Mohamed Gorcii

Hôpital Universitaire Fattouma Bourguiba, Al Munastīr, Al Munastīr, Tunisia

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Publications (23)30.58 Total impact

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    ABSTRACT: Alternariosis is a fungal infection that is usually described in immunocompromised patients. We report a case of cutaneous alternariosis in a renal transplant recipient caused by Alternaria tenuissima. The diagnosis was supported by histopathologic (ie, yeastlike cells, filamentous structures) and mycologic findings from a cutaneous biopsy. Cutaneous lesions regressed 1 month following a decrease in the dosage of immunosuppressive therapy. The patient also was treated with intravenous amphotericin B followed by oral fluconazole without improvement. Cryotherapy remarkably accelerated healing of the lesions.
    Cutis. 05/2014; 93(5):237-240.
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    ABSTRACT: Visceral leishmaniasis (VL) has been endemic in northern Tunisia and has occurred sporadically in the center of Tunisia. Recently, there have been several cases from areas known to be free of VL. We report in this work all human and canine cases of VL recorded between 2003 and 2011 and an entomological study of phlebotomine fauna in a previously non-endemic region. Sixty-three cases of VL were diagnosed and identified as L. infantum using several different methods. Eight species of 179 sand flies were caught and identified by both morphological and molecular methods. Two genera were present, Phlebotomus and Sergentomya, with an abundance of the subgenus Phlebotomus (Larrousius) spp., a classic vector of VL in Tunisia. Moreover, Leishmania DNA was detected in seven unfed Phlebotomus pernicousus and L. infantum was identified in three of them. This result confirms the establishment of a transmission cycle of VL in the studied region by the coexistence of infected vectors with infected hosts.
    Journal of Vector Ecology 06/2013; 38(1):1-5. · 1.23 Impact Factor
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    ABSTRACT: Objective Studying the epidemiological variations of visceral leishmaniasis in Tunisia and proving the importance of parasitological investigations to raise the diagnosis.Patients and methodsSix patients hospitalised during the period between January 1998 and January 2009 at Fattouma Bourguiba Teaching Hospital in Monastir, five men and an only one woman, aged from 26 to 70 years old, originating from the central and eastern regions of the country. Epidemiological, clinical, biological and therapeutic data were obtained from the patient's medical files.ResultsThe major clinical symptoms were fever, weakness and spleen enlargement. Biological data revealed the presence of anaemia in every case and leucopoenia associated or not associated with thrombopenia in four cases. The diagnosis of visceral leishmaniasis was confirmed by the identification of the parasite in the blood or in the bone marrow. All patients were treated with two courses of antimoniate of meglumine separated by a 6-week interval. The outcome was positive and the patients were cured.Conclusion Visceral leishmaniasis is increasing among adults in Tunisia. Moreover, it is spreading outside its epidemiological area in the north to reach the central and southern regions. It should be raised when fever and spleen enlargement occur. Biological data are hardly specific. Diagnosis is based on finding the parasite in human fluids, mainly by molecular techniques. The rapid establishment of a specific treatment is vital.
    Pathologie Biologie 04/2013; 61(2):54–58. · 1.67 Impact Factor
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    ABSTRACT: Infections are a major determinant of outcome in kidney transplantation. Opportunistic pathogens are common in kidney recipients and several organs can be affected. Central nervous system infection in transplant recipients is a medical emergency. There is limited information in the literature concerning post-transplantation cryptococcal infection. Deafness and blindness are not classic findings. We report a case of meningocerebral cryptococcosis complicated by deafness and blindness after kidney transplantation. Physicians need to consider the possibility of Cryptococcus neoformans when symptoms persist despite empiric antimicrobial therapy.
    Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2013; 24(1):72-5.
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    ABSTRACT: Over a period of ten years, a series of 694 Leishmania strains from Tunisian leishmaniasis foci were isolated and identified by isoenzymatic analysis. Strains were obtained from human cutaneous and visceral leishmaniasis in immunocompetent subjects, visceral leishmaniasis in imunocompromised individuals and from dogs with visceral leishmaniasis. Two classically dermotropic species, Leishmania (L.) major and Leishmania killicki were found. L. major with the single zymodeme MON-25 was the most isolated in cutaneous leishmaniasis foci of the Centre and South of Tunisia with a recent northern extension. L. killicki zymodeme MON-8 was sporadically found both in its classical microfocus of Tataouine in southeastern Tunisia as well as in some new foci in Southwestern, Central and Northern Tunisia. Leishmania infantum with its three zymodemes MON-1, MON-24 and MON-80 was isolated from both visceral and cutaneous human cases. The majority of L. infantum strains were found in the Northern part of the country; however, some strains were reported for the first time in the Southern part. L. infantum MON-1 was the only zymodeme isolated from canine leishmaniasis.
