RESULTS:

Introduction. Pancreatic tuberculosis is an extremely rare form of extrapulmonary tuberculosis. This condition can be challenging to diagnose due to its rarity nonspecific symptoms and radiological features that may mimic a neoplastic origin.

Case report. A 46-year-old immunocompetent patient with no past history of tuberculosis exposure presented with spontaneously resolving jaundice over the past month accompanied by nonspecific fever episodes and general fatigue with no other associated digestive symptoms. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a poorly defined partially necrotic mass in the pancreatic head with heterogeneous hypodensity and enhancement after contrast injection. Additionally there were nodal and hilar macro-nodal lesions with necrotic appearances as well as peripancreatic lymphadenopathy. The patient was scheduled for an endoscopic ultrasound (EUS) examination which revealed the presence of a heterogeneous lesion with areas of necrosis in the posterosuperior aspect of the head and isthmus of the pancreas accompanied by perilesional and coeliac lymphadenopathies with necrotic centres. EUS-guided tissue sampling allowed the diagnosis of pancreatic tuberculosis with both histological examination and GeneXpert MTB/RIF testing rapidly positive for Mycobacterium tuberculosis followed by culture on solid Loewenstein–Jensen medium. The patient responded well to antitubercular chemotherapy.

Conclusion. Pancreatic tuberculosis though rare should be considered in cases of pancreatic masses especially in endemic regions. Tissue samples with necrosis should be tested for M. tuberculosis using GeneXpert and Loewenstein–Jensen culture. This work highlights the GeneXpert MTB/RIF test as highly sensitive specific and fast making it ideal for diagnosing extrapulmonary tuberculosis particularly when smear results are negative.

Introduction : Pancreatic tuberculosis is an extremely rare form of extrapulmonary tuberculosis. This condition can be challenging to diagnose due to its rarity nonspecific symptoms and radiological features that may mimic a neoplastic origin.

Case report: A 46-year-old immunocompetent patient with no past history of tuberculosis exposure presented with spontaneously resolving jaundice over the past month accompanied by non specific fever episodes and general fatigue with no other associated digestive symptoms. Abdominal CT and MRI scans revealed a poorly defined partially necrotic mass in the pancreatic head with heterogeneous hypodensity and enhancement after contrast injection. Additionally there were nodal and hilar macro-nodal lesions with necrotic appearances as well as peripancreatic lymphadenopathy. The patient was scheduled for an Endoscopic ultrasound (EUS) examination which revealed the presence of a heterogeneous lesion with areas of necrosis  in the posterosuperior aspect of the head and isthmus of the pancreas accompanied by perilesional and celiac lymphadenopathies with necrotic centers. EUS-guided tissue sampling allowed the diagnosis of pancreatic tuberculosis with both histological examination and GeneXpert MTB/RIF testing rapidly positive for Mycobacterium tuberculosis followed by culture on solid Loewenstein-Jensen medium. The patient responded well to antitubercular chemotherapy.

Conclusion: Pancreatic tuberculosis though rare should be considered in cases of pancreatic masses especially in endemic regions. Tissue samples with necrosis should be tested for Mycobacterium tuberculosis using GeneXpert and Loewenstein-Jensen culture. This work highlights the GeneXpert MTB/RIF test as highly sensitive specific and fast making it ideal for diagnosing extra-pulmonary tuberculosis particularly when smear results are negative.

Serratia marcescens (S. marcescens) is a Gram-negative rod-shaped bacterium belonging to the Enterobacteriaceae family commonly found in various environments. This opportunistic pathogen can cause urinary tract infections respiratory infections and septicemia but endocarditis is particularly rare and concerning due to its rapid and devastating progression. We report the second case in the world of infective endocarditis (IE) caused by S. marcescens in a preterm infant born at 34 weeks of gestation. The patient was a preterm male infant born at 34 weeks of gestation from a triplet pregnancy admitted to the neonatal intensive care unit on day 2 of life for respiratory distress. The mother aged 39 had undiagnosed gestational diabetes. Premature rupture of membranes had occurred 10 days before delivery necessitating prophylactic treatment with amoxicillin. On day 4 of life the newborn developed a fever with elevated CRP levels and leukocytosis leading to antibiotic therapy with colistin imipenem and amikacin. Blood cultures revealed the presence of carbapenemase-producing S. marcescens sensitive to fluoroquinolones. A cardiac ultrasound showed vegetations on the mitral valve confirming the diagnosis of IE. Despite intensive treatment the newborn died on day 16 of life due to septic shock.
This rare case of endocarditis caused by S. marcescens highlights the severity of this infection in preterm infants. Treatment relies on appropriate antibiotic therapy. Prevention requires strict hygiene measures. Further research is needed to establish optimal therapeutic recommendations.

