Revue Tunisienne de BIOLOGIE CLINIQUE

Febrile pancytopenia : Think about visceral leishmaniasis !

2025-01-15T17:45:28+00:00

We report the case of a 19-year-old patient from a consanguineous marriage,originally from Bizerte,with no particular medical history,who was admitted to hospital for a deteriorating general condition,persistent fever for 10 days,chills and night sweats.He was febrile at 40°C,tachycardic and displayed bilateral retroauricular and inguinal lymphadenopathies with splenomegaly.

Pancytopenia was revealed with a Complete blood count(CBC) showing leukopenia (2860/mm³), neutropenia (1000/mm³),microcytic non-regenerative anemia [(hemoglobin(9.2 g/dL),mean corpuscular volume(72.3 fL),reticulocytes count(50,000/mm³)]and thrombocytopenia(67,000/mm³).Hepatocellular cytolysis and inflammatory syndrome were found,with respectively high transaminases,high C-reactive protein level (115mg/l) and ferritin level (12982µg/l).Fibrinogen was low with 1.67g/l.

A bone marrow aspiration was performed.A rich,polymorphic marrow with evidence of some hemophagocytosis (image 1)and numerous histiocytes with a "sea-blue" were found(image 2). The presence of Leishmania amastigote(3 to 5 µm) with round or oval nuclei and a punctate kinetoplast,in the macrophages or on extracellularly(image 3a,3b)were observed.The diagnosis of visceral leishmaniasis complicated by macrophagic activation syndrome(H-score equal=221) was retained.Macrophagic activation syndrome combines non-specific clinical signs (fever,deterioration in general condition,hepatosplenomegaly,lymphadenopathy) with suggestive laboratory findings (bi or pancytopenia,deterioration in liver function,coagulopathy, increased LDH,ferritin and triglycerides,haemophagocytosis)[1].

The patient was treated with amphotericin B at a dose of 3 mg/kg/day along with corticosteroid therapy.The clinical course was complicated by renal insufficiency due to drug toxicity,which was managed by hydration.Ultimately,the clinical and biological course was favorable.

Visceral leishmaniasis is a parasitic vector-borne disease caused by the protozoa of the genus Leishmania.It’s a public health problem in Tunisia [2].The association of febrile pancytopenia and macrophagic activation syndrome should lead one to think of visceral leishmaniasis. Careful examination of the bone marrow smear by an experienced cytologist is necessary. As for the presence of histiocytes with a sea-blue appearance,there were insufficient clinical arguments to look for an overload disease.Early diagnosis of this association ensured early specific treatment to be started, thus improving the prognosis[3].

Frequency of serological markers of rheumatoid arthritis in patients with chronic hepatitis C

2025-02-14T09:38:00+00:00

Background: Viral hepatitis C is a chronic liver disease caused by hepatitis C virus (HCV) which can trigger autoimmune responses. We aimed to investigate the frequency of rheumatoid factor (RF) and anti-cyclic citrullinated peptides autoantibodies (CCP-Ab) in Tunisian patients with chronic hepatitis C (CHC). Materials and Methods: Sera of 88 patients with CHC were collected over a period of two years. RF and CCP-Ab were performed by indirect ELISA. Ninety healthy blood donors (HBD) served as control group. Results:. Serological markers of RA were more frequent in CHC patients than in HBD (50% versus 7.8%, p<10^-6). CCP-Ab were significantly more frequent in patients with CHC than in HBD (p=0.03). RF were significantly more frequent than CCP-Ab in patients with CHC (p<10^-5). CCP-Ab or RF were significantly more frequent in female patients than in male patients (p=0.03). RF-IgA and CCP-Ab levels were positively correlated with age (r=0.317, p=0.01 and r=0.353, p=0.005 respectively). RA serological markers were significantly more frequent in patients with cirrhosis than in patients without cirrhosis (p=0.03). Conclusion: The current study has shown that CHC is associated with a high frequency of serological markers of rheumatoid arthritis.

Viral respiratory infection (excluding SARS-CoV-2) in Morocco: A retrospective study from September 2019 to April 2023

2025-06-05T13:13:40+00:00

Introduction: Viral respiratory infections are a significant cause of morbidity and mortality worldwide. Viruses are implicated in more than 80% of respiratory infections. Objectives: The aim of this work was to study the epidemiology of respiratory viruses and assess the impact of the COVID-19 pandemic on their circulation between 2019 and 2023. Materials and methods: This retro-prospective descriptive study was conducted at the Virology Laboratory of the Mohammed V Military Teaching Hospital in Rabat, Morocco from September 2019 to April 2023. Samples were collected from patients admitted with acute respiratory infection that tested negative for SARS-CoV-2 by PCR and underwent multiplex respiratory PCR test using the BioFire® Respiratory 2.1 kit on a nasopharyngeal swab. Demographic data were extracted from Laboratory Information System. Statistical analysis was carried out using SPSS 22.0 and Microsoft Excel. Results: A total of 1050 PCR tests were performed. The positivity rate was 54% (564 patients). The median age of patients with a positive PCR was 31 years (1-91 years). The M/F sex ratio was 1.52. The positivity rate was 57%, 53%, 72%, 52% and 44% during the years 2019 (September to December), 2020, 2021, 2022 and 2023 (January to April) respectively. Among the viruses detected, Enterovirus/Rhinovirus was the most common (50%), followed by Influenza virus (16%) and Respiratory Syncytial Virus (11%). Four hundred fifty positive PCRs was mono-infections (80%) and 114 (20%) were co-infections, of which 108 were with 2 viruses and 6 with 3 viruses. Conclusion: The implementation and lifting of pandemic-related barrier measures significantly influenced respiratory virus circulation, aligning with seasonal patterns. In our context, Enterovirus/Rhinovirus and Influenza testing is recommended first for adults whereas Enterovirus/Rhinovirus and RSV testing is recommended first for children. Otherwise, multiplex testing should be considered for severe cases or those with risk factors.

Utility of the triglyceride-Glucose index and TG/HDL-C ratio in glycemic control monitoring

2025-06-27T15:48:49+00:00

Background: Elevated hemoglobin A1c (HbA1c) levels are associated with increased cardiovascular risk in type 2 diabetes (T2D). This study aimed to assess the relationship between the Triglyceride-Glucose (TyG) index and the triglycerides-to-HDL cholesterol ratio (TG/HDL-C) with HbA1c levels, and to evaluate their predictive power for glycemic control. Materials and Methods : We conducted a cross-sectional study over 5 months (September 2023–January 2024) in adult T2D patients. Poor glycemic control was defined as HbA1c ≥7%. TyG index and TG/HDL-C ratio were calculated and compared between patients with good and poor glycemic control. Results: Among 140 patients (mean age: 62.5 ± 8.4 years), 62.9% had HbA1c ≥7%. Poor glycemic control was significantly associated with longer diabetes duration (p=0.031), fasting plasma glucose (p<0.001), higher triglycerides (p=0.003), lower HDL-C (p<0.001), and insulin therapy (Odds Ratio (OR) = 4.762; p=0.002). Both TyG index and TG/HDL-C ratio were positively correlated with HbA1c values (r = 0.524 and r = 0.274; p < 0.001). In multivariate analysis, the TyG index was independently associated with poor glycemic control (adjusted OR = 68.4; p < 0.001). Its diagnostic performance showed an AUC of 0.80 with a cutoff value of 4.85 (79% sensitivity,69% specificity). Conclusion: The TyG index is a simple and accessible marker for evaluating glycemic control in patients with type 2 diabetes.