Clinical profile of patients newly diagnosed with human immunodeficiency virus [abstract]

OBJECTIVE: Comprehensive medical examination of newly presenting patients infected with the human immunodeficiency virus (HIV) is important to establish health status and stage disease progession. This study was conducted to determine the clinical and epidemiological characteristics of persons newly diagnosed with HIV presenting a primary care clinic for sexually transmitted infections (STIs). METHODS: A retrospective analysis of the medical records of 125 patients (aged 13 years and over) was undertaken over a 12-month period. All patients were serologically confirmed positive for HIV. Information abstracted included socio-demographic factors, presenting complaints and medical examination findings. The EPI Info 6 software was used for data entry and analysis. RESULTS: Most patients (64 percent) were between 20 and 39 years old (range 14-68 years; M:F= 1:1.4). Five percent were homosexuals/bisexuals. Sixty-five per cent used a condom less than half the time and 10 percent never used condoms. Males were more likely than females to have had multiple sex partners during the last three months (p= 0.01). Initial assessment revealed that 53 percent were asymptomatic, 24 percent symptomatic and 21 percent had AIDS at time of presentation. The most common presentation was generalised by lymphadenopathy (67 percent), which was significantly higher than skin rash (27 percent), oral candidiasis (24 percent), cough (24 percent), weight loss (24 percent), and pallor of mucous membranes (19 percent. p< 0.001). Co-infection with syphilis occurred in five percent of patients. CONCLUSIONS: This study confirms that young people continue to account for the majority of cases of newly diagnosed HIV infection. Heterosexual mode of transmission predominates and women are disapropriately affected. HIV infection should be considered as a differential in patients who have persistent generalized lymphadenopathy and other risk factors. (AU)

Lymphatic filariasis in the Caribbean region: the opportunity for its elimination and certification

In order to support the case for a certification of elimination of lymphatic filariasis (LF) in some Caribbean countries, we compared the prevalence of circulating Wucheria bancrofti antigen in communities in Guyana, Suriname, and Trinidad. For the study, we assayed school children in six communities in Guyana, five communities in Suriname, and three communities in Trinidad for the prevalence of circulating W. bancrofti antigen, using a new immunochromatographic test for LF. We also assayed adults in these three countries, with a special focus on Blanchisseusse, Trinidad, where mass treatment for LF elimination had been carried out in 1981. The prevalence of W. bancrofti circulating antigen found in the school children populations ranged from 1.7 percent to 33.2 percent in Guyana and were .22 percent overall in Suriname and 0.0 percent in Trinidad. Among adults in two Guyana communities the prevalences were 16.7 percent and 32.1 percent. The results were all negative from 211 adults in communities in the north, center, and south of Trinidad, as well as from 29 adults in Suriname. The data suggest that contrary to reports of LF endemicity from the World Health Organization, LF may no longer be present in Trinidad and may be of very low prevalence in Suriname. Trinidad and Tobago and other Caribbean nations proven negative could seek to be awarded a certificate of LF elimination. In Suriname the small localized pocket of infected persons who may serve as a reservoir of LF infection could be tested and appropriately treated to achieve LF elimination. Such LF-positive countries as Guyana should access new international resources being made available for LF elimination efforts. An adequate certification program would help identify which countries should seek the new LF elimination resources (AU)

Sinus histiocytosis with massive lymphadenopathy involving the orbit: reversal of compressive optic neuropathy after chemotherapy

A 38-year-old woman from Antigua had compressive optic neuropathy of the right eye caused by orbital involvement with sinus histiocytosis. There was also nasal sinus involvement and massive cervical lymphadenopathy resulting in radiographic compression of the airway and carotid sheath. Because of the compressive optic neuropathy and threat to the airway and carotid perfusion, the patient underwent a 6-month chemotherapeutic regimen of cyclophosphamide, vincristine, and prednisone. After chemotherapy, the visual dysfunction resolved in correlation with diminution of the orbital mass, and marked regression of the cervical lymphadenopathy. This case demonstrates the potential efficacy of chemotherapy in the treatment of compressive optic neuropathy in cases of orbital sinus histiocytosis with massive lymphadenopathy (Au)

The Rosai Dorfman syndrome in a 50-year old male

A case is presented of a 50-year-old man with Rosai Dorfman Syndrome (Sinus histiocytosis with massive lymphadenopathy) who had facial, cervical and cutaneous involvement (AU)