    Acta tropica 08/2012; 124(3):221-8. · 2.79 Impact Factor
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    ABSTRACT: Our aim was to study the distribution and the fertility of the hydatid cysts in function of the age and the sex of patients and to identify the strain(s) responsible(s) of the children hydatidosis. We have analyzed a total of 241 cysts coming from 195 children aged 2 to 16 years operated in the CHU F. Bourguiba of Monastir during the period from November 1999 to December 2009. For each cyst, the localization and the fertility of the métacestode as well as age, sex and origin of the patient are listed. Identification of strains was carried out by PCR/RFLP and has targeted the ribosomal gene ITS1. The lung was the primary localization of cyst (61.8%) followed by the liver (34.85%). The greatest number of cases is observed in the age groups 4-9 years (138 cases) where children's infection is more frequent in the male than in the female sex. The fertility of the cyst was independent of its site or its size and no incidence of age of children was detected. The G1 sheep strain is responsible for the contamination of children. The cystic echinococcosis described as a young adult disease may actually observed at any age and remains a serious problem of public health in Tunisia.
    Pathologie Biologie 06/2012; 60(3):166-9. · 1.67 Impact Factor
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    ABSTRACT: The aim of this study is to assess the usefulness of a simple, low-cost method for the detection and species identification of Leishmania isolated by in vitro culture or detected directly from clinical samples. A total of 110 samples were used in this study. Among these, 21 were human and canine peripheral bloods, 63 skin lesion material samples, eight reference strains and 18 Leishmania culture. Detection of Leishmania DNA with PCR using primers designed to amplify the internal transcribed spacer 1 (ITS1) region of the rRNA gene proved sufficiently sensitive at the level of 0.1 parasites per PCR reaction. Furthermore, followed by single-strand conformational polymorphism (SSCP), the PCR-ITS1 allowed the species identification of Leishmania. The inter-specific polymorphism of Leishmania was first validated on reference strains, and then this method was applied on clinical samples and culture. Typing identified all human and canine visceral leishmaniasis samples (21 samples) as L. infantum, 95.23% of the cutaneous leishmaniasis samples as L. major and 3.17% as L. killicki and 1.58% as L. infantum. A scheme of the PCR diagnosis procedure for the detection and identification of Leishmania parasites is proposed in this study.
    Pathologie Biologie 02/2012; · 1.67 Impact Factor
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    ABSTRACT: Metlaoui district in the South-west of Tunisia is a classical focus of cutaneous leishmaniasis (CL) due to Leishmania major. Since 2005, a single case of CL due to L. killicki has been reported. We report twenty four human cases due to this parasite, affecting men and women from 2 to 70 years old. Leishmania killicki have been typed using molecular techniques: polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) and gene sequencing. Four strains from patients have been successfully cultured on NNN medium and isoenzymatically typed as L. killicki MON-8. Our results strongly suggests that Metlaoui is a new L. killicki focus with a stable transmission cycle. Sand flies fauna in the same focus was also studied. 1400 Phlebotomine sand flies (785 males/615 females) have been caught during an entomological survey. Leishmania major DNA has been found in one P. papatasi female, the most abundant species, whereas L. killicki DNA has been found in one Phlebotomus sergenti female emphasizing the probable role of this species as vector of this zoonotic parasite.
    Acta tropica 01/2012; 122(3):276-83. · 2.79 Impact Factor
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    ABSTRACT: Leishmania killicki was originally described in 1980 in southeast Tunisia. It was also recently reported in Lybia and Algeria. Nevertheless, neither vector nor reservoirs of this parasite are known. The identification of the vector and the animal reservoir host of L. killicki is critical for the establishment of an efficient control strategy. blood, popliteal lymph node, spleen, bone marrow, liver and skin were collected from 50 rodents in 2009 in south western Tunisia. Samples were smeared onto glass slides, cultured on NNN medium and tested by polymerase chain reaction for Leishmania detection. Parasites were detected by PCR from 10 Psammomys obesus and from two Ctenodactylus gundi. Parasite identification was performed simultaneously by internal transcribed spacer 1 PCR-RFLP and by PCR sequencing. Both Leishmania major and Leishmania killicki were identified from infected Psammomys and Ctenodactylus gundi respectively. This is the first report of Leishmania killicki identified from Ctenodactylus gundi in Tunisia. This result supports the assumption that C. gundi is a potential reservoir for Leishmania killicki.
