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Crimean-Congo haemorrhagic fever (CCHF) is an emerging tick-borne disease causing severe and fatal haemorrhagic syndrome in humans. Hyalomma spp. ticks are the primary vectors and sheep are important CCHF virus (CCHFV)-amplifying hosts. In this study, blood samples and ticks collected in October 2019 from 270 sheep from 15 farms across Tunisia constituted the main research material. Moreover, the sera of the same animals taken at different periods between 2018 and 2019 were also used to obtain comparative results. To investigate the presence of anti-CCHFV antibodies in sheep, all sera were tested using ELISA. Reactive sera were further characterised by a virus neutralisation test (VNT). Overall, one out of the 270 tested sheep was both ELISA- and strongly VNT-positive to CCHFV. Another two sheep were borderline ELISA-positive but did not exhibit neutralising antibodies. Ninety-one ticks were collected from all sampled sheep, of which 34 (37.4%) belonged to Hyalomma spp. This is the first report of anti-CCHFV antibodies in sheep from Tunisia. Both the results of this study and the recent CCHFV detection in ticks collected from camels in southern Tunisia indicate that further studies are needed to determine the competent tick vector in the country and to characterise the epidemiological cycle of CCHFV.

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Coronaviruses (CoVs) are documented in a wide range of animal species, including terrestrial and aquatic, domestic and wild. The geographic distribution of animal CoVs is worldwide and prevalences were reported in several countries across the five continents. The viruses are known to cause mainly gastrointestinal and respiratory diseases with different severity levels. In certain cases, CoV infections are responsible of huge economic losses associated or not to highly public health impact. Despite being enveloped, CoVs are relatively resistant pathogens in the environment. Coronaviruses are characterized by a high mutation and recombination rate, which makes host jumping and cross-species transmission easy. In fact, increasing contact between different animal species fosters cross-species transmission, while agriculture intensification, animal trade and herd management are key drivers at the human-animal interface. If contacts with wild animals are still limited, humans have much more contact with farm animals, during breeding, transport, slaughter and food process, making CoVs a persistent threat to both humans and animals. A global network should be established for the surveillance and monitoring of animal CoVs.

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BACKGROUND: Tick-borne encephalitis virus (TBEv) is a flavivirus that circulates in a complex cycle involving small mammals as amplifying hosts and ticks as vectors and reservoirs. The current study aimed to investigate the presence of TBEv in Tunisian sheep. A sample of 263 adult sheep were selected from 6 localities where Ixodes ricinus is well established. Sera were screened using ELISA for TBEv IgG detection, then the doubtful and positive sera were tested by the seroneutralisation test (SNT) and screened for West Nile Virus (WNv) IgG for cross-reaction assessment. RESULTS: The ELISA for TBEv IgG detected one positive serum and 17 borderlines. The SNT showed one positive serum among the 18 tested, giving an overall antibody prevalence of 0.38% (95% CI = 0.07-2.12%). All but one serum tested negative to WNv ELISA. None of the sheep farmers reported neurological signs among sheep or humans in their households. CONCLUSIONS: The results may indicate the circulation of TBEv for the first time in Tunisia and in North Africa. Further studies based on either virus isolation or RNA detection, are needed to confirm the presence of TBEv in North Africa.

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Paratuberculosis (Ptb) is a widespread chronic infection caused by Mycobacterium avium subsp. paratuberculosis (Map) that affects both domestic and wild ruminants. Most of the studies focused on cattle while, the prevalence of Ptb in sheep in different regions of the world is not well investigated. This study aimed to address this gap of knowledge by screening adult female sheep for paratuberculosis antibodies in different geographical regions of Tunisia. A total number of 338 female sheep from 15 small to middle-sized, extensively managed sheep farms in six regions across Tunisia were sampled. Animals were clinically examined before blood sampling. Sera were tested for the presence of anti-Mycobacterium avium subsp. paratuberculosis antibodies using a commercial ELISA kit. Six farms out of 15 comprised at least one seropositive animal and 11 female sheep out of 338 tested animals (3.25%; 95% CI = [1.83-5.73]) were seropositive to M. avium subsp. paratuberculosis. The seroprevalence was significantly lower in 5-year-old females (p = .04) and animals that do not graze (p = .02). Due to its huge economic and social impacts, paratuberculosis represents a health problem in Tunisia and several other countries Further investigations are needed to rank sheep Ptb in Tunisia among other diseases and to assess the main risk factors using a larger nation-wide survey.

