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  • Chakroun, Amal  (11)
  • 1
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    The Re-emergence of a Forgotten Disease: Neurobrucellosis
    Springer Science and Business Media LLC ; 2020
    In:  Dr. Sulaiman Al Habib Medical Journal Vol. 2, No. 4 ( 2020), p. 190-
    Details
    In: Dr. Sulaiman Al Habib Medical Journal, Springer Science and Business Media LLC, Vol. 2, No. 4 ( 2020), p. 190-
    Type of Medium: Online Resource
    ISSN: 2590-3349
    URL: Article
    DOI: 10.2991/dsahmj.k.201010.001
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 2
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    1423. Clinical Presentation Of Brucellosis: An Experience Of 29-Year Period
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S718-S718
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S718-S718
    Abstract: Brucellosis is a multi-organ zoonotic disease which may present with a myriad manifestation. In our country, brucellosis remains endemic and represents a public health problem. We aimed to study the clinical, therapeutic and evolutionary features of brucellosis. Methods We conducted a retrospective study including all patients hospitalized for brucellosis in the infectious diseases department between 1990 and 2018. Positive blood cultures to Brucella spp and/or standard agglutination test (SAT) titer & gt; 1/160 confirmed the diagnosis. Results During the study period, we encountered 216 cases of brucellosis, among whom 140 cases were males (64.8%). The mean age was 40±17 years. Patients came from rural areas (89.8%) and had a close contact with animals (70.8%). The consumption of unpasteurized milk was noted in 182 cases (84.2%). A family history of brucellosis was noted in 53 cases (24.5%). In total, 68 patients had a previous medical history of treated brucellosis (31.4%). There were 113 cases (52.3%) of acute brucellosis and 103 cases (47.7%) of sub-acute brucellosis. Spondylodiscitis (65 cases; 63.1%), neurobrucellosis (17 cases; 16.5%) and sacroiliitis (12 cases; 11.7%) were the most common forms of the sub-acute brucellosis. The revealing symptoms were fever (83.8%), night sweats (71.3%), arthralgia (55.1%) and back pain (53.2%). Laboratory investigations revealed leukopenia (14.4%), anemia (49%) and elevated C-reactive protein levels (42.1%). Blood cultures were positive to Brucella in 17.1% of the cases. Patients received a combination therapy based on doxycycline and rifampicin in 141 cases (65.2%). Triple therapy regimen including doxycycline, rifampicin and co-trimoxazole was prescribed in 51 cases (23.6%). The mean treatment duration was 52±20 days in the acute form and 6±3 months in the sub-acute form. The disease evolution was favourable in 94.4% of the cases. Sequelae were noted in 12% of the cases and relapse in 3.7% of the cases. Four patients were dead (1.9%). Conclusion Due to its various clinical presentation, the diagnosis of brucellosis might be delayed. High index of suspicion is required in order to promptly diagnose the disease. Control and eradication of brucellosis in animals are mandatory so as to eradicate brucellosis. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1605
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 3
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    1697. The Burden Of Multidrug-Resistant Urinary Tract Infections
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S831-S831
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S831-S831
    Abstract: Urinary tract infections (UTIs) are the most common reason for consultation and for antibiotic use. Many factors interfere and increase the risk for antimicrobial resistance. We aimed to study the clinical, laboratory and evolutionary particularities associated with multidrug-resistant (MDR) UTIs. Methods We conducted a retrospective study including all patients hospitalized for UTIs in the infectious diseases department between 2011 and 2018. Results A total of 867 cases of UTIs were included in the study, among which 407 cases (46.9%) were MDR. There were 306 males (35.3%). The mean age was 53±21 years. Overall, MRD UTIs were significantly associated to male gender (39.1% vs 32%; p=0.02). Patients aged ≥65 years were significantly more affected with MRD UTIs (54.5% vs 36.5%; p & lt; 0.001). Previous medical history of diabetes (38.1% vs 24.6%; p & lt; 0.001), antibiotic consumption (30.7% vs 13%; p & lt; 0.001) and surgical intervention of the urinary tract (13% vs 5.4%; p & lt; 0.001) were significantly associated with MDR UTIs. The mean delay to hospitalization was significantly longer among MDR UTIs cases (5[3-10 days] vs 3[2-7 days] ; p & lt; 0.001). In total, MDR UTIs were more frequently documented to Klebsiella pneumoniae (19.4% vs 12%; p=0.002). Comparison of the disease evolution showed that MRD UTIs were significantly associated with complications (9.1% vs 5.2%; p=0.02), recurrence (4.4% vs 1.5%; p=0.01) and death (2.2% vs 0.4%; p=0.02). As to laboratory investigations and antibiotic duration, no significant difference was noted. Conclusion Our study showed that MDR UTIs were associated with not only complications, but also with a poor prognosis. The continuous surveillance for antimicrobial resistance and the rational use of antibiotics are crucial in order to improve the prognosis. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1875
