Human adenoviruses (HAdV) are the main cause of viral conjunctivitis. In Tunisia and North Africa more generally, there is no regular nationwide surveillance program that monitors viruses causing conjunctivitis and keratoconjunctivitis. In this study, we report the results of HAdV screening in conjunctival samples collected for over 14 years in Tunisia. A total of 282 conjunctival samples received between 2000 and 2013 were investigated. Detection and identification of genotype were performed by PCR-sequencing at the hexon gene; 64.5% of samples (n = 182) revealed positive by PCR detection without correlation noted between infection, age, sex, social class or clinical manifestations of viral conjunctivitis. HAdV-D8 was the largely predominant genotype in Tunisia, representing 81.3% of all isolates, and was detected continuously from 2000 to 2013. Minor co-circulating genotypes were also identified HAdV-E4, HAdV-B3, B55 and HAdV-B7 accounting for 10.7%, 4.9%, 1.9% and 0.9% of isolates, respectively. In conclusion, this work reports epidemiological data on adenoviral conjunctivitis from a region where such information is very scarce and contributes to a better knowledge of the worldwide distribution of causative genotypes. It also presents an approach for the identification of circulating HAdV in the country and demonstrates the importance of molecular tools for both detection and identification of genotypes, which allow rapid virological investigation, especially during epidemics. (C)2016 Elsevier Masson SAS. All rights reserved.

Les adénovirus humains (HAdV) sont les principales causes de conjonctivite virale. L’incidence des conjonctivites à HAdV n’est pas assez documentée dans certains pays qui n’ont pas établi des programmes nationaux de surveillance, notamment en Tunisie et en Afrique du Nord plus généralement. Dans cette étude, nous rapportons les résultats de la recherche des HAdV dans les prélèvements conjonctivaux collectés sur plus de 14 années, en Tunisie. Au total, 282 prélèvements conjonctivaux reçus entre 2000 et 2013, ont été investigués. La détection et l’identification du génotype ont été réalisées par PCR-séquençage au niveau du gène de l’hexon. Les HAdV ont été détectés dans 64,5 % des cas sans noter de corrélation entre l’infection, l’âge, le sexe, la classe sociale ou les manifestations cliniques de la conjonctivite virale. L’analyse phylogénétique a montré que HAdV-D8 est le génotype majeur (81,3 %) en Tunisie ayant une circulation continue durant plus que 14 ans, de 2000 à 2013. D’autres génotypes mineurs ont également été détectés : HAdV-E4, HAdV-B3, B55 et HAdV-B7, comptant pour 10,7 %, 4,9 %, 1,9 % et 0,9 % des isolats, respectivement. En conclusion, ce travail rapporte les données épidémiologiques sur la conjonctivite adénovirale d’une région où cette information est très rare et contribue à une meilleure connaissance de la distribution mondiale des génotypes pathogènes. Il démontre également l’importance des techniques moléculaires aussi bien pour la détection des HAdV que pour l’identification des génotypes permettant une investigation virologique rapide des cas d’où l’intérêt de leur utilisation surtout en cours d’épidémies.

Purpose. - To investigate the microbiological profile of acute postoperative endophthalmitis in a referral center in Tunisia and to assess the antibiotic sensitivity of the organisms.Patients and methods. - This is a retrospective study over a period of eleven years, conducted on patients hospitalized with acute infectious postoperative endophthalmitis. Cultures were performed on aqueous (93%) and vitreous specimens (68%) obtained at presentation. Each sample underwent direct examination, culture and antibiotic susceptibilities.Results. - The number of acute postoperative endophthalmitis cases identified during the study period was 308. Organisms were found in 43% of samples (endophthalmitis was bacterial in 39.5%, fungal in 0.9% and polymicrobial in 2.6%). Cultures grew primarily Staphylococcus epidermidis in 31.4% of cases, Streptococcus pneumoniae in 22.7% of cases and Staphylococcus aureus in 12.7% of cases. Gram-positive cocci are more sensitive to vancomycin and Gram-negative bacilli are more susceptible to ofloxacin and ciprofloxacin.Conclusion. - In our study, microbiological samples were positive in 43% and coagulase-negative Gram-positive cocci are the most common organisms. However, antibiotic resistance has been increasing over the years. (C) 2015 Elsevier Masson SAS. All rights reserved.