Introduction. Peritonitis is characterized by acute inflammation of the peritoneum often resulting from digestive organ perforation or intra-abdominal septic focus. It may be either of infectious or noninfectious origin. The germs involved are those of the digestive flora (Enterobacteriaceae and Anaerobic) while gram-positive cocci and yeasts can be isolated in nosocomial infections. Our study aims to isolate and identify the germs involved in community-acquired peritonitis in order to assess their susceptibility to the antibiotics available in our Country.

Methods. This is a retrospective study of bacteriological profile of community peritonitis in Rabat Morocco. A total of 150 adult patients with peritonitis were admitted and samples were collected intraoperatively for bacteriological examination between July 1 2022 and April 30 2023.

Results. Among the 150 patients 101 (67.8%) were males and 48 (32.2%) were females with sex/ratio of 2.1. The mean age of the patients was 40.5 years +/- 20.12. The distribution of germs was dominated by Escherichia coli (44%). Overall 70% of Escherichia coli isolated had a resistance to Ampicillin but no resistance to Ampicillin has been reported by Enterococcus.

Discussion. In the present study we were interested in the bacteriological profile of community peritonitis in order to adapt the antibiotic therapy to our bacterial ecology. Our findings indicate a concerning trend of increasing resistance among Escherichia coli to the commonly used Amoxicillin/Clavulanic Acid combination in our clinical setting.

Conclusion. Consequently there is a need to reassess the empiric antibiotic prescribed for the management of community-acquired peritonitis.

Peritoneal dialysis is a blood purification technique used in cases of end-stage chronic kidney failure based on the filtering capabilities of the peritoneum. Infections often caused by poor asepsis during catheter manipulation are generally attributed to Staphylococcus epidermidis and Staphylococcus aureus. Corynebacterium usually considered non-pathogenic is rarely involved in these infections. We present a case of peritonitis due to Corynebacterium amycolatum in a patient undergoing peritoneal dialysis. The diagnosis was made based on cytobacteriological examination of the dialysate fluid which on two occasions showed high levels of white blood cells with a predominance of neutrophilic polymorphonuclear and a monomorphic appearance of colonies on agar medium whose identification by biochemical tests and antibiotic sensitivity study confirmed the presence of C. amycolatum. The patient was successfully treated with vancomycin resulting in symptom resolution and sterilization of the dialysate fluid. Although rare the involvement of Corynebacterium species underscores the importance of confirming its pathogenicity. Further studies are needed to better understand the epidemiology of these infections and guide future treatments. This case also highlights the need for a rigorous approach to confirming the pathogenicity of Corynebacterium despite its traditional classification as a contaminant.

Tuberculosis (TB) is one of the most common pathogens of bacterial lung infections especially in underdeveloped nations like Morocco where the incidence of TB was 97 cases per 100 000 persons in 2019. Thanks to its national TB prevention and control plan Morocco was able to achieve remarkable progress in the management of TB with an 80% reduction in the total number of patients diagnosed with TB between 1980 and 2018. The national plan also allowed us to reach and maintain a therapeutic rate above 86% since 2002. Sternal TB is a rare clinical condition accounting for 1% of all musculoskeletal TB cases. Due to its rarity and the lack of awareness of clinical presentations the diagnosis of sternal TB can be quite complex. We describe the case of a 14-year-old Moroccan patient consulting in the Military Hospital Mohammed V-Rabat with central chest pain for 4 months which was not associated with breathing physical exercise or eating. The patient also had a history of asthenia fever and weight loss. A computed tomography scan of the chest showed a destructive lesion of the sternum. Afterward a chirurgical biopsy was performed and enabled to confirm the microbiological diagnosis of TB with the realization of the real-time PCR. The antitubercular therapy was given to the patient who had complete resolution of symptoms. This condition should be included in the differential diagnosis of chronic chest pain that mimics costochondritis particularly in patients from endemic areas.

Tuberculosis is a major public health problem worldwide. In Morocco tuberculosis is still endemic with almost 30000 cases notified annually.

The distribution of tuberculosis cases according to localization shows a significant percentage of extra- pulmonary tuberculosis (43%) compared with 57% for Pulmonary tuberculosis.

Cutaneous tuberculosis is an exceptional extra-pulmonary form of the disease with an incidence of 0.5% to 2% of cases. Given that the clinical symptoms of cutaneous tuberculosis are variable and nonspecific diagnosis is not always easy.

We report a rare case of cutaneous tuberculosis in a patient with a history of pulmonary and cutaneous sarcoidosis.

The Group A Streptococcus (GAS) also known as Streptococcus pyogenes (S. pyogenes) is a human pathogen causing various infections ranging from mild such as tonsillitis and impetigo to severe and invasive conditions like septicemia and necrotizing fasciitis. Despite a decline in incidence and severity during the twentieth century due to antibiotics there has been a reported increase in severe cases since the 1980s in industrialized countries. S. pyogenes is a human pathogen with a natural reservoir in the pharynx and skin exhibits asymptomatic carriage in various body sites. It is responsible for a spectrum of clinical manifestations from asymptomatic carriage to severe invasive infections. Transmission occurs through respiratory droplets or direct contact with skin lesions. Bacteriologically S. pyogenes is a Gram-positive β-hemolytic streptococcus. This summary highlights a case of invasive Group A Streptococcus infection in a 28-year-old diagnosed at the microbiology laboratory of the Mohammed V Military Training Hospital in Rabat Morocco. A 28-year-old patient without any specific medical history presented with acute febrile oligoarthritis. Following a recent flu-like syndrome and febrile tonsillitis the patient experienced asymmetric inflammatory oligoarthralgia affecting the left knee left ankle and right shoulder accompanied by functional impairment of the left lower limb. Upon admission clinical examination revealed swelling positive patellar tap and sternal involvement. Laboratory and imaging findings indicated an abscessed collection in the left knee and anterior mediastinitis. Emergency aspirations revealed Group A Streptococcus specifically Streptococcus pyogenes leading to a diagnosis of septic arthritis. Dual antibiotic therapy and knee joint drainage resulted in symptom resolution after 45 days. The rise in severe Group A Streptococcus infection underscores the need for early detection and treatment. Widely sharing the French High Council for Public Health’s antibiotic prophylaxis recommendations is crucial for awareness. Collaborating between clinicians and microbiologists is essential for effective management.

Tuberculosis is an infectious disease caused by the Mycobacterium tuberculosis complex. It is a major public health problem and one of the world's leading causes of morbidity and mortality. It occurs in both pulmonary and extra-pulmonary forms the pulmonary form being the most common. Primary iliac bone tuberculosis remains a rare clinical entity even in endemic areas. Its diagnosis can be challenging due to its similarity to other bone conditions. We report a rare case of primary iliac bone tuberculosis in a 63-year-old patient on peritoneal dialysis with the following medical history: hypertension type II diabetes complicated by diabetic retinopathy and diabetic kidney disease. Recent advances in molecular biology in particular with the advent of the Genexpert® have considerably improved patient management providing microbiological evidence in less than two hours.

Tuberculosis is an infectious disease that most often affects the lungs caused by human-to-human transmission of Mycobacterium tuberculosis. Peritoneal tuberculosis is an extra-pulmonary form of the disease that usually manifests as an ascitic syndrome with or without fever in a context of altered general condition often in endemic areas. The diagnosis of peritoneal tuberculosis is not always easy as the clinical signs are often insidious and unspecific. We report a case of peritoneal tuberculosis in an 18-year-old female who had presented for 10 days with a progressive increase in abdominal volume associated with vomiting and diarrhoea.