    Parasites & Vectors 08/2011; 4:159. · 3.25 Impact Factor
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    ABSTRACT: Topoisomerase II gene of Leishmania genus was used to develop a molecular tool for detection and species differentiation of Leishmania from clinical samples. Identification was achieved by a polymerase chain reaction followed by digestion with 2 restriction endonucleases BstU1 and Taq1. Despite the relatively low sensitivity, it is able to differentiate between 3 complexes responsible for cutaneous leishmaniasis.
    Diagnostic microbiology and infectious disease 10/2010; 68(2):152-8. · 2.45 Impact Factor
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    ABSTRACT: Fungus ball is rarely associated with acute renal failure (ARF). We report the case of a 65-year-old diabetic patient who has been admitted for a right kidney infection. Urinary exam showed a leucocyturia with a negative urine culture. Ultrasonography showed pelvicaliceal dilation. Nephroscopy revealed a fungal material in ureter. Culture of this material was positive for Candida tropicalis. After endoscopic and antifongic therapy, the serum creatinin decreased from 336 micromol/L to 150 micromol/L, indicating the good evolution of his renal function.
    Néphrologie & Thérapeutique 06/2010; 6(3):171-2. · 0.50 Impact Factor
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    ABSTRACT: The prevalence of onychomycosis due to non-dermatophytic moulds have been increased during the last few years. The reported pathogenic fungi are multiple and their list is continuously increasing. We report a case of onychomycosis in the left great toe due to Aspergillus sclerotiorum in a 45-year-old woman without any pathologic history. Clinical aspect was a distolateral onychomycosis with subungual hyperkertosis, white coloration of the nail and periungual inflammation. This onychomycosis was improved by local treatment with amorolfine solution. Onychomycoses due to Aspergillus spp. are more frequent in toenails, mainly in the great toe. They affect especially adult woman. According to many authors, clinical feature of the onychomycosis can suggest its aspergillar nature. Aspergillar onychomycoses can be successfully treated by local or systemic antifungal drugs.
    Journal De Mycologie Medicale - J MYCOLOGIE MEDICALE. 01/2010; 20(2):128-132.
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    ABSTRACT: Fungus ball is rarely associated with acute renal failure (ARF). We report the case of a 65-year-old diabetic patient who has been admitted for a right kidney infection. Urinary exam showed a leucocyturia with a negative urine culture. Ultrasonography showed pelvicaliceal dilation. Nephroscopy revealed a fungal material in ureter. Culture of this material was positive for Candida tropicalis. After endoscopic and antifongic therapy, the serum creatinin decreased from 336μmol/L to 150μmol/L, indicating the good evolution of his renal function.
    Nephrologie & Therapeutique - NEPHROL THER. 01/2010; 6(3):171-172.
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    ABSTRACT: The aim of this study was to assess the use of parasitological, serological and molecular methods for the detection of Leishmania infection in blood of 67 dogs and to investigate the prevalence of canine leishmaniasis (CanL) in Kairouan (central Tunisia), an area known to be of reduced endemicity and has not been studied since 1973. Veterinarians clinically examined all dogs, and the titer of anti-Leishmania antibodies was determined by indirect immune-fluorescence antibody test. The presence of Leishmania was performed by PCR and in vitro culture. IFAT was positive in 12% of dogs and promastigote form of the parasite was isolated by in vitro culture from only 4.5% of them. However, DNA of Leishmania was detected by PCR in 20.9% of dogs. PCR was more sensitive than IFAT (p = 0.004) and in vitro culture (p < 10(-5)). A prevalence of 21% was found in Kairouan, which is significant high (p < 10(-3)) when compared to that of thirty years ago. This state is in correlation with the increase in other Mediterranean countries. Furthermore, 50% of positive dogs were asymptomatic. Preventive measures must be taken against these dogs as for symptomatic ones since their role in the transmission of the infection to vectors has been proven.