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 4
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    1658. Particularities Of Pulmonary Tuberculosis Among Children
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S817-S817
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S817-S817
    Abstract: The diagnosis of pulmonary tuberculosis (PTB) among children remains challenging due to the non-specific clinical symptoms, laboratory features and the difficulty of sampling for microbiological investigations. We aimed to study clinical, therapeutic and evolutionary features of PTB among children. Methods We conducted a retrospective study including all children aged ≤ 18 years diagnosed with PTB between 1995 and 2016. Results We encountered 67 children with PTB, among whom 37 (55.2%) were female. The median age was 15 years [1-18years]. According to residency, 36 patients came from rural area (53.7%). We noted 7 cases (10.4%) of miliary tuberculosis (TB). Three cases of pleural TB (4.5%), one case of lymph node TB (1.5%) and one case of neuromeningeal TB were associated to PTB. Induced sputum or gastric aspirate were positive for Mycobacterium tuberculosis in 67.9% of the cases. Serologic tests for human immunodeficiency virus was positive in one case (1.5%). The mean duration of antitubercular therapy was 8 ±2 months. The treatment regimen was based on a quadritherapy for the first 2 months, followed by a bitherapy for the rest of the period. Fixed dose drug combinations were prescribed in 17 cases (25.3%). The disease evolution was favourable in 65 cases (97%). Two patients were dead (3%). There were no relapsing cases. Conclusion Prompt diagnosis and treatment of PTB among children improve the prognosis. Screening for PTB among children exposed to adult tuberculosis is crucial in order to prevent the disease. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1836
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 5
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    1641. A Comparative Analysis Of Lymph Node Tuberculosis Between Children And Adults
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S810-S810
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S810-S810
    Abstract: Lymph node tuberculosis (LNTB) represents the most common site of extrapulmonary tuberculosis. Among children, due to non-specific clinical features, the diagnosis is often delayed. We aimed to compare the clinical, therapeutic and evolutionary features of LNTB between adults and children. Methods We conducted a retrospective study including patients hospitalized for LNTB in the infectious diseases and pediatric department between 1993 and 2018. Children aged ≤18 years were included. Results Overall, we encountered 231 cases of LNTB. There were 40 children (17.3%) with a mean age of 11±4 years and 191 adults (82.7%) with a mean age of 42±16 years. As to gender, females were more affected (adults: 67% vs children: 70%), with no significant difference (p & gt;0.05). A family history of tuberculosis was significantly more frequent among children (20% vs 6.3%; p=0.01). Raw milk consumption (38.2% vs 30%; p & gt;0.05) and close contact with animals (29.8% vs 35%; p & gt;0.05) were noted among both adults and children. Fever (53.4% vs 32.5%; p=0.01), night sweats (35.8% vs 10%; p=0.001), loss of appetite (38.2% vs 17.5%; p=0.01) and weight loss (35.1% vs 15%; p=0.01) were significantly more frequent among adults. Tuberculin skin test was positive in 75.8% of the cases among adults and in 86.2% of the cases among children (p & gt;0.05). Multifocal tuberculosis was significantly more frequent among adults (23.8% vs 5.7%; p=0.01). Antitubercular therapy was prescribed for a mean duration of 10±4 months among adults and for 9±3 months among children, with no significant difference (p & gt;0.05). Side effects of antitubercular drugs were more frequent among adults (33% vs 10.3%), with a significant difference (p=0.004). Comparison of the disease evolution showed no significant difference between adults and children, regarding recovery (94.8% vs 90%), relapse (5.2% vs 5%) and death (0.5% vs 2.5%). Conclusion The clinical presentation of LNTB among children was less common and misleading. A family history of tuberculosis and a high index of suspicion might shorten the diagnostic delay. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1821