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A case-control study was conducted, aimed to describe the clinical human brucellosis (CHB) pattern during 2015 in the Gafsa region (Southwest Tunisia) and to investigate the main risk factors involved in the disease occurrence. One hundred and four CHB cases were notified in 2015 in Gafsa district. All CHB cases that own ruminants were contacted, but only 32 accepted to participate in a matched case-control study. Thirty-two and thirty-one CHB cases and controls, respectively, were included in the study. The subjects were interviewed using a structured questionnaire. A total of 662 domestic ruminants (cattle, sheep and goats) belonging to cases and controls, were screened using the Rose Bengal Test, as recommended by the World Organisation of Animal Health. During 2015, the incidence of CHB was estimated to 30.8 per 100,000 inhabitants affecting mainly males aged between 30 and 39 years. The overall animal seropositivity to Brucella, was 21 and 1.9% in case and control farms, respectively (p < 0.0001). Only five risk factors were found to be significant: overall animal seropositivity (OR = 65.2; 95%CI: 13.3-318.7); handling aborted females (OR = 43.1; 95%CI: 8.3-222.7); presence of male ruminants in the herds (OR = 18.5; 95%CI: 5.18-66); owning seropositive goats (OR = 18.3; 95%CI: 2.4-137.6), owning seropositive sheep (OR = 9.66; 95%CI: 2.9-31.5) and history of abortion during the previous year in the herd (OR = 4.6; 95%CI: 1.3-12.6). Vaccination of animals against brucellosis was associated with lower odds of human brucellosis (OR = 0.03; 95%CI: 0.004-0.2). Raw milk and derivatives consumption was not a risk factor of human brucellosis. Based on this study, ruminants' vaccination coverage should be increased by enhancing the number of vaccinated animals and systematically including male ruminants in Tunisia. Comprehensive education programmes targeting both farmers and general population should be implemented.

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The authors report a survey carried out in a cattle farm between January and April 2009 in Mateur region (Northern Tunisia). Seroprevalence by Microscopic Agglutination Test (MAT) was estimated to 81.4 ± 6% and 35 ± 2% in cows and calves, respectively. Seropositivity to more than one serovar was noticed in 91% (81/89) of infected animals. The examination of the distribution pattern of Leptospira serovars involved in this outbreak indicates that serovar Pomona was the predominant one (75.3%), followed by Autumnalis (59.5%), Bim (58.4%) and Munchen (55%). High titres (between 400 and 6400) were found in 68.7% of the tested animals and were correlated with clinical onset of leptospirosis. Leptospirosis is an underestimated pathogen in Tunisia; further investigations are needed to study the epidemiology both in man and animals and to implement effective control measures.

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INTRODUCTION: The negative impact of obstructive sleep apnea (OSA) on quality of life of affected individuals is a central consequence of this disease. The recognition of the quality of life as a therapeutic target is a relatively new concept. OBJECTIVES: To evaluate the quality of life and its determinants in patients with OSA. MATERIALS AND METHODS: We conducted a cross-sectional study during the period from 1st July 2012 to 30th June 2013. The target population was patients with OSA and in employment examined in consultations of pneumology in the teaching hospital Farhat-Hached in Sousse (Tunisia). This study was based on a generic questionnaire (SF-36) to assess the quality of life. RESULTS: The study population included 103 cases with a mean age of 55.15±11.4years and a sex ratio of 0.71. Our patients were obese in 95.1 % of cases with an average BMI of 39.13±7.19kg/m2. The majority of our patients had an impaired quality of life with an average score of 44.76 (SF36) and extremes of 22 and 70. There was a positive linear relationship between physical and mental components of the SF-36 and gender, age, BMI, and anxiety and depressive disorders. CONCLUSION: The OSA is a demanding disease whose impact on the quality of life seems important and requires special attention. The management of this disease should not be limited to controlling the disease but aspire to overall patient satisfaction.

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BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent clinical condition and frequently associated with obesity. Recent literature has suggested the independent contribution of OSAS in the pathogenesis of metabolic disturbances. Metabolic syndrome (MS), a cardiovascular risk factor, was frequently associated with OSAS. METHODS: This is a prospective study without intervention. Will be included, all consecutive patients referred to the Department of Pulmonology for suspected OSAS confirmed by respiratory polygraphy. Anthropometric, clinical and biological parameters needed to define the MS will be collected. MS was defined according to the IDF 2005. Assessment of cardiovascular risk related to MS will be performed by appropriate scores. EXPECTED RESULTS: To determine the prevalence of MS in a sample of OSAS patients recruited in the Department of Pulmonology of Farhat Hached Hospital (Sousse, Tunisia). To identify risk factors independently associated with the presence of MS in patients with OSAS among the following parameters (age, gender, degree of obesity and the various parameters of OSAS severity). To assess compared cardiovascular risks according to the presence of MS by validated scales to demonstrate the impact of MS in patients with OSAS.