    Parasite (Paris, France) 03/2009; 16(1):65-9. · 1.12 Impact Factor
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    ABSTRACT: The term Tinea Faciei (TF) designates a superficial dermatophyte infection of the glabrous skin of the face, characterized by clinical polymorphism. The aim of the present study is to assess epidemiologic, clinical, mycological, and therapeutic characteristics of TF in a Tunisian dermatology department. This retrospective study examined the records of cases of TF observed in our dermatology department over the past 5 years (2003-2007). Fourteen patients with TF were seen during the study period. The sex ratio (5 male/9 female) was 0.56. The average age of these 4 children and 10 adults was 22 years. While the clinical form was typical of TF in 10 cases, 4 patients had a clinical form modified by topical steroids (Tinea incognito). Direct microscopic examination showed hyphal elements in 12 cases, and the mycological culture was positive for 11. Five patients had Trichophyton Violaceum, and 4 T. Mentagrophytes. TF is frequently misdiagnosed because of its variable appearance. Atypical forms known as tinea incognito are observed after modification of the dermatophyte infections by corticosteroid treatment. Our study included 4 cases of Tinea incognito. T. Mentagrophytes and T. Rubrum are the agents reported most frequently. Unusually, T. Violaceum was found most frequently in our series.
    La Presse Médicale 03/2009; 38(9):1230-4. · 0.87 Impact Factor
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    ABSTRACT: Introduction The term Tinea Faciei (TF) designates a superficial dermatophyte infection of the glabrous skin of the face, characterized by clinical polymorphism. The aim of the present study is to assess epidemiologic, clinical, mycological, and therapeutic characteristics of TF in a Tunisian dermatology department. Patients and methods This retrospective study examined the records of cases of TF observed in our dermatology department over the past 5 years (2003–2007). Results Fourteen patients with TF were seen during the study period. The sex ratio (5 male/9 female) was 0.56. The average age of these 4 children and 10 adults was 22 years. While the clinical form was typical of TF in 10 cases, 4 patients had a clinical form modified by topical steroids (Tinea incognito). Direct microscopic examination showed hyphal elements in 12 cases, and the mycological culture was positive for 11. Five patients had Trichophyton Violaceum, and 4 T. Mentagrophytes. Discussion TF is frequently misdiagnosed because of its variable appearance. Atypical forms known as tinea incognito are observed after modification of the dermatophyte infections by corticosteroid treatment. Our study included 4 cases of Tinea incognito. T. Mentagrophytes and T. Rubrum are the agents reported most frequently. Unusually, T. Violaceum was found most frequently in our series.
    Presse Medicale. 01/2009; 38(9):1230-1234.
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    ABSTRACT: We synthesized recombinant Echinococcus granulosus protoscolex recP29 antigen to be preliminarily assessed by ELISA and immunoblotting. RecP29-serology was carried out on 54 young patients with cystic echinococcosis (CE). Patients were classified into either cured (CCE) (n=40) or non-cured (NCCE) (n=14) CE patients. RecP29 ELISA showed a gradual decrease of antibody concentrations in all CCE cases that were initially (before treatment) seropositive to this antigen (25 out of 40) or that seroconverted following treatment. A complete seronegativity was reached within 3 years post-surgery in all of these cases. Conventional HCF ELISA yielded seronegativity in only 10% of initially recP29-seropositive CCE patients (P=0.086). Likewise, recP29 immunoblotting yielded seronegativity in 93% of 29 out of 40 initially recP29-immunoblot-positive CCE patients after 3 years follow-up, compared with 72% in the HCF immunoblotting (P=0.060). Eleven out of 14 NCCE patients were initially positive by recP29 ELISA, and 10 out of these maintained a marked anti-recP29 antibody reactivity until the endpoint of the follow-up period. All 14 NCCE cases were initially seropositive by recP29 immunoblotting, and 13 cases remained seropositive until the end of the study. Thus, recombinant P29 protein appears prognostically useful for monitoring those post-surgical CE cases with an initial seropositivity to this marker.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 12/2008; 103(4):355-64. · 1.82 Impact Factor
