Infective endocarditis is still frequently associated with rheumatic disease among young adults in Tunisia, with a high frequency of negative blood cultures and high in-hospital mortality, given that the population affected is relatively young.

Hepatitis A virus (HAV) has different epidemiologic and clinical patterns, depending on the level of endemicity in a given geographic area. Tunisia is considered a region of high endemicity for hepatitis. Improvement of socioeconomic conditions in this country has made a determination of the seroprevalence of this disease advisable. We assessed the seroprevalence of HAV in Sousse in central Tunisia. A total of 2,400 school children 5-20 years of age (mean +/- SD age = 11.7 +/- 3.5 years) were selected by two-stage cluster sampling and tested serologically for IgG antibody to HAV by using an enzyme-linked immunosorbent assay. The overall seroprevalence among this population was 60% (44%, in children < 10 years old, 58% in those 10-15 years of age, and 83% in those > 15 years of age. Seroprevalence also varied according to area of residence. At the age of 10, 21.3% of school children living in the urban areas and 87.7% of those living in rural areas had antibodies to HAV. Other factors that increased seroprevalence included non-potable water, crowding, and a low education level of parents with odds ratios of 4.37, 2.96, and 2.62, respectively. This study has shown an increase of seroprevalence with age, suggesting that transmission among younger children has decreased, particularly in urban areas. Programs to prevent hepatitis A may need to be modified based upon the changing age distribution of the disease and mass vaccination program could be indicated if additional incidence and prevalence data confirm the intermediate endemicity of HAV.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease associated with a high case fatality rate and transmitted mainly by Hyalomma marginatum. The geographical distribution of H. marginatum covers most of the Western Mediterranean basin. We aimed to investigate whether CCHF virus (CCHFv) is circulating in Tunisia. Samples from unexplained acute febrile patients (n = 181) and a high risk group of humans, mainly slaughter workers (n = 38), were collected in the summer of 2014 and analyzed for exposure to CCHFv using serological tests and real-time RT-PCR. Ticks were collected from Northern and Southern Tunisia during May–June 2014 and examined for the presence of CCHFv by real-time RT-PCR. Of the 181 febrile patients, 5 showed only high titers of IgM suggesting a recent exposure to CCHFv. Among 38 slaughter workers, 2 had IgG anti-CCHFv responses yielding a seroprevalence of 5.2%. No CCHFv was detected in ticks and sera. Our results provide evidence of human exposure to CCHFv in Tunisia.

In this report we attempt to evaluate the prevalence of antibodies against Rickettsia conorii, R. typhi, Coxiella burnettii, and Ehrlichia chaffeensis in central Tunisia. Five hundred sera from blood donors, collected between March and June 1993, were tested for these 4 antibodies using an indirect immunofluorescence antibody assay (IFA). Nine percent of the sera had antibodies against R. conorii (IgG > 1:32) by IFA, and 8% by Western blotting; with IFA, 3.6% had antibodies to R. typhi, 26% to C. burnetii (> 1:50), and none to E. chaffeensis. Infection rates with R. conorii and R. typhi did not differ significantly between the sexes, but fewer young people had antibodies to R. typhi. A significantly higher prevalence of antibodies to C. burnetii was noted for males with no difference between age classes. No significant difference was detected between urban and rural areas. This study confirmed the endemicity of rickettsioses, and revealed a high seroprevalence of Q fever, in central Tunisia.

Rift Valley fever virus (RVFv) is capable of causing dramatic outbreaks amongst economically important animal species and is capable of causing severe symptoms and mortality in humans. RVFv is known to circulate widely throughout East Africa; serologic evidence of exposure has also been found in some northern African countries, including Mauritania. This study aimed to ascertain whether RVFv is circulating in regions beyond its known geographic range. Samples from febrile patients (n = 181) and nonfebrile healthy agricultural and slaughterhouse workers (n = 38) were collected during the summer of 2014 and surveyed for exposure to RVFv by both serologic tests and PCR. Of the 219 samples tested, 7.8% of nonfebrile participants showed immunoglobulin G reactivity to RVFv nucleoprotein and 8.3% of febrile patients showed immunoglobulin M reactivity, with the latter samples indicating recent exposure to the virus. Our results suggest an active circulation of RVFv and evidence of human exposure in the population of Tunisia.