Granuloma inguinale in association with pregnancy and HIV infection.

OBJECTIVES: A retrospective study to confirm the clinical impression of an increasing prevalence of granuloma inguinale (GI) in women, and to evaluate its association with pregnancy and HIV infection. METHODS: Clinical records of all patients with a definitive diagnosis of GI attending the gynecology and antenatal clinics at King Edward VIII Hospital, Durban, South Africa, over a period of 36 months (January 1991-December 1993). RESULTS: A total of 123 women were diagnosed with GI. The diagnosis was made by tissue smear alone in 21% (n = 26), histology 43% (n = 53) and by a combination of smear and histology in the rest. Forty-two percent (n = 52) were pregnant. The only difference between pregnant and non-pregnant women were the presence of rectal and pelvic lesions in the latter. Sixty-nine percent (n = 36) delivered vaginally while the remaining (n = 16) were delivered by cesarean section. The indications for cesarean section were obstetric except for a patient in labor with extensive untreated vulval granuloma. In the majority (85%) GI had no influence on pregnancy outcome. There was no evidence of congenital GI in the neonates. Twenty-seven percent (30/113) had positive syphilis serology and 16% (18/110) had antibody to HIV. There were no differences in the clinical features and outcome of HIV positive and negative women. CONCLUSION: This study shows that GI is increasing in pregnancy in Durban, South Africa. Despite the concern that pregnancy promotes dissemination of GI, such an effect could not be established as the clinical response to treatment and outcome were similar in both pregnant and non-pregnant women. Infection with HIV also did not alter the clinical presentation and outcome of the disease in the patients studied.

[Infection caused by the human immunodeficiency virus, hepatitis B virus and delta virus in homosexual males]. / Infección por el virus de la immunodeficiencia humana, el virus de la hepatitis B y el virus delta en varones homosexuales.

Serological markers of hepatitis B (HBV) and human immunodeficiency (HVI) viruses were investigated in the sera of 90 homosexual males. In addition, in HBsAg positive individuals antibodies against delta virus (DV) were also investigated. Forty sera (44.4%) were positive for HBV and HIV, 61 (67.7%) for HBV and 52 (57.7%) for HIV. HBsAg was detected in 8 cases (8.8%), 7 of which had positive anti-HIV sera. In no case infection by DV was detected. These data show the high prevalence of HBV and HIV infection in the study population. They also suggest that the HBsAg carrier status is more common among HIV positive homosexual males and that the investigated homosexual population has not yet been infected by DV.

Indinavir crystallization and urolithiasis.

The crystallization of indinavir in synthetic urine at different pH values and indinavir concentrations was kinetically studied. It was found that precipitation time notably decreases at urinary pH values above 6.0. The effects of some products as potential crystallization inhibitors were studied. Some natural saponins such as escin and glycyrrhizic acid provoked a notable increase in the precipitation time of indinavir, this pointing out their possible use to prevent renal tubular solid deposition.

Takayasu's disease and pregnancy. Three case studies and a review of the literature.

Takayasu's disease is commonest in women of childbearing age. Obstetricians are therefore faced with the dilemma of optimal management in pregnancy. This report of 3 cases suggests that Takayasu's disease is associated with a good maternal and fetal outcome. The basic disease appears to be unaffected by pregnancy.

Granuloma inguinale (donovanosis) in women. An analysis of 61 cases from Durban, South Africa.

BACKGROUND AND OBJECTIVES: Granuloma inguinale (GI) appears to be making a resurgence in South Africa. Local cases were reviewed in order to determine an increasing prevalence and whether differences appeared between pregnant and non-pregnant women. STUDY DESIGN: Retrospective analysis of clinical records of patients attending a large tertiary teaching hospital, serving an underprivileged population. RESULTS: Sixty-one women with GI were diagnosed over a 3-year period. The most common clinical presentation was genital ulceration in both pregnant (88.5%) and nonpregnant (45.7%) patients. The next most common presentation was genital tract bleeding (19.7%), which occurred mainly among nonpregnant women. The vulva was the most frequent anatomical site involved (54.1%), in both pregnant (88.5%) and nonpregnant (28.6%) women. Multiple sites of infection (vulva, vagina, cervix) occurred only among nonpregnant women. Fourteen of 33 (42.4%) patients whose syphilis serology results were available had reactive tests. Erythromycin and tetracycline were the most common single antimicrobial agents used for therapy and response varied according to site and size of lesion. CONCLUSIONS: This study confirms our clinical impression of the increasing prevalence of GI, especially among women in Durban, South Africa. The protean manifestations of the disease are demonstrated with sharp distinctions between pregnant and nonpregnant women and there was a high prevalence of concomitant syphilis.

