Lyme disease: report of two cases.

Lyme disease is a tick-borne multisystem disease. It was first described in Lyme, Connecticut, USA in 1975. Cases have been reported in Canada, Switzerland, Austria, Australia and Great Britain. It is an inflammatory disease that has varied clinical manifestations ranging from skin rash (erythema migrans), arthritis, fibromyalgia, and regional lymphadenopathy, cardiac conduction defects to neurological manifestations of meningoencephalitis, Bell's palsy, peripheral neuropathy, and painful radiculoneuropathy. There has been no case record of Lyme disease in Kenya and indeed literature on Lyme disease in Africa is very scanty. We present two cases of Lyme disease with predominant neurological manifestations; outline their clinical presentation and management.

No increased prevalence of adrenocortical insufficiency in human immunodeficiency virus-associated tuberculosis.

SETTING: Acute medical wards, Kenyatta National Hospital, Nairobi, Kenya. OBJECTIVE: To determine the prevalence of adrenocortical insufficiency in human immunodeficiency virus (HIV)-1 infected and non-infected patients with tuberculosis. DESIGN: One hundred and seventy-four patients with proven tuberculosis (90 HIV-1 positive and 84 HIV-1 negative) were assessed for adrenocortical insufficiency with a 30 min synacthen stimulation test. RESULTS: Fifty-one percent of those with pulmonary tuberculosis and 56% of those with extra-pulmonary tuberculosis had a subnormal cortisol response. However there was no statistically significant difference between the HIV-1 infected and non-infected patients in either group. CONCLUSION: While an impaired cortisol response is common in tuberculosis, it is no more prevalent in HIV-1 infected patients than non-infected patients with tuberculosis.

Prevalence of human immunodeficiency virus infection: its impact on the diagnostic yields in exudative pleural effusions at the Kenyatta National Hospital, Nairobi.

This was a descriptive cross-sectional study carried out at Kenyatta National Hospital (KNH), Nairobi, among consecutively admitted adult patients with exudative pleural effusions over a one year period. The aim of the study was to determine the prevalence of human immunodeficiency virus (HIV) infection in these patients and to compare the diagnostic yields from the pleural fluid and pleural biopsy between the HIV seropositive and HIV seronegative patients. Sixty six patients were studied, with a mean age of 33.8 (+/- SD = 15.6) years and a male to female ratio of 1.6:1. Overall, 27 patients(40.9%) were found to be HIV seropositive. The commonest cause of exudative pleural effusions, overall, was tuberculosis (78.8%) followed by neoplasms (7.6%). Comparing the aetiology of exudative pleural effusion in HIV seropositive and HIV seronegative patients, tuberculosis was still the commonest cause accounting for 42.3% and 57.7% of the cases in each of the groups respectively. Conversely, 42.3% of patients with tuberculous pleural effusions were HIV seropositive. There was no significant difference in yields from pleural fluid, pleural biopsy culture and histology in the diagnosis of tuberculosis in the two patient groups. The only two patients with empyema were HIV seropositive and the bacterial isolates were Salmonella typhimurium and Pseudomonas aeruginosa. Kaposi's sarcoma was the cause of exudative pleural effusion in the one HIV seropositive patient with a malignant effusion. The only patient with a parapneumonic effusion was HIV seronegative. No fungi were isolated.

PIP: 66 adult patients of mean age 33.8 years with exudative pleural effusions were studied to determine the prevalence of HIV infection and compare the diagnostic yields from the pleural fluid and pleural biopsy between the HIV-seropositive and HIV-seronegative patients. The patients were consecutively admitted to Kenyatta National Hospital (KNH) over a 1-year period and of male:female ratio 1.6:1. 27 patients were found to be HIV seropositive. Tuberculosis (TB) and neoplasms were the most common causes of exudative pleural effusions, responsible for 78.8% and 7.6% of cases, respectively. Comparing the etiology of exudative pleural effusion in HIV-seropositive and HIV-seronegative patients, TB remained the most common cause, accounting for 42.3% and 57.7% of cases in each of the groups, respectively. 42.3% of the patients with TB pleural effusions were HIV seropositive. No significant difference was identified in the yields from pleural fluid, pleural biopsy culture, and histology in the diagnosis of TB in the 2 patient groups. The only 2 patients with empyema were HIV seropositive and the bacterial isolates were Salmonella typhimurium and Pseudomonas aeruginosa. Kaposi's sarcoma was the cause of exudative pleural effusion in the 1 HIV-seropositive patient with a malignant effusion. The only patient with a parapneumonic effusion was HIV seronegative. No fungi were isolated.

