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Micrococcus lylae, a Gram-positive bacterium of the Micrococcaceae family, is considered an opportunistic microorganism with only a few reported cases of infection. In this report, we present a case of cholangitis caused by Micrococcus lylae in a 69-year-old woman with a medical history of type 2 diabetes and a cholecystectomy performed a decade ago. She was admitted to the gastroenterology department with symptoms indicative of acute cholangitis. Abdominal computed tomography and endoscopic ultrasound showed a consistent and symmetrical dilatation and thickening of the main bile duct, containing micro stones and a macro stone in the cystic duct stump. The patient received empirical antibiotic therapy based on ceftriaxone and metronidazole. She underwent ERCP with biliary endoscopic sphincterotomy and marginal biopsy, followed by balloon-assisted manipulation to facilitate bile release and collection of an intraoperative bile fluid sample for microbiological examination to identify the pathogen and guide the treatment adjustments. The microbiological examination demonstrated the exclusive presence of Micrococcus lylae. The patient's condition notably improved, marked by the normalization of inflammatory indicators. After three days, the patient was discharged in a stable condition, continuing the antibiotic regimen with the oral administration of ciprofloxacin and metronidazole. Jaundice resolved after one week, and liver function tests were completely normalized on follow-up at one month.

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BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is increasing worldwide and is a major cause of death in many countries. It has become a major challenge for national tuberculosis control programs. Therefore, rapid identification of MDR strains of Mycobacterium tuberculosis and monitoring of their transmission could contribute significantly to the fight against tuberculosis. The GenoType MTBDRplus assay has been recommended by the World Health Organization to identify rifampicin (RIF)- and isoniazid (INH)-resistant M. Tuberculosis isolates. The objectives of this study were to evaluate the performance of the GenoType MTBDRplus test in the detection of rifampicin and isoniazid resistance of M. tuberculosis isolates in a Moroccan hospital and then to determine the frequency of mutations associated with resistance to these two major anti-tuberculosis drugs. METHODS: This is a retrospective study conducted at the bacteriology department of the Mohammed V military hospital over a period of one year from 01/01/2018 to 12/31/2019. A total of 92 isolates of M. tuberculosis from pulmonary and extra-pulmonary specimens were evaluated for drug susceptibility by MGIT™ 960 AST system and compared to the GenoType MTBDRplus assay. The MGIT™ 960 AST system was used as the gold standard for the evaluation of the GenoType MTBDRplus assay. RESULTS: Sensitivity and specificity of the GenoType MTBDRplus assay for the detection of RIF-resistant M. tuberculosis isolates were 83.33% and 100%, respectively. Its sensitivity and specificity for the detection of INH-resistant M. tuberculosis were 88.23% and 100% respectively. The concordances of the GenoType MTBDRplus assay and the MGIT™ 960 AST system for the detection of sensitivity to RIF and INH were 99% (1/92) and 98% (2/92), respectively. Among the five RIF-resistant isolates, the MUT3 mutation in the rpoB gene (codon S531L mutation) was present in 80% of isolates, whereas mutations in the rpoB MUT1 gene were present in only one (20%) RIF-resistant isolate. INH resistance was detected in 15 isolates, of which nine isolates (60%) had specific mutations of the katG gene (codon S315T1) and conferred a high level of resistance to INH. CONCLUSIONS: The results of this study have shown that the GenoType MTBDRplus test has a high sensitivity and specificity for the detection of resistance to RIF and INH.

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Breast tuberculosis is a rare entity even in endemic countries. It is often considered as a diagnostic conundrum given the non-specific clinical and imaging characteristics. Therefore, the definitive diagnosis is based on the identification of bacilli by microbiological or histopathological examination. We report the case of a 52-year-old woman, with a 2-month history of a painful lump of the left breast. The imaging features were consistent with a breast abscess. The purulent collection was aspirated and a tuberculous mammary abscess was diagnosed by molecular biology (GeneXpert). Through this observation, we discuss the clinical, radiological and biological signs by highlighting the contribution of molecular biology in the rapid management of this rare pathology.

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Shewanella putrefaciens is a Gram-negative bacillus and marine pathogen that rarely causes disease in humans. We report the first Moroccan case of multidrug-resistant Shewanella putrefaciens bacteremia and describe the bacteriological, clinical, and antibiogram characteristics of this isolate, which was repeatedly isolated from the blood of a 66-year-old hypertensive man who underwent femoral coronary angiography after a myocardial infarction.

