints de polyarthrite rhumatoïde (PR), 94 de spondyloarthrites (SpA) dont 81 spondyloarthrite ankylosante (SA), 13 rhumatisme psoriasique (RP) et 27 connectivites dont 13 connectivite indifférenciée, 7 lupus érythémateux systémique (LES), 4 sclérodermie systémique (SCs), 2 myosite et un syndrome de Sjogren primitif. La moyenne d’âge était de 50 ans ± 15 ans avec une prédominance féminine (62 %). L’incidence de COVID-19 était de 23,6 % avec 30 cas confirmés (test PCR et/ou TDM thoracique), 34 cas de forte suspicion. Quatre patients ont nécessité une hospitalisation dont 1 en unité de soins intensifs et 3 décès ont été constatés. Le nombre de patients vaccinés était de 76 (28,04 % de la population incluse) dont le motif principal d’abstention était la crainte des effets secondaires. Vingt-deux patients (8,11 %) rapportaient avoir suspendu ou arrêter au moins un traitement de leur rhumatisme inflammatoire durant la période de confinement, la plupart par peur d’une contamination (18,18 %) ayant occasionné une majoration de l’activité de la maladie chez un seul patient.

Conclusion

Il s’agit d’une étude de prévalence de la COVID-19 monocentrique avec prédominance de la forme légère de la maladie dans une population de patients faiblement vaccinés avec une adhérence thérapeutique quasi totale.

[A giant lipoma of parapharyngeal space in a child]

INTRODUCTION

Tumors of the parapharyngeal space are rare and composing a wide variety of histological types. The aim of this study was to report a case of giant parapharyngeal lipoma in a child and to present clinical, paraclinical, and treatment aspects.

CASE REPORT

A 14-year-old child presented with a painless progressive mass on the right side of the upper neck. It was growing asymptomatically since 2 years. Cervical CT-scan and MR showed a low-density mass in the right parapharyngeal, consistent with a mass of adipose tissue origin. The mass was surgically removed via cervical-parotid approach. The fatty mass was completely excised. Histopathology confirmed it to be a lipoma. The patient has been followed up for three years, and there have been no signs of recurrence.

CONCLUSION

Diagnostic orientation in parapharyngeals tumors is necessary for better care. This guidance is being facilitated through imaging advances. Their surgical approaches and complete excision depend on volumes, localizations and their proximity to neurovascular structures.

Retropharyngeal abscess in adults: five case reports and review of the literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

[Nasal septal abscess complicating acute sinusitis in a child]

Nasal septal abscess is a rare complication of acute sinusitis in children. We report the case of a 9-year-old girl who presented at the emergency unit with a bilateral eyelid edema evolving over 2 days, associated with bilateral rhinorrhea and nasal obstruction. Clinical examination found a tumefied nasal septum and nasal obstruction. A computed tomography scan of the nose and paranasal sinuses showed pansinusitis with an abscess of the nasal septum. Treatment consisted in the evacuation of the abscess associated with a triple antibiotic therapy. Progression was favorable. Acute sinusitis is seldom complicated by an abscess of the nasal septum, and very few cases are reported in the literature. Early diagnosis and treatment can avoid complications, which engage not only the functional but also the vital prognosis.

[Leeches of the upper aerodigestive tract]

INTRODUCTION

The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation.

PATIENT AND METHODS

This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT.

RESULTS

Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients.

DISCUSSION

UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

[Retropharyngeal abscess revealing diabetes: a case report]

Retropharyngeal abscess, a rare event in adults, is usually observed in immunodeficient persons or subsequent to foreign bodies. We report a case of retropharyngeal abscess which revealed diabetes mellitus. A 47-year-old woman with an uneventful history complained of fever, dysphagia and trismus. Clinical findings were swelling of the pharyngeal posterior wall. The CT scan showed an abscess in the retropharyngeal space. Puncture revealed the purulent nature of the collection. The bacteriological study identified a Gram-negative aerobic germ (Citrobacter freundii). Laboratory tests disclosed diabetes mellitus with ketosis. The treatment consisted in surgical drainage and lavage of the retropharyngeal space using a saline solution with gentamycin associated with infusion of appropriate antibiotics. Abscess formation in the retropharyngeal space is a rare event in adults. The immunological status of the patient should be carefully explored. Management requires drainage of the collection and infusion of active antibiotics.

