Parasitological observations of chronic diarrhoea in suspected AIDS adult patients in Kinshasa (Zaire).

The parasitological profile of chronic diarrhoea in 46 Zairian adults suspected of Aids demonstrated that the frequency of protozoa was five times higher than that of helminths; 86% of the protozoa were sporozoa: Isospora belli was the most frequent (19%), followed by Cryptosporidium isolated for the first time in Zaire (8%) and Blastocystis hominis (2%). 37 of the 46 patients were immunodeficient.

PIP: Chronic diarrhea occurs in close to 90% of acquired immunodeficiency syndrome (AIDS) cases Zaire, but there has been no systematic analysis of the parasite species. In the present study, 46 adults with a history of episodic diarrhea (mean duration, 18 months) and clinical symptoms suggestive of AIDS underwent fecal diagnosis. In the 19 stool samples that were positive for parasites, protozoa were 5 times more common than helminths. 13 (86%) of the 15 protozoa-positive samples contained sporozoa. Of these, Isospora belli was the most common (19%), followed by Cryptosporidium (8%). Laboratory analysis and clinical symptoms revealed that 37 of these 46 chronic diarrhea patients were, in fact, immunosuppressed. Of the 9 immunocompetent patients, 5 had parasite- free stools. Significant was the finding that all 4 patients with cryptosporidiosis and 8 of the 9 patients with isosporosis were immunodeficient. Overall, these findings suggest that the parasitological profile of chronic diarrhea differs between immunosuppressed and immunocompetent African patients.

Acquired immunodeficiency syndrome in a heterosexual population in Zaire.

38 patients with the acquired immunodeficiency syndrome (AIDS) were identified in Kinshasa, Zaire, during a 3 week period in 1983. The male to female ratio was 1.1:1. The annual case rate for Kinshasa was estimated to be at least 17 per 100 000. Opportunistic infections were diagnosed in 32 (84%) patients, disseminated Kaposi's sarcoma (KS) with opportunistic infection in 5 (13%), and disseminated KS alone in 1 patient. Immunological characteristics of these patients were as reported for cases in the USA and Europe, but immunological abnormalities were also found in 6 controls with infectious diseases but no symptoms of AIDS. Female AIDS cases were younger than male patients with AIDS (mean ages 28.4 vs 41.1 years, respectively), and were more often single (14/18 vs 2/20). Homosexuality, intravenous drug abuse, and blood transfusion did not appear to be risk factors in these patients. The findings of this study strongly argue that the situation in central Africa represents a new epidemiological setting for this worldwide disease--that of significant transmission in a large heterosexual population. Two instances of clusters of AIDS (not included in the above series) involving males and females with frequent heterosexual contact further implicate heterosexual transmission.