Kawasaki disease in Barbados

The mucocutaneous lymph node syndrome (Kawasaki Disease) is reported in three Barbadian children. This appears to be the first report of the condition from the West Indies. The disease should be suspected in any paediatric patient who presents with an acute febrile illness associated with lymphadenopathy and skin and mucous membrane changes which are unresponsive to antibiotic therapy. Patients should be carefully investigated for cardiac complications which contribute significantly to mortality and morbidity from the disease (AU)

Thymic cyst of the neck

A case of cervical thymic cyst in a 16-year old male is described. The lesion is quite rare and was seen for the first time at the University Hospital of the West Indies. The literature has been reviewed and the embryology and pathogtenesis of the condition have been discussed. A pre-operative diagnosis of thymic cyst in the neck is difficult and should be included in the differential diagnosis of swellings in the neck (AU)

Chronic cervical lymphadenopathy

The records of 157 patients admitted to U.H.W.I between January, 1973, and December, 1976, with chronic cervical adenopathy were examined. Sixty-eight per cent were found to have some form of malignant disease. Metaststic carcinoma was most common, the primary site of origin occurring most frequently in the head and neck region (AU)

Sinus Histiocytosis with massive lymphadenopathy: clinico-pathological features of four cases

Four cases of sinus histiocytosis fulfilling the clinico-pathological requirements laid down by Rosai and Dorfman are reported. This benign disease is characterized by massive lymphadenopathy especially in the cervical region and pathologically by enlargement of lymph node sinuses by phagocytic histiocytes. The disease is self-limiting, regressing over a variable period of time from months to years. These four cases and the six reported by Rosai and Dorfman are, to our knowledge, the total number of cases reported in the West Indies to date (AU)

The syndrome of the sea-blue histiocyte

Nine patients had a syndrome characterized by the presence of a sea-blue histiocyte and splenomegaly. Lipid analysis of liver from the most recent patient revealed accumulations of specific glycosphingolipids and phospholipids. Urinary mucopolysaccharide excretion was increased, and there was a suggestion of mucopolysaccharide storage in the hepatic parenchymal cells. Clinically, patients with the disease may have a relatively benign course, with mild purpura secondary to thrombocytopenia, or may have progressive hepatic cirrhosis, hepatic failure and death. The name "syndrome of the sea-blue histiocyte," the striking morphologic feature of the disease, is suggested for these cases (AU)

A case of primary carcinoma of the fallopian tube: with a review of the literature

Primary adenocarcinoma of the right Fallopian tube is reported in a 53-year-old Negro woman. The diagnosis was established by histopathological examination of the surgically resected specimen, there being no suspicion of the tumour pre-operatively. Metastates occurred to the iliac lymph nodes. The patient was treated by hyterectomy and bilateral salpingo-oophorectomy followed by high voltage irradiation of the pelvis. This is the first example of primary tubal carcinoma encountered at the University Hospital of the West Indies. The relevant literature is reviewed and discussed (AU)

Histiocytosis X: acute disseminated variant

The clinical course of a 14-year-old girl with the acute disseminated variant of histiocytosis X is described. The aetiology and its relationship to eosinophilic granuloma of bone and to the chronic disseminated variant ("Hand-Schuller-Christian disease") are reviewed and the pathogenesis of the haematological changes is discussed (AU)

Histiocytic medullary reticulosis: report of the first case in Jamaica

A case of histiocytic medullary reticulosis in an 18-year-old East Indian man is presented. To our knowledge, this is the youngest case to have been reported and the first described in an East Indian. The diagnosis was established at autopsy. The patient presented the typical clinical picture of a rapidly progressive illness of 5 weeks' duration, with fever, wasting, hepatosplenomegaly, lymphadenopathy, and pancytopenia. An intresting hematologic finding, hitherto unreported, was erythrophagocytosis by atypical mononuclear cells in the peripheral blood. The histopathologic picture was charecterized by proliferation of erythrophagocytic histiocytes and thier precursors in the spleen, bone marrow, liver, and lymph nodes. The most severe changes were observed in the spleen and the bone marrow. The affected organs demonstrated iron deposits, most marked in the Kupffer cells of the liver. (AU)

Unusual aspects of reticuloses

Tumours of the reticulo-endothelial system appear to be common at the U.C.W.I. Hospital and within the last three years some 80 cases have been seen. 7 of these cases with very unusual initial manifestations were presented in the hope that awareness of the bizarre symptomatology of the reticuloses may lead to earlier diagnosis (AU)