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Retropharyngeal abscess is an uncommon location of tuberculosis (TB). In this report, we describe a multidrug-resistant tuberculous retropharyngeal abscess in a 21-year-old female patient who was treated for lymph node TB for one year. CT scan revealed a large retropharyngeal abscess that was aspirated intraorally under local anesthesia. The diagnosis of TB was retained by molecular and histological study. GeneXpert MTB/ RIF (Cepheid, Sunnyvale, CA, USA),performed on the pus, showed rifampicin resistance and a first- and second-line drug resistance test using Genotype MTBDRplus VER.2 and MTBDRsl VER.1 (Hain Lifescience GmbH, Nehren, Germany) showed TB highly resistant to rifampicin, isoniazid, and aminoglycosides. Treatment is primarily medical as it combines specific antituberculous antibiotics, and aspiration for drainage of the abscess. Our patient was put on long-term 2nd line anti-TB treatment.

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BACKGROUND: The authors report a case of tumor-like colonic tuberculosis revealed by PCR in a 32-year-old patient with a low-level peritoneal effusion on CT scan with negative histological study on colonic biopsy. METHODS: The colonic biopsy received at the laboratory after grinding in a porcelain mortar, was the object of a molecular study by GeneXpert MT/RIF (Cepheid, Sunnyvale, CA, USA) using the automated real-time PCR technique and a conventional study based on Ziehl-Nielsen staining and culture on Lowenstein-Jensen® solid medium (LJ) and Mycobacteria Growth Indicator Tube (MGIT®) liquid medium. RESULTS: The patient was a 32-year-old male without any personal or family history of tuberculosis and without signs of tuberculosis impregnation. He had a story of ingestion of non-pasteurized dairy products including milk and cheese. For 45 days he had constipation with abdominal pain and feeling of heaviness. Physical examination of the patient revealed abdominal tenderness without adenopathy. The laboratory workup showed a normal blood count, CRP, liver and kidney function tests. The HIV test was negative. Medical imaging revealed a low-level peritoneal effusion that could not be punctured. Colonoscopy showed a thickening of the colon. The colonic biopsy, after crushing and sonication, was searched for the Mycobacterium tuberculosis complex by both molecular biology and conventional methods. Molecular research by GeneXpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) using the automated real-time PCR technique, revealed the presence of the Mycobacterium tuberculosis complex without detection of rifampicin resistance. On the other hand, the direct examination after special Ziehl-Nielsen staining was positive (Figure 2) and the cultures on Lowenstein-Jensen® solid medium (LJ) and Mycobacteria Growth Indicator Tube (MGIT®) liquid medium were also positive after two and three weeks, confirming the molecular diagnosis. The histology study showed moderate non-specific chronic colitis with no histological arguments for tuberculosis or malignancy. The patient was placed on curative tuberculosis treatment according to the national protocol, with a favorable clinical-radiological course. CONCLUSIONS: Colonic tuberculosis is a disease that may mimic many other diseases; therefore, a correct approach is necessary for the correct diagnosis and treatment.

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Escherichia coli is a rare cause of infectious endocarditis. We report a clinical case of E. coli endocarditis of a native mitral valve in a young 26-year-old woman with a recurrent urinary tract infection who had a high fever for one week despite probabilistic treatment with amoxcillin-clavulanic acid 3 g per day. The patient was successfully treated with antibiotics and recovered without surgery.

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Pasteurella pneumotropica is an important bacterial pathogen in both animals and humans. Most reported Pasteurella infections in humans involve skin and soft tissues, often after an animal bite, scratch, or lick to an open wound. We report a case of septic arthritis with Pasteurella pneumotropica in a diabetic and cardiopathic patient who was the victim of a rat bite in the street, with a good evolution after medical and surgical treatment.

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We evaluated the body fluid module on Sysmex UF-1000i (UF-1000i-BF) for analysis of white blood cell (WBC) and red blood cell (RBC) in cerebrospinal fluid. We collected 93 cerebrospinal fluid samples and compared the results of the UF-1000i-BF mode with the Fast-Read 102 disposable counting cell. Results shows a good correlation between the UF-1000i and the microscopic examination. The concordance percentage is 99.06% for white blood cells and 85.18% for red blood cells. The UF-1000i-BF mode offers rapid and reliable total WBC and RBC counts for initial screening of cerebrospinal fluid, and can improve the workflow in a routine laboratory.

