Historically, tinea capitis has been a problem among the population in general and in Morocco in particular. It is still a significant reason for consultation in routine medical practice, particularly among the population living in poor hygienic conditions. It is an infection almost exclusively of preschool and school-age children, due to changes in sebaceous secretion and skin pH during puberty, affecting both sexes, with a female predominance. Inflammatory cases or Kerion are caused by zoophilic species such as Trichophyton mentagrophytes, Trichophyton verrucosum, Microsporum canis, and less frequently by Microsporum gypseum. The identification of the species makes it possible to pinpoint the source of contamination and to condition the prophylaxis. Aware of the rarity of inflammatory tinea capitis caused by M. gypseum, we thought it would be interesting to report a new case diagnosed in the Parasitology-Mycology laboratory of the Avicenne Military Hospital in Marrakech, while focusing on the epidemiological, clinical and mycological characteristics of this dermatophyte through a review of the literature.
Nosocomial pneumonia (NP) is the second most common cause of nosocomial infection in the intensive care unit (ICU). They pose significant diagnostic, therapeutic and economic problems and increase the risk of death by increasing the length of stay in the ICU. The emergence of resistance to last-resort antibiotics in therapy defines multi-resistant bacteria (MRB). Our work is a retrospective descriptive and analytical study spread over one year (from 1 to 30 December 2019) which focused on patients admitted to the intensive care unit of Ibn Tofail Hospital in Marrakech and who presented with a nosocomial MRB pneumopathy. BMRs were isolated in 38% of cases. Imipenem-resistant Acinetobacter baumanii (IRBA) was the most isolated multi-resistant pathogen. The high level of co-resistance to other antibiotic families leaves little room for treatment. The risk factors found to play a role in the acquisition of BMR NPs were: age between 36 and 45 years, length of hospital stay between 10 and 20 days, presence of co-morbidity, radiological picture suggestive of NPs and broad spectrum antibiotic therapy. Measures to prevent NP are increasingly being adopted as an indicator of quality of care in intensive care units worldwide. Thus, reducing the incidence of NP and MRB should be a goal for all hospitals. In our context, measures to control MRBs must be reinforced by hygiene measures and precautions, in particular the identification of infected or colonised patients, the technical and geographical isolation of patients carrying MRBs and the use of appropriate treatment. Thus, regular epidemiological surveillance is necessary to guide management and define an adequate prevention strategy adapted to the context.
Nosocomial pneumonia is the second most common cause of nosocomial infection in the intensive care unit. They pose serious diagnostic, therapeutic and economic problems and increase the risk of death by increasing the length of stay in the ICU. Our work is a retrospective descriptive study of all patients hospitalized in the ICU who presented with ventilator-associated pneumonia (VAP) over a period of one year in the intensive care unit of Ibn Tofail Hospital in Marrakech. In our study, gram-negative bacilli were the most frequently isolated germs, with Acinetobacter baumannii predominating. Gram-positive cocci came in second place, represented by Staphylococcus aureus. In 69% of cases, the infection was polymicrobial. The resistance rate of the isolated strains was high; 95.7% of Acinetobacter baumannii were resistant to imipenem. Isolated strains of Enterobacteriaceae were resistant to the combination of amoxicillin and clavulanic acid in 53.3% of cases, to C3G in 30.7% of cases, to imipenem in 2.7% of cases, to amikacin in 1.4% of cases and to cotrimoxazole in 41.7% of cases. Staphylococcus aureus resistance was 4% to penicillin M and decreased compared to other antibiotics. The emergence of resistance to antibiotics of last resort in therapy defines multi-resistant bacteria. These were isolated in 38% of cases. Acinetobacter baumannii was the most isolated multidrug-resistant pathogen. In the light of this study, it appears that good management of antibiotic prescriptions, strict application of hygiene and asepsis measures as well as resistance monitoring within each ICU are necessary for the reduction of nosocomial pneumopathies with multi-resistant germs.
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