[Orbital apex syndrome secondary to herpes zoster infection. A case report]

The orbital apex syndrome is defined by the association of visual loss, ophtalmoplegia, blepharoptosis, proptosis along with forehead and upper eyelid anesthesia. This syndrome is secondary to traumatism, malignancy or infection of orbital apex. Herpes zoster is an uncommon cause. We discuss the physiopathologic mechanism, evolution and management of this affection.

[Tuberculous osteoarthritis of the foot in the diabetic: not unrecognize this diagnostic trap. About one case]

Osteoarticular tuberculosis is the fourth leading extrapulmonary localization of tuberculosis. The disease has a progressive course and is often diagnosed in the stage of bone destruction, causing an important diagnostic problem in diabetics with nervous osteoarthropathy. We report the case of a 23-year-old patient with multicomplicated diabetes type 1, treated for pulmonary tuberculosis who consulted after a trauma distended the left ankle. Bone biopsy was performed because of the diagnostic doubt between diabetes and infectious osteoarthropathy. Pathology reported active tuberculosis. Osteoarticular tuberculosis is still a severe disease because of the functional prognosis that requires early diagnosis, a difficult task in some conditions particularly in the diabetic where the disease may mimic nervous osteoarthropathy. Bone biopsy should be performed if there is a doubt.

Ultrastructural studies on nodules induced by pyrimidine auxotrophs of Sinorhizobium meliloti

Twenty three pyrimidine auxotrophs of Sinorhizobium meliloti Rmd201 were generated by random mutagenesis with transposon Tn5. On the basis of biochemical characters these auxotrophic mutants were classified into car, pyrC and pyrE/pyrF categories. All auxotrophs induced white nodules which were ineffective in nitrogen fixation. Light and electron microscopic studies revealed that the nodules induced by pyrC mutants were more developed than the nodules of car mutants. Similarly the nodules induced by pyrE/pyrF mutants had more advanced structural features than the nodules of pyrC mutants. The nodule development in case of pyrE/pyrF mutants was not to the extent observed in the parental strain. These results indicated that some of the intermediates and/or enzymes of pyrimidine biosynthetic pathway of S. meliloti play a key role in bacteroidal transformation and nodule development.

Isolation and symbiotic characterization of aromatic amino acid auxotrophs of Sinorhizobium meliloti

Ten aromatic amino acid auxotrophs of Sinorhizobium meliloti (previously called Rhizobium meliloti) Rmd201 were generated by random mutagenesis with transposon Tn5 and their symbiotic properties were studied. Normal symbiotic activity, as indicated by morphological features, was observed in the tryptophan synthase mutants and the lone tyrosine mutant. The trpE and aro mutants fixed trace amounts of nitrogen whereas the phe mutant was completely ineffective in nitrogen fixation. Histology of the nodules induced by trpE and aro mutants exhibited striking similarities. Each of these nodules contained an extended infection zone and a poorly developed nitrogen fixation zone. Transmission electron microscopic studies revealed that the bacteroids in the extended infection zone of these nodules did not show maturation tendency. A leaky mutant, which has a mutation in trpC, trpD, or trpF gene, was partially effective in nitrogen fixation. The histology of the nodules induced by this strain was like that of the nodules induced by the parental strain but the inoculated plants were stunted. These studies demonstrated the involvement of anthranilic acid and at least one more intermediate of tryptophan biosynthetic pathway in bacteroidal maturation and nitrogen fixation in S. meliloti. The alfalfa plant host seems to provide tryptophan and tyrosine but not phenylalanine to bacteroids in nodules.