title: [Analysis of severe Legionellosis hospitalized in intensive care units in Tunisia].
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.
authors.affiliation: CHU Farhat Hached, avenue Ibn El Jazzar, 4000, Sousse, Tunisie, mnmarzouk@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Marzouk
authors.forename: A
authors.initials: A
authors.lastname: Boukadida
authors.forename: I
authors.initials: I
authors.lastname: Chouchene
authors.forename: A
authors.initials: A
authors.lastname: Ferjani
authors.forename: N
authors.initials: N
authors.lastname: Hannachi
authors.forename: M
authors.initials: M
authors.lastname: Besbes
authors.forename: S
authors.initials: S
authors.lastname: Bouchoucha
authors.forename: J
authors.initials: J
authors.lastname: Boukadida
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000652:urine; D001494:Baths; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006798:Housing; D006801:Humans; D006813:Humidity; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007875:Legionella / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014416:Tunisia; D014871:Water Microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial