clinical strains of Streptococcus agalactiae, recovered from female genital specimens and from gastric fluid or ear specimens from infected newborns, were isolated at the Laboratory of Microbiology of Charles Nicolle Hospital of Tunis. They were investigated to determine the prevalence of antibiotic resistance and to characterize the mechanisms of resistance to macrolide and tetracycline. All strains were susceptible to penicillin, ampicillin and quinupristin-dalfopristin. They were resistant to chloramphenicol (3.1 %), rifampicin (19.1 %), erythromycin (40 %) and tetracycline (97.3 %); 3.1 % were highly resistant to streptomycin and 1.3 % to gentamicin. Among the erythromycin-resistant isolates, 78.7 % showed a constitutive macrolide-lincosamide-streptogramin B (MLS B ) phenotype with high-level resistance to macrolides and clindamycin (MIC 50 .256 mg ml ) and low MICs of clindamycin (MIC 50 58 mg ml "1 ) and 2.2 % showed an M phenotype with a low erythromycin-resistance level (MIC range512-32 mg ml "1 ) and low MICs of clindamycin (MIC range: 0.75-1 mg ml). All strains were susceptible to quinupristin-dalfopristin and linezolid (MIC 90 : 0.75 mg ml "1 for each). MLS B phenotypes were genotypically confirmed by the presence of the erm(B) gene and the M phenotype by the mef(A) gene. Resistance to tetracycline was mainly due to the tet(M) gene (93.1 %) encoding a ribosome protection mechanism. This determinant is commonly associated with the conjugative transposon Tn916 (P¡0.0002). tet(O) and tet(T) existed in a minority (2.2 % and 0.4 %, respectively). The efflux mechanism presented by tet(L) was less frequently present (4.5 %). No significant association was found between erm(B) and tet(M) genes.
Introduction and importance
Abdominal wall endometriosis is a rare clinical condition associated with abdominal pain and psychologic disorders. It's pathophysiology remains unclear. Clinical history and imaging findings are necessary for the diagnosis. Its management is challenging, and requires close collaboration between gynaecologists and visceral surgeons specially in complex procedures. The aims of our study are to present risk factors, clinical presentation, imaging findings and management features. It was a retrospective descriptive study including fifteen patients presenting abdominal wall endometriosis. Data about age, medical history, imaging findings, surgical procedures and outcome are reported.
Cases presentation
Fifteen women were included in our study. The most common symptom was cyclic abdominal pain. Twelve of them had history of caesarean section, and three had history of myomectomy. All patients underwent ultrasound and MRI. We performed surgical excision to all cases. One patient needed large excision with abdominoplasty procedure.
Clinical discussion
Abdominal wall endometriosis is a rare clinical condition with unclear pathophysiology. It occurs frequently after gynaecologic or obstetric surgery. Most reported complaint was catamenial abdominal pain with abdominal wall mass. Ultrasonography, computed tomography and MRI are useful for diagnosis, specially to eliminate differential diagnoses. Abdominal wall endometriosis management is based on surgery. Excision goals are to remove the mass and to confirm histological diagnosis of parietal endometriosis.
Conclusion
Parietal endometriosis is a rare and challenging condition with unclear pathophysiology. It requires specific management. This pathology will be encountered more frequently considering the increasing rate of caesarean section.
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