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 6
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    1434. Rickettsial Infections Complicated With Acute Renal Failure
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S722-S722
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S722-S722
    Abstract: Rickettsiosis, an acute febrile illness, is generally considered as a benign disease. However, severe cases were reported, among which acute renal failure (ARF) represented 13 to 18% of the cases. We aimed to study the clinical and evolutionary features of rickettsiosis complicated with ARF, when compared with all rickettsial infections. Methods We conducted a retrospective study including all patients hospitalized for rickettsiosis in the infectious diseases department between 1995 and 2018. The diagnosis was confirmed by serologies (seroconversion). Results Overall, we encountered 28 patients (6.4%) with ARF among 440 patients with rickettsiosis. There were 19 males (67.9%). Patients with ARF were significantly older (53±16 vs 38±17 years; p & lt; 0.001). They consulted for eruptive fever (78.6%), febrile cephalalgia (10.7%) or isolated fever (10.7%). Arthralgia and vomiting were noted in 75% and 35.7% of the cases, respectively. There were 4 cases (14.3%) of meningitis and 2 cases (7.1%) of meningoencephalitis. The mean creatinine levels were 158 µmol/L [120-444 µmol/L]. In comparison with all rickettsial infections, eschars were more frequently noted among patients with ARF (46.4% vs 23.8%; p=0.008). They were more frequently diagnosed with septic shock (14.3% vs 0.5%; p & lt; 0.001) and retinitis (10.7% vs 1.5%; p=0.015). Comparison of the disease evolution showed that death was significantly more frequent among cases with ARF (7.1% vs 0.2%; p=0.011). The mean length of hospital stay was significantly longer among patients with ARF (8.7±4.7 vs 5.3±3.5 days; p=0.001). As to gender and the revealing symptoms, no significant difference was noted. Conclusion Rickettsial infections complicated with ARF had a poor prognosis, especially among the elderly. Prompt empiric antibiotic therapy might improve the prognosis. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1616
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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    1365. How Severe Are Rickettsial Infections Among Children
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S693-S693
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S693-S693
    Abstract: Rickettsial infections (RI) usually mimic benign viral infection due to similarities in clinical symptoms. However, severe forms and complications have been reported with rickettsiosis. Children can be affected as well. We aimed to study the particularities of RI among children. Methods We conducted a retrospective study including all patients aged ≤ 18 years hospitalized for RI between 2000 and 2018. The diagnosis was confirmed by serologies (seroconversion). Results In total, we encountered 59 children with confirmed RI, among whom 45 were male (76.3%). The mean age was 14 ±3 years. Forty children had a close contact with animals (71.4%). All patients consulted for a febrile maculopapular skin rash, which was associated to headache in 45 cases (76.3%), vomiting in 28 cases (47.4%) and cough in 8 cases (13.5%). Physical examination revealed an eschar in 13 cases (22%) and meningeal syndrome in 11 cases (18.6%). Laboratory investigations showed thrombocytopenia (31 cases; 52.5%) and liver cytolysis (26 cases; 44%). Severe forms of RI were represented by meningitis in 11 cases (18.6%), pneumonia in 2 cases (3.3%) and myocarditis in one case (1.6%). The treatment was based on doxycycline in 42 cases (71.2%), fluoroquinolones in 10 cases (17%) and macrolide in 7 cases (11.8%) for children aged less than 8 years. The mean duration of treatment was 9 ±3 days. The disease evolution was favourable in all cases. Conclusion The diagnosis of RI among children should be largely based on high index of suspicion, careful clinical and laboratory results. Prompt diagnosis is crucial in order to start antibiotics and avoid, therefore, fatal untreated forms. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1547
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 8
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    1700. What Is Specific With Bacterial Escherichia Coli Urinary Tract Infection
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S832-S833
