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Analyse des cas de légionellose grave hospitalisés dans les services de réanimation en Tunisie

Analysis of severe Legionellosis hospitalized in intensive care units in Tunisia

  • Santé Publique / Public Health
  • Published:
Bulletin de la Société de pathologie exotique

Résumé

Cette étude est la première visant à présenter les particularités de la légionellose en Tunisie. Il s’agit d’une étude multicentrique portant sur tous les cas de légionellose en Tunisie (2008–2012). Sur un total de 14 cas, 11 ont été étudiés, avec un âge moyen de 53,1 ans et un sex-ratio (H/F) de 2,6. Un pic estivo-automnal a été noté. Les facteurs de contamination étaient : une grande humidité de l’habitat (n=4), séjour dans une collectivité (n=3), pratique d’ablutions dans des lieux publics (n=4). L’acquisition était communautaire dans 9 cas et nosocomiale (n=2). La symptomatologie était de type respiratoire (n=11) +/− signes digestifs (n=6) et/ou neurologiques (n=4). La radiographie pulmonaire a montré des lésions bilatérales (n=6). Des signes biologiques à type d’hyponatrémie (n=9) et de CPK élevés (n=9) ont été notés. Le diagnostic positif était posé par antigénurie (n=10) et par IFD (n=1). Une bithérapie a été instaurée dans 10 cas. L’évolution était marquée par le décès de 5 patients. La légionellose apparait rare dans notre pays et semble survenir dans un contexte relativement différent de celui des pays occidentaux, notamment la notion d’ablutions. Il est fortement recommandé de renforcer le système national de surveillance et d’inscrire la légionellose dans le registre des maladies à déclaration obligatoire.

Abstract

This study is the first one that describes the situation of Legionnaires’ disease (LD) in Tunisia, with its clinical and epidemiological characteristics and investigates the risk factors associated with Legionella infections in our country. We conducted a retrospective multicentric study during 5 years (2008–2012) concerning all confirmed LD cases in Tunisia and we investigated risk factors for infection. The total of confirmed LD cases was 14. Incidence was 0.03. Mean age: 53.1, sex ratio (M/F): 2.6. Summer-autumnal peak was noted. Risk factors for infection were: the great humidity at home (n=4), living in community (n=3) and practice ablutions (before prayer) in public places (n=4). Community acquired legionellosis (n=9) and nosocomial (n=2). Pulmonary symptoms (n=11)+/-gastrointestinal (n=6) and/or neurological signs (n=4). Beta lactams therapy failed (n=11). CXR showed bilateral lesions (n=6). Abnormalities in laboratory values were noted: hyponatremia (n=9), high CPK levels (n=9). Diagnosis was confirmed by positive urinary Legionella antigens test (n=10) and by direct immunofluorescence (n=1). Treatment was based on bitherapy (n=10). Five patients died. The incidence of LD appears lower than other countries. Some risk factors, as ablutions, are different from that reported in Western countries and seem to be specific to our society. Given the seriousness of its consequences, it is strongly recommended to improve the national surveillance system up and register LD as notifiable disease.

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Authors and Affiliations

  1. CHU Farhat Hached, avenue Ibn El Jazzar, 4000, Sousse, Tunisie

    M. Marzouk, A. Boukadida, I. Chouchene, A. Ferjani, N. Hannachi, S. Bouchoucha & J. Boukadida

  2. CHU Abderrahman Memmi, Ariana, Tunis, Tunisie

    M. Besbes

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  1. M. Marzouk
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  2. A. Boukadida
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  3. I. Chouchene
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  4. A. Ferjani
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  8. J. Boukadida
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Correspondence to M. Marzouk.

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Marzouk, M., Boukadida, A., Chouchene, I. et al. Analyse des cas de légionellose grave hospitalisés dans les services de réanimation en Tunisie. Bull. Soc. Pathol. Exot. 108, 191–196 (2015). https://doi.org/10.1007/s13149-014-0414-1

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  • DOI: https://doi.org/10.1007/s13149-014-0414-1

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