Pneumonia caused by Bordetella bronchiseptica in a patient with a thoracic trauma.

We report a case of pneumonia, caused by Bordetella bronchiseptica, in a previously healthy, immunocompetent 37-year-old male patient who had suffered chest injury in a car accident. The patient was admitted to the Intensive Care Unit where endotracheal intubation was performed. Seventy-two hours later he presented with fever associated with pulmonary affection which was diagnosed as right lobar pneumonia. Abundant colonies of B. bronchiseptica were isolated from the pharyngeal exudate and respiratory secretions, suggesting prior oropharyngeal colonization by B. bronchiseptica, as a result of repeated contact with his dog, with subsequent infection of the lower respiratory tract assisted by the process of intubation. We review different human infections produced by B.bronchiseptica as well as the antibiotic susceptibility studies performed.

Infections with Pseudomonas paucimobilis: report of four cases and review.

Pseudomonas paucimobilis (formerly CDC group IIK, biotype 1) is a strictly aerobic, nonfermenting, oxidase- and catalase-positive, gram-negative bacillus that is widely distributed in water and soil. Its name derives from the difficulty encountered in demonstrating its motility, even in liquid media. This microorganism is responsible for two types of infection in humans: sporadic or community-acquired infections, probably of endogenous or environmental origin (bacteremia, meningitis, urinary tract infection, and wound infection); and outbreaks of nosocomial infection associated with the contamination of sterile fluids employed in hospitals. We present four cases of infection caused by P. paucimobilis (two of bacteremia, one of leg ulcer infection, and one of cervical adenitis). The majority of infections produced by P. paucimobilis have a good prognosis; no deaths related to this entity have been reported in the literature. The published results of susceptibility tests suggest that the aminoglycosides (either alone or in combination with a beta-lactam antibiotic) or the quinolone may be the agents of choice in the treatment of these infections.

Non-typhi Salmonella bacteraemia.

We reviewed retrospectively the clinical records of patients with non-typhi Salmonella bacteraemia in our hospital from 1979 to 1988. During the study period 45 non-typhi Salmonella bacteraemias were diagnosed in 43 patients. Ten patients were under one year old and 11 were over 60. Seven cases of sepsis presented in patients with AIDS. Only three episodes were nosocomially acquired. In two of three patients the bacteraemia was preceded by an episode of acute gastroenteritis and one third presented without gastroenteritis. Complications and mortality were infrequent in spite of the differing degrees of adequacy of antibiotic treatment which was inappropriate in many cases. We have attempted to assess optimal antibiotic therapy, taking into account the duration and means of administration, in different groups of patients with nontyphi Salmonella bacteraemia.

[Otitis externa maligna and cranial neuropathy]. / Otitis externa maligna y neuropatía craneal.

Malignant external otitis (MEO) is a disease of the external auditive channel (EAC) due to Pseudomonas aeruginosa which usually involves individuals with diabetes mellitus. It may result in the invasion of the cranial base with cranial neuropathy and a high mortality rate despite therapy. We report the clinical features, diagnostic procedures, evolution and therapy of 8 patients with MEO, seven of which had cranial neuropathy. All patients have diabetes except one who had acquired immunodeficiency syndrome. All had otalgia, otorrhea and headache lasting for several months. Six patients had homolateral (as related to the MEO) facial palsy. One patient with bilateral MEO developed bilateral facial palsy and lesion of the cranial nerves VI (unilaterally) and IX through XII (bilaterally). In all patients P. aeruginosa was cultured from the EAC exudate scintigraphy with 99Tc showed uptake at medium ear and mastoid level in all 8 patients, suggesting a possible osteomyelitis. Scintigraphy with 67Ga was positive in the 6 cases where it was carried out, showing uptake in the soft tissues of the cranial base. Computed tomography was carried out in 6 patients, and it was useful to define the anatomical