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The diverticula of trachea are a frequent observation in thoracic computed tomography, in particular in patients presenting an obstructive syndrome. On the occasion of a case report of a patient presenting a dilation of bronchi, we underline the interest of the post-treatment of the computed tomography acquisition, and present a review of the literature on this entity.

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UNLABELLED: Chronic obstructive pulmonary disease (COPD) constitutes a penalty in physical activities of patients. Its mental repercussions are important and expressed in a significant impairment of quality of life. OBJECTIVES: To evaluate the quality of life and its determinants in Tunisian patients with COPD. METHODS: We conducted a cross-sectional study over a period of 6 months from January 2008 to June 2008 and focused on patients with COPD hospitalized and monitored in the department of respiratory diseases in Farhat Hached Teaching hospital of Sousse in Tunisia. We used the French version of Saint George's respiratory questionnaire (SGRQ) to study the quality of life and the Hospital Anxiety Depression (HAD) for the exploration of anxiety and depression. RESULTS: Among 100 patients included in the study, the SGRQ overall score average was 44.31 ± 13.85%. Ten patients had depression and 9 patients had an anxiety state. The results of the multiple linear regression analysis showed that four factors were associated significantly with impaired quality of life: dyspnea, the number of exacerbations, comorbidity and depression. CONCLUSION: The psychological impact and effect on quality of life of COPD are additional tools combined with physical and spirometric data during the follow-up of treatment of patients and should be systematically sought by practitioners, which is still rare in Tunisia.

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BACKGROUND: Consumption of raw milk and unpasteurized dairy products is common in Tunisia where bovine tuberculosis remains enzootic. We herein investigated the frequency of M. bovis isolation from raw milk. METHODS: Three hundred and six milk samples collected from 102 infected cows in different Tunisian regions were analysed. M. bovis isolates were further characterized by spoligotyping and variable number tandem repeat typing. RESULTS: A total of five (4.9 %) M. bovis strains exhibiting three different genotypes were isolated. CONCLUSION: This study demonstrates that consumers of raw milk or derivatives in Tunisia are at high risk of zoonotic infection with M. bovis.

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BACKGROUND: Promoting a smoke-free hospital is a priority component for tobacco control strategies. The aim of our investigation was to study the attitudes and behaviors of the hospital staff of the F.-Hached UH of Sousse towards smoking, and to assess their knowledge about the harms of passive smoking and about tobacco regulations in the hospital. METHODS: We conducted a descriptive cross-sectional study using an anonymous self-administered questionnaire. In January-February 2008, the questionnaire was submitted to hospital staff members selected at random from the care units at F.-Hached UH of Sousse, Tunisia. RESULTS: The response rate was 92.8% (452 participants). The average age of the population was 39.7±19 years; all professional categories were represented. The prevalence of active smoking among the staff interviewed was 19% (89.5% males). About 75% of the smokers stated they smoked on the work site and 8% in the presence of patients. The majority of the smokers wished to stop smoking. Discomfort from exposure to tobacco smoke was reported by 83.4% of respondents. The large majority of staff respondents (95%) knew that tobacco smoke is dangerous and 80% were aware of the existence of a law that prohibits smoking in the hospital. CONCLUSION: The prevalence of smoking remains high among male hospital workers. In our hospital, the majority of the care staff favored promotion of a tobacco-free hospital. The success of this project will depend on education, implicating the entire hospital staff in the anti-smoking battle. Smoking staff members should be supported in their attempts to stop smoking.

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BACKGROUND: In addition to excessive daytime somnolence, exercise limitation is a likely consequence of the cardiorespiratory problems that occur in patients who have obstructive sleep apnoea (OSA). However, few studies have evaluated the aerobic capacity of this patient group. AIMS: To evaluate submaximal exercise capacity over the 6-minute walking test (6-MWT). To determine the factors that influence 6-minutes walking distance (6-MWD). INCLUSION CRITERIA: 120 consecutive patients with severe OSA treated by continuous positive airway pressure who were medically stable will be included. EXCLUSION CRITERIA: 6-MWT contraindications, orthopaedic or rheumatologic diseases likely to influence walking capacity and corticosteroid therapy. INVESTIGATIONS: polysomnography, electrocardiogram, plethysmography, and two 6-MWT's. Indicators of impaired exercise capacity: stops during the walk, 6-MWD less than or equal to predicted lower limit of normal, end walking dyspnoea greater than or equal to 5/10, oxygen saturation fall greater than or equal to five points, end walking heart rate less than or equal to 60 % maximal predicted. Data from our obese patients aged 40-60 years old will be compared with data from 45 age-matched obese subjects free from OSA. EXPECTED RESULTS: OSA will significantly affect the submaximal exercise capacity and will accelerate the ageing of the cardiorespiratory-muscle chain. Submaximal exercise capacity of obese subjects having OSA, compared to subjects free from OSA, will be significantly deteriorated. 6-MWD of OSA patients will be significantly influenced by: resting plethysmographic data, apnoea hypopnoea index, arterial hypertension, obesity or smoking histories.