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    ABSTRACT: Echinococcus granulosus protoscolex soluble somatic antigens (PSSAs) were assessed for their prognostic value in the serological follow-up of young patients treated for cystic echinococcosis (CE), compared to conventional hydatid fluid (HF) antigen. Based on different clinical courses and outcome of infection, as well as imaging findings, patients were retrospectively classified into two different groups including either cured CE (CCE; i.e., absence of active cysts or presence of inactive cysts, respectively) and noncured CE (NCCE) patients still presenting active cysts at the end of an up to 5-year follow-up period. An immunoglobulin G (IgG)-PSSA enzyme-linked immunosorbent assay (ELISA) showed a gradual decrease in antibody levels in CCE cases, reaching seronegativity in 20% of the cases at least within 5 years postsurgery. In comparison, the conventional IgG-HF ELISA showed a significantly lower progressive decrease in antibody levels, serology becoming negative in only 15% of CCE patients at the endpoint of the follow-up period. Serological analysis of PSSA by immunoblotting yielded an interesting immunoreactive double band of 27 and 28 kDa that, in 15 (75%) of 20 CCE cases, exhibited a rapid decrease and subsequent disappearance of respective antibody reactivities within 3 years postsurgery. Conversely, anti-27- and -28-kDa antibody reactivity strongly persisted until the endpoint of the follow-up period in all of the five NCCE patients. Further analysis of the 27- and 28-kDa doublet by using affinity-purified antibodies showed that the double band was not detectable in HF. Furthermore, a predominantly IgG4 subclass-restricted humoral immune response against the 27- and 28-kDa antigens was demonstrated in seroreactive CE patients. Overall, an anti-27- and -28-kDa response appeared to correlate with cyst activity. In conclusion, PSSA represents a useful candidate to carry out a serologic follow-up of CE subsequent to treatment and deserves further respective evaluation for other age groups of CE patients.
    Journal of clinical microbiology 06/2008; 46(5):1631-40. · 4.16 Impact Factor
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    ABSTRACT: The study was designed to determine comparatively the prognostic value of immunoblotting and ELISA in the serological follow-up of young cystic echinococcosis (CE) patients exhibiting either a cured or a progredient (non-cured) course of disease after treatment. A total of 54 patients (mean age 9 years, range from 3 to 15 years) with surgically, radiologically and/or histologically proven CE were studied for a period up to 60 months after surgery. Additionally, some of the patients underwent chemotherapy. Based on the clinical course and outcome, as well as on imaging findings, patients were clustered into 2 groups of either cured (CCE), or non-cured (NCCE) CE patients. ELISA showed a high rate of seropositivity 4 to 5 years post-surgery for both CCE (57.1%) and NCCE (100%) patients, the difference found between the two groups was statistically not significant. Immunoblotting based upon recognition of AgB subcomponents (8 and 16 kDa bands) showed a decrease of respective antibody reactivities after 4 years post-surgery. Only sera from 14.3% of CCE patients recognized the subcomponents of AgB after 4 years, while none (0%) of these sera was still reactive at 5 years post-surgery. At variance, immunoblotting remained positive for AgB subcomponents in 100% of the NCCE cases as tested between 4 and 5 years after surgical treatment. Immunoblotting therefore proved to be a useful approach for monitoring post-surgical follow-ups of human CCE and NCCE in young patients when based upon the recognition of AgB subcomponents.
    Parasitology 02/2008; 135(Pt 1):105-14. · 2.36 Impact Factor
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    ABSTRACT: An epidemiological study of canine leishmaniasis (CanL) was carried out in nine districts of Sfax, in the southern central part of Tunisia. Sera from 250 dogs were tested by two serological methods: the indirect immunofluorescence antibody test and the counter-immunoelectrophoresis. Seven to eight months later, before the next season of transmission, seropositive dogs from the first test were re-examined and a second sampling was performed. Infection status was assessed by serology and by other methods. PCR, in vitro culture and direct examination were applied on blood and other samples (bone marrow, liver, lymph node, spleen and cutaneous biopsies). The seroprevalence of the infection in dogs was 6%. Infection was then confirmed by at least one other method. The PCR is the method which agreed most with serology, all seropositive dogs were found PCR-positive. The sensitivity of the direct examination and the culture was only 33% and 55% respectively as compared with serology. A similar value of seroprevalence has been observed previously in Sousse, in the northern central part of Tunisia. The present report suggests a significant increase of CanL in the Sfax area and confirms that the disease is continuing to move southwards in Tunisia.
    Parasite (Paris, France) 10/2007; 14(3):247-51. · 1.12 Impact Factor