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S832-S833
    Abstract: Bacterial urinary tract infections continue to be a major health problem, responsible for a significant morbidity and mortality. Its prognosis is more severe than non-bacterial forms. The aim of this work was to study the clinical and evolutionary features of bacterial urinary tract infections caused by Escherichia coli (E.coli). Methods We conducted a retrospective study including all patients hospitalized in infectious diseases department for urinary tract infection (UTI) caused by E.coli between 2010 and 2017. Results During the study period, we enrolled 613 cases of UTI caused by E.coli, among whom 75 cases (12.2%) were bacterial. There were 47 females (62.7%). The mean age was 59 ±17 years. Thirty-three patients were aged ≥ 65 years (44%). Diabetes was noted in 38 cases (50.7%) and renal lithiasis in 14 cases (18.7%). A history of UTI was reported in 13 cases (17.3%). The most common clinical presentation was acute pyelonephritis (59 cases; 78.7%) and followed by prostatitis (8 cases; 10.6%). Renal abscess was noted in 5 cases (6.7%) and prostatic abscess in 3 cases (4%). There were 36 cases of multidrug-resistant bacteria (48%). Community-acquired UTI were noted in 70 cases (93.3%). The mean duration of treatment was 18 ± 6 days. Surgery and radiological drainage were indicated in 4 (5.3%) and 2 cases (2.7%), respectively. The outcome was favourable in 58 cases (77.3%). Complications were noted in 10 cases (13.3%) represented mainly by acute renal failure in 4 cases (5.3%). Relapse was noted in 9 cases (12%) and reinfection in 6 cases (8%). Two patients died (2.7%). Conclusion Bacterial urinary tract infections were associated to complications such as renal and prostatic abscess, requiring surgery and long duration of treatment. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.1878
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 9
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    651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S383-S384
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S383-S384
    Abstract: Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p & lt; 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p & lt; 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.845
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 10
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    765. Epidemiological And Clinical Features Of Rickettsiosis
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. Supplement_1 ( 2020-12-31), p. S428-S428
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. Supplement_1 ( 2020-12-31), p. S428-S428
    Abstract: Rickettsiosis is a common tick-borne disease in tropical regions. The treatment is usually delivered in front of high index of suspicion, since the diagnosis confirmation might be delayed. We aimed to study the epidemiological and clinical features of rickettsiosis in our region. Methods We conducted a retrospective study including all patients hospitalized in the infectious diseases and pediatric department for confirmed rickettsiosis between 1995 and 2017. The diagnosis was confirmed by serological tests (seroconversion) or a positive polymerase chain reaction assays for Rickettsia. Results There were 424 patients among whom 232 (54.7%) were male. The mean age was 39 ±18 years. There were 62 children aged ≤18 years (14.6%). During six months period, from May to October, 360 patients were diagnosed with the disease (84.9%). In total, 334 patients had a close contact with animals (78.7%). The revealing symptoms were fever (100%), arthralgia (77.6%), cephalalgia (72.4%) and vomiting (44.8%). Physical examination showed maculopapular skin rash in 350 cases (82.5%), inoculation eschar in 105 cases (24.8%) and meningeal syndrome in 43 cases (10.1%). There were 43 cases (10.1%) of meningitis, 6 cases of meningoencephalitis (1.4%) and 5 cases of myocarditis (1.2%). Laboratory investigations revealed liver cytolysis (60%) and thrombocytopenia (57.5%). Doxycycline was used in 288 cases (68%), fluoroquinolones in 113 cases (26.6%) and macrolide in 23 cases (5.4%). The mean duration of antibiotics was 8 ±4 days. The disease evolution was favourable in 418 cases (98.6%). Four patients (1%) were dead and 2 patients (0.4%) were transferred to intensive care unit. Conclusion Rickettsiosis is not a rare disease. Careful clinical and laboratory investigations guide the diagnosis process, which is confirmed with serological tests. Disclosures All Authors: No reported disclosures
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa439.955
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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