Echinococcus granulosus infection is a preventable zoonosis of human and veterinary public health importance in Tunisia. We aimed to comprehensively quantify human and animal echinococcosis losses in Tunisia. Itemized cost menus were developed for the health of both domestic animals and humans, and for productivity monetary losses. The incidence and prevalence of the disease in all species were obtained from national and personal reports. The domestic animal and human costs of echinococcosis in Tunisia were estimated using age-stratified rates and losses, productivity losses (including those not formally employed) and Monte Carlo sampling to represent the uncertainty inherent in some epidemiological and economic values. Echinococcosis in Tunisia causes significant direct and indirect losses in both humans and animals of approximately US dollars 10-19 million annually. These estimates are based on numerous methodological improvements over previous studies and are of considerable consequence relative to Tunisia's US dollars 21.2 billion gross domestic product. A cost-benefit analysis of control programmes using the methodological advances presented here and regional comparison to other endemic diseases is warranted. These may provide information to assist policy decision-makers in prioritizing the allocation of scarce resources.

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The incidence of cyst formation during GnRH agonist treatment is lower than previously reported. In such cases, the quality of oocytes and embryos were significantly compromised, with a significant increase in the cycle cancellation rate and a decrease in the implantation and pregnancy rates. Neither conservative management nor cyst aspiration improved the IVF outcome.

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Extradural spinal meningiomas are rare. Our understanding of purely extradural spinal meningiomas is still incomplete and they may be easily confused with malignant neoplasms, much more common in this location. We report a rare case of a purely extradural thoracic spine meningioma in a 70-year-old man, with an unusual progression. In addition we discuss the pathogenesis of these tumors and the potential pitfalls in differential diagnosis and review the relevant literature concerning their treatment and outcome.

The intestinal helminths infecting stray dogs were investigated in the Testour and Bouzid regions of Tunisia. Overall, 21% of the dogs necropsied were found to be infected with Echinococcus granulosus. The prevalence among the animals from Testour (27.0%) was significantly higher than that in the dogs from Bouzid (6.9%). Although the prevalence of this species in the dog populations did give a significant fit to the age-prevalence models reported earlier, the best fit was not consistent with the known biological parameters of the parasite. The frequency distribution of E. granulosus was highly aggregated, with a mean abundance of infection of 538 parasites/host and a mean intensity in infected animals of 2534 parasites/host. Several Taenia species were also found in the dogs, but none of these showed evidence of an aggregated distribution and the frequency distribution of each fitted a Poisson distribution, which is unusual for naturally acquired infections. All the other cestode species and the nematode species encountered had aggregated distributions in the dogs. As there was relatively little correlation between the worm burdens of the different parasite species in the dogs, individual dogs may not be generally susceptible or resistant to intestinal helminths of several species.

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