Infection and morbidity in patients with tuberculosis in Nairobi, Kenya.

OBJECTIVE: To examine the role of acute infection as a cause of morbidity in patients with tuberculosis. DESIGN: Cross-sectional documentation of predefined acute morbid events. SETTING: Infectious Diseases Hospital, Nairobi, Kenya. PATIENTS: Adults (> or = 15 years), inpatients and outpatients with a diagnosis of tuberculosis presenting with one or more of a series of clinical features. A new event was defined as one occurring at least 1 week after the initial event. INTERVENTIONS: Patients' treatment was modified depending on the results of laboratory investigations. MAIN OUTCOME MEASURES: There were 642 events from 398 patients, 235 HIV-positive patients had 438 events and 163 HIV-negative patients had 204 events (P < 0.0001). Forty-two out of the 235 (18%) HIV-positive patients were bacteraemic compared with nine out of the 163 (6%) HIV-negative patients (P = 0.0003). The most common isolates from blood were Salmonella typhimurium and Streptococcus pneumoniae. RESULTS: Faecal specimens were obtained more commonly from HIV-positive patients (P < 0.001), and often contained bacterial pathogens. CONCLUSIONS: Many of the causes of morbidity in patients with tuberculosis and HIV are not due to tuberculosis or antituberculous therapy, and will not be identified without microbiological investigation.

PIP: Tuberculosis (TB) is a common complication of HIV in Africa. A 1988-89 study further confirmed that considerable morbidity and mortality from acute bacterial infection occurred in HIV patients. It has also been found that anti-TB therapy seems to be as effective in HIV-positive as in HIV-negative TB patients. This paper reports on the level and nature of infectious morbidity suffered by HIV-positive patients receiving treatment for TB. The assessment is based upon a sample of inpatients and outpatients at the Infectious Diseases Hospital in Nairobi. Patients were aged 15 years and older, with a TB diagnosis presenting with 1 or more of a series of clinical features. 642 morbid events were seen in 398 patients: 235 HIV-positive patients had 438 event and 163 HIV-negative patients had 204 events. 18% of the HIV-positive patients versus 6% of the HIV-negative patients were bacteremic. Salmonella typhimurium and Streptococcus pneumoniae were most commonly isolated from sera, while fecal specimens were obtained more commonly from HIV-positive patients and often contained bacterial pathogens. The authors conclude that many causes of morbidity in patients with TB and HIV are not due to TB or anti-TB therapy and will not be identified without microbiological investigation. These results suggest that even with effective anti-TB chemotherapy HIV-positive patients will remain or become unwell.

The efficacy and safety of a controlled release formulation of salbutamol in the management of patients with asthma in Nairobi, Kenya.

The treatment of asthma in Africa is influenced by cultural and environmental factors as well as the availability of drugs. Poor compliance with regard to long-term maintenance treatment of chronic asthma is also a problem in Africa. The present study reports on 45 patients from 2 centres in Nairobi treated with 8 mg twice daily of an oral controlled release formulation of salbutamol ("Volmax"). The treatment produced a significant improvement in lung function measured by the PEFR compared with baseline data on previous therapy. Controlled release salbutamol was rated as effective or very effective by 84.2% of patients and for 81.6% of patients their physicians preferred this preparation to the therapy used before the study. Side effects were infrequent and usually occurred during the first few days of treatment. The study which is the first report in Africa to assess this novel formulation of salbutamol in a group of African patients, demonstrates that controlled release salbutamol 8 mg administered twice daily is safe and effective, offering benefits over current therapies in the treatment of asthma.

Cryptococcal hepatitis and meningitis in a patient with acquired immunodeficiency syndrome: a case report.

A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.