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Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) treated by continuous positive airway pressure (CPAP) need to use long-term CPAP to prevent cardiovascular disease. The method of survival analysis was used to allow for long-term CPAP use in 72 patients who were prescribed a CPAP. During a mean follow-up of 22+/-15 months, one patient died and 17 patients stopped their treatment, 29% of them in the first 6 months. In compliant patients, the median value of daily CPAP use was 4.5hours. Kaplan Meier analysis showed that 92% of patients were still using CPAP at 6 months, 83% at 12 months and 59.9% at 3 years. Chronic obstructive pulmonary disease was identified as a predictor factor of long-term CPAP use (OR=4.53, p=0.01). CPAP is a well-accepted long-term therapy for OSAHS with 60% of patients continuing to be compliant with treatment at 3 years.

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Pneumonia caused by varicella infection is a serious and severe complication of the disease when it occurs in adults. The authors report two cases of a varicella pneumonia in a 36 and a 41 year-old non-immunocompromised man. They were admitted to hospital for acute respiratory failure, not requiring intensive care, associated with exanthema. High resolution CT revealed well-defined diffuse nodules throughout both lungs, nodules with a surrounding halo of ground-glass opacity. Thrombocytopenia, hepatic cytolysis and an increase in lacticodeshydrogenase were noted. The patients made a full recovery with anti-viral therapy and oxygen therapy. Varicella pneumonia is the most common complication of varicella in adults. Anti-viral treatment is usually successful.

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The tubercular pneumothorax is a rare and severe form of tuberculosis which persists in Tunisia. We reviewed retrospectively our experience at the Pneumology-Allergology Department of the Sousse Hospital with 23 cases of tubercular pneumothorax observed between 1985 and 2003. The suggestive symptom, pneumothorax, always occurred within a context poor general health and fever. The chest roentgengraph showed pneumothorax (n=8) or hydropneumothorax (n=15), and pulmonary lesions associated in 82.5% of patients. Bacteriological proof was obtained in 21 cases; in the two other patients, histological examination of the surgical specimen was highly suggestive of tuberculosis. Treatment associated antitubercular chemotherapy in compliance with the National Plan of against Tuberculosis (n=23), chest drainage (n=21) and respiratory physiotherapy (n=18). Five patients underwent surgery: pleural decortications (n=3), pulmonary resections (n=2). Two were lost to follow-up. The course was favourable in 78% of patients; there were two cases of partitioned pyopneumothorax and one post-operative death. In our experience, tubercular pneumothorax was always associated with active cavitated tuberculosis. The course was almost favorable with antitubercular chemotherapy and chest drainage.

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We report the case of a 15-year-old girl with osteosarcoma in the left distal femur who developed a recurrent spontaneous pneumothorax. The patient was treated by neoadjuvant chemotherapy followed by surgery (limb-sparing surgical procedure with insertion of a knee prosthesis) and then adjuvant chemotherapy. The initial extension assessment was normal. No pulmonary metastasis was found. The chest tomography performed at the end of treatment (8 months after surgery) revealed two peripheral pulmonary nodules not seen on the chest X-ray. Palliative chemotherapy was given, the thoracic tomography after four chemotherapy courses showed a progress of the pulmonary metastasis and on the right more abundant bilateral pneumothorax which had recurred two months after thoracic draining. Thoracoscopy showed no pleural lesions.

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We report the case of a 42-year-old woman operated for neurofibroma of the scalp on two occasions who consulted for bilateral chest pain which reveated two voluminous bilateral pulmonary masses. Biopsy of one of these masses was in favor of secondary or primary leiomyosarcoma. The association of Von Recklinghausen's disease and soft tissue sarcoma is rare: most often neurofibroma which degenerates is observed. Other types of sarcoma, like leiomyosarcoma, have been described.

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