Background Tuberculosis (TB) is a public health problem worldwide. Characterizing its trends over time is a useful tool for decision-makers to assess the efficiency of TB control programs. We aimed to give an update on the current chronological trends of TB in Southern Tunisia from 1995 to 2016 and to estimate future trajectories of TB epidemic by 2030. Methods We retrospectively collected data of all notified TB new cases by the Center of Tuberculosis Control between 1995 and 2016 in South of Tunisia. Joinpoint Regression Analysis was performed to analyze chronological trends and annual percentage changes (APC) were estimated. Results In the past 22 years, a total of 2771 cases of TB were notified in Southern Tunisia. The annual incidence rate of TB was 13.91/100,000 population/year. There was a rise in all forms of TB incidence (APC = 1.63) and in extrapulmonary tuberculosis (EPTB) (APC = 2.04). The incidence of TB increased in children and adult females between 1995 and 2016 (APC = 4.48 and 2.37, respectively). The annual number of TB declined in urban districts between 2004 and 2016 (APC = -2.85). Lymph node TB cases increased (APC = 4.58), while annual number of urogenital TB decreased between 1995 and 2016 (APC = -3.38). Projected incidence rates would increase to 18.13 and 11.8/100,000 population in 2030 for global TB and EPTB, respectively. Conclusions Our study highlighted a rise in all forms of TB and among high-risk groups, notably children, females and lymph node TB patients in the last two decades and up to the next one.
Panniculitis has various etiologies. One of the less common causes is trauma and hence traumatic fat necrosis (FN). These soft tissue injuries usually appear on the shins, thighs, breasts, arms, and buttocks. FN is mainly caused by trauma and may be associated with other conditions such as pancreatic disease. FN arising after intramuscular injections is uncommon and usually appears as firm, encapsulated, mobile, nontender, and solitary or multiple subcutaneous nodules.We report an interesting case of FN caused by intramuscular injections of cefazolin and meglumine antimoniate (MA) in a 38-year-old female patient. MA is regarded as the first-line systemic treatment for cutaneous leishmaniasis (CL).However, these drugs are not devoid of various potentially adverse reactions.
Background and Aim: Malignant otitis externa is a rare but potentially fatal infection. It tends to affect the elderly as well as patients with diabetes and immunocompromised status. We aimed to identify the epidemiological, clinical, therapeutic, and evolutionary features of malignant otitis externa. Materials and Methods:We conducted a retrospective study including patients hospitalized in the infectious diseases department in Sfax (South of Tunisia) for malignant otitis externa between 1994 and 2020. Non-documented cases were excluded from the study at enrolment. Results:We encountered 82 patients, among whom 45 were male (54.9%). The mean age was 62 ±14 years. Seventy-four patients had diabetes mellitus (90.2%). The most common clinical symptoms were otalgia (86.5%) and otorrhea (69.5%). Pseudomonas aeruginosa was the most common organism (56%). The first-line antimicrobial used on admission was a combination of ciprofloxacin (65.8%) and ceftazidime (51.2%). The median duration of treatment was 6 weeks [4-32 weeks]. The disease evolution was favorable in 67 cases (81.8%). According to the length of hospital stay, patients hospitalized for ≥ 21 days consulted after significantly longer duration of complaints (49 days vs. 36 days; P=0.01) and had significantly more frequent complications (35.3% vs. 10.4%; P<0.001), while the recovery was significantly more frequent in patients hospitalized less than 21 days (89.6% vs. 70.6%; P=0.02). Conclusion:Despite advancements in treatment and the variability of imaging modalities, malignant otitis externa remains a fatal disease. The diagnostic delay may worsen the disease outcome, requiring a longer duration of treatment and referral to surgery.
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