La kératite polymicrobienne associant une co-infection bactérienne, mycosique et amibienne est une infection rare et grave mettant en jeu le pronostic visuel. Nous rapportons l'observation d'une patiente âgée de 29 ans, interne des hôpitaux, porteuse de lentilles de contact souples pour correction de sa myopie depuis un mois avec une mauvaise hygiène. Cette patiente s'est présentée aux urgences d'ophtalmologie au lendemain d'une garde de 24 h pour baisse bilatérale de l'acuité visuelle, douleur, rougeur et photophobie. L'examen avait trouvé une acuité visuelle à 1/20 à l'OD et « voit bouger la main » à l'œil gauche. L'examen à la lampe à fente trouve à l'OD : une KPS avec des infiltrats sous-épithéliaux diffus et au niveau de l'œil gauche, présence d'un abcès cornéen paracentral de 2 mm de diamètre rond atteignant le stroma associé à un œdème de cornée. Le segment antérieur était calme au niveau des 2 yeux. La patiente a été mise en urgence sous antibiotiques fortifiés, fungizone collyre, triflucan cp et désomédine collyre. Le prélèvement des lentilles et de leur produit de conservation a révélé la présence d'amibes type Acantamoeba et de Candida Parapsilosis. Le prélèvement au niveau de l'abcès a montré la présence de Pseudomonas Aeruginosa. L'évolution sous traitement était favorable avec amélioration de l'acuité visuelle et la disparition de l'abcès et des infiltrats. Les auteurs discutent les particularités épidémiologiques, cliniques, thérapeutiques et évolutives des kératites poly-microbiennes chez les porteurs de lentilles de contact. La kératite polymicrobienne chez les porteurs de lentille de contact est une complication redoutable qui peut provoquer la cécité. Elle doit être évoquée systématiquement, particulièrement l'atteinte amibienne débutante. Un traitement adapté, instauré très précocement et de manière rigoureuse permet d'améliorer le pronostic.

Human adenoviruses (ADV) are distributed worldwide; they are associated with a variety of diseases. Some ADV can be implicated in large epidemics of conjunctivitis, gastroenteritis and respiratory infections. Classical diagnosis of ADV infections is based on virus isolation on cell culture and identification of the serotype by neutralization test or hemagglutination inhibition assay. However, these methods have a lack of rapidity that makes them impractical in clinical situations. With the advent of PCR, the diagnosis of ADV was improved. In this work, we have used molecular techniques for the identification of ADV serotypes implicated in conjunctivitis in Tunisia. A total of 199 conjunctival swabs received between October 2000 and May 2005 were investigated. Serotype identification was performed using a PCR followed by restriction enzyme analysis in the hexon gene. Typing by sequencing of the PCR product was used to confirm the serotype identification. Among the 199 tested clinical specimens, 24% were positive for ADV. Two different profiles were observed: one predominant corresponding to the majority of the detected ADV; this profile is in favour of two distinct serotypes, ADV37 or ADV8; the second profile was specific of ADV4 and was found in one case observed in 2005. Sequencing confirmed two serotypes: ADV8 with an endemoepidemically circulation in our country and ADV4 that appeared sporadic. The present work showed the importance of molecular techniques not only for ADV detection but also for identification of the circulating serotypes. These techniques are practical and interesting mainly for the rapid virological investigation during epidemics. (c) 2006 Elsevier Masson SAS. Toes droits reserves.

This study reports the genetic characteristics of coxsackievirus A24 isolates from Tunisia, including a coxsackievirus A24 variant (CVA24v) that caused an outbreak of acute haemorrhagic conjunctivitis (AHC) between September and November 2003. The virus genome was detected by PCR from conjunctival swabs obtained from patients with AHC. Four virus isolates were obtained from PCR-positive samples and were serotyped by sequence analysis of the VP1 and VP4 genomic region and by seroneutralisation. Phylogenetic analysis of the VP1, VP4 and 3C genomic regions was performed. Other Tunisian CVA24 isolates from paralytic cases and healthy individuals were also amplified, sequenced and included in the phylogenetic analysis. The epidemic strain belonged to the CVA24 serotype. Phylogenetic analysis of the 3C region of the genome revealed a strong relationship between the Tunisian epidemic strain and strains that caused outbreaks in Korea (2002) and Guadeloupe and French Guiana (2003). Phylogenetic analysis of the VP1 and VP4 regions showed a clear distinction between serotype CVA24 isolates from conjunctivitis and non-conjunctivitis cases. This is the first study to report an outbreak of AHC caused by CVA24v in the North African region.

Human adenoviruses (ADV) are distributed worldwide; they are associated with a variety of diseases. Some ADV can be implicated in large epidemics of conjunctivitis, gastroenteritis and respiratory infections. Classical diagnosis of ADV infections is based on virus isolation on cell culture and identification of the serotype by neutralization test or hemagglutination inhibition assay. However, these methods have a lack of rapidity that makes them impractical in clinical situations. With the advent of PCR, the diagnosis of ADV was improved. In this work, we have used molecular techniques for the identification of ADV serotypes implicated in conjunctivitis in Tunisia. A total of 199 conjunctival swabs received between October 2000 and May 2005 were investigated. Serotype identification was performed using a PCR followed by restriction enzyme analysis in the hexon gene. Typing by sequencing of the PCR product was used to confirm the serotype identification. Among the 199 tested clinical specimens, 24% were positive for ADV. Two different profiles were observed: one predominant corresponding to the majority of the detected ADV; this profile is in favour of two distinct serotypes, ADV37 or ADV8; the second profile was specific of ADV4 and was found in one case observed in 2005. Sequencing confirmed two serotypes: ADV8 with an endemoepidemically circulation in our country and ADV4 that appeared sporadic. The present work showed the importance of molecular techniques not only for ADV detection but also for identification of the circulating serotypes. These techniques are practical and interesting mainly for the rapid virological investigation during epidemics.