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Morocco does not record any indigenous malaria case since 2004 and is certified by the World Health Organization as malaria-free since 2010. However, the country continues to record a significant number of imported malaria cases from endemic areas, especially from West Africa. The purpose of our work is to determine the epidemiological and diagnostic characteristics of malaria cases diagnosed at Ibn Sina Hospital Center in Rabat, Morocco. This work is a retrospective study of a series of malaria cases diagnosed between January 2012 and December 2016 at the Central Laboratory of Parasitology and Mycology of Ibn Sina Hospital Center. The methods used for the parasitological diagnosis are the search for the parasite at direct examination on thin blood film and thick drop and the search for parasite antigens by a rapid diagnostic immunochromatographic test (OptiMAL-IT® kit). Of 192 patients in whom malaria was sought, we recorded 54 positive cases (average of 10.8 cases per year). The prevalence was 28.12%. The age ranged from 4 to 76 years (average of 29.5 years). The sex ratio was 2.6. All cases had in their antecedents a notion of recent travel in an endemic area. The most common travel area was West Africa: Ivory Coast, with 31.43% of cases, followed by Guinea, with 14.29% of cases. The symptomatology was dominated by fever in 52 patients (96.3% of cases), followed by headache in 22 cases (40.74%). Anemia was present in 7 and thrombocytopenia in 12 patients. The most isolated species was Plasmodium falciparum (84.21% of cases), followed by P. vivax (10.53% of cases) and P. ovale (5.26% of cases). One case involved two species: P. falciparum and P. vivax. Parasitaemia was between less than 0.1 and 20%. Despite the local eradication of malaria, the persistence of imported cases, mainly due to the lack of chemoprophylaxis, should call for the strengthening of health education of travelers, especially in endemic areas.

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The Gorlin syndrome, or naevoid basal-cell carcinoma syndrome (NBCS) is an autosomal dominant cancer prone disease (at risk of multiple basal cell carcinomas, and other malignant or benign proliferations). We have previously reported data from peripheral blood lymphocytes of patients with this condition, showing a significant level of spontaneous chromatid and chromosome rearrangements and an overall lengthening of the cell cycle. In this paper, we confirm this disease to be a chromosome instability syndrome from studies on fibroblasts of 5 patients. Spontaneous chromosomal rearrangements, an increased frequency of sister chromatid exchanges and a slowing of the cell cycle were found, compared to age-matched control material. There was also an increased sensitivity to aberration production by mechlorethamine in patient fibroblasts. The chromosome instability we found was not restricted to a given cell lineage, but appears to be part of the general condition of this syndrome. The recently discovered gene responsible for Gorlin syndrome, PTC (or PTCH), encodes a transmembrane protein with yet poorly known functions. However, the demonstration of Gorlin syndrome as a chromosome instability syndrome suggests that this protein has a role in DNA maintenance, repair and/or replication.

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We report on the clinical and cytogenetic assessment of five cases of Down syndrome phenotype with either a partial duplication of chromosome 21 or a normal karyotype, and we quote a case of del (21q) syndrome. Down syndromes with a partial duplication of chromosome 21 (as well as cases of del (21q), which are partly the phenotypic countertype of trisomy 21) are of paramount importance in the understanding of genes involved in the phenotype of Down syndrome. The goal is to find the relevant genes implicated in the main traits of Down syndrome (i.e. mental retardation, Alzheimer disease, and serious visceral malformations). Such a goal, in our opinion, cannot be reached just by publishing the genotype and the phenotype of a small cohort of patients: 1. a sufficient number of accurate cases is needed, and 2. data have to be computerized for definite conclusions to be reached. The main aims of this report are to present our study protocol and to invite colleagues to participate in a collaborative study in order to collect a maximum of these (rare) cases.

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The Gorlin syndrome, or naevoid basal-cell carcinoma syndrome (NBCS) is an autosomal dominant disease. It has been suspected for long that this cancer prone disease (multiple basal-cell carcinomas; other malignant or benign proliferations) is a chromosome instability syndrome. We previously reported a lengthening in the cell cycle of lymphocytes from two patients with NBCS. With a larger sample (n = 7), we confirm this disease to be a chromosome instability syndrome, although clearly, expression of this characteristic can vary between patients: (1) spontaneous chromatid breaks occurred more often in a subset of the patients; (2) spontaneous micronuclei were found more frequently in NBCS than in the controls; (3) we confirm the cell cycle to be affected in this disease. As these results were obtained on lymphocytes--a cell lineage not affected in NBCS manifestations--the chromosome instability we found would appear to be part of the general condition of this syndrome.

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We report on two cases of partial monosomy 21 and review cases with a partial or an apparently full monosomy 21. In situ hybridization and/or molecular studies appear to be necessary tools to study imbalance in such a small chromosome and to perform further genotype-phenotype correlations. The segregation mode in cases with a translocation is adjacent 1, adjacent 2, and 3:1 in about 1/4, 1/4 and 1/2 of the cases, respectively.

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The naevoid basal-cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder with multiple basal-cell carcinomas, an increased risk for other neoplasms, and various malformations. Chromosome instability has been implicated in the pathogenesis of this syndrome, but these reports are somewhat contradictory. We have investigated five patients, two with confirmed NBCCS and three suspected. No evidence for chromosome instability was found in lymphocytes at three sample times after stimulation using metaphase aberration analysis, sister-chromatid exchange (SCE) in second division cells, or micronuclei. A significant lengthening of the cell cycle was found for the two confirmed NBCCS patients, but not for the suspected cases.

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