Aetiology of genital ulcer disease in patients attending an STD clinic in Kingston, Jamaica

The purpose of this study was to determine the aetiology of genital ulcers (GUD) in STD clinic attenders, using state-of-the-art diagnostic tests, and to compare this with clinical diagnosis. Patients attending an STD clinic in Kingston, Jamaica for a new STD complaints were screened for GUD and clinically diagnosed. Swabs of ulcers were taken and tested for T. pallidum (TP), herpes simplex virus (HSV), and H. ducreyi (HD), using polymerase chain reaction (PCR). Sera were tested for syphilis and HIV infection. Of 4873 patients screened, 304 (6.2 percent) had GUD. In patients with ulcers, 158 (52 percent) were HSV (+), 73 (24 percent) were HD (+), and 31 (10 percent) were TP (+). Dual infections were identified in 20 (7 percent) ulcers. Clinically, herpes was diagnosed in 85/158 (54 percent) of HSV (+) ulcers, chancroid in 54/72 (75 percent) of HD (+) ulcers, and syphilis in 21/31 (68 percent) of TP (+) ulcers. Over three-quarters of GUD in Kingston had defined aetiology for herpes, chancroid or syphilis using PCR, with herpes being the commonest. Uniformly, clinical diagnosis performed poorly and Jamaican algorithms for the management of GUD will need to take into account the findings of this study, and should include counselling for herpes.(AU)

Human T cell lymphotropic virus (HTLV-1): cutaneous manifestations

Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)

Electron microscopy of herpes simplex hepatitis with hepatocyte pulmonary embolization in kwashiorkor

We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells. With pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.(AU)

Haemophagocytic syndrome

Two fatal cases of haemophagocytic syndrome diagnosed on the basis of autopsy findings at the Queen Elizabeth Hospital, Barbados, are presented. They were both young patients, a male 20 years of age and a female 28 years of age, with common clinical features of severe constitutional symptoms, pharyngeal haemorrhages, pancytopenia, and fever. The female patient had elevated titres to herpes simplex virus indicative of recent infection as well as postmortem evidence of overwhelming mixed bacteria sepsis. In both cases, histopathological studies showed lymphoid depletion and histiocytes displaying haemophagocytosis. (AU)

Herpes simplex virus infections in immunocompromised Jamaican patients

Data are presented on 13 immunocompromised patients with herpes simplex virus (HSV) infection. Eleven patients had recurrent HSV infection. Eight had genital herpes, 3 had disseminated infection and two had localised extragenital infection. Nine patients had confirmed recurrent HSV-type 2 infection. The benefits of recent antiherpetic therapy in the prevention of recurrent HSV infections in immunocompromised Jamaican patients are discussed (AU)

Risk factors for carcinoma of the uterine cervix in Jamaican women

Risk factors of cervical cancer include early age at coitus, multiple sexual partners and antibodies to herpes simplex virus, type 2 (HSV-2). To examine the interrelationships of these risk factors, a comparison was made between 78 histologically confirmed cancer cases (stages O-IV) and 151 control women in Jamaica. The rank of order of the percentages of control women with low socioeconomic status, first coitus before 20 years of age, first pregnancy before 20 years of age and more than two sexual partners were: 77, 97, 65, and 76 respectively. The percentage of women with cancer who had first coitus before 20 years of age (77) and 2 or more partners (55) were lower than that of controls. A third factor associated with cervical cancer is the presence of HSV-2 antibodies. The age-specific prevalence of HSV-2 antibodies varied from 7 percent to 32 percent in women aged 21-69 years. An increase in prevalence of HSV-2 was observed with increasing age. The age-adjusted prevalence was 11 per cent. The age-specific occurrence of HSV-2 antibodies in cancer cases were not statistically significant as compared with matched controls (p> 0.01). The data suggest that infection with HSV-2 is a covariable of venereal factors, and the role of the virus in the genesis of some cases of cervical cancer in Jamaican women may not be excluded (AU)

Two cases of herpes simplex encephalitis at the University hospital of the West Indies

Two antigenically distinct herpes simplex viruses (HSV) are described. They were isolated from clinically diagnosed cases of acute encephalitis in a 10-year-old boy and a 36-year-old man. These viruses were identified as HSV by standard complement-fixation neutralized and cytopathology in different host systems. However, these isolates differ from classical HSV in the following aspects: (1) inability to infect adult Swis albino mice; (2) stability to organic solvents; (3) inability to be neutralized by hyperimmune sera to HSV-1; (4) requirement of chromatography on DEAE-cellulose to render them susceptible to DNase. In contrast, freezing and thawing alone were sufficient to render the HSV-1 susceptible to DNase. Further investigations will be necessary to determine whether the differences observed between the HSV-1 and the neurotropic strains provide sufficient basis for the establishment of a new sub-group for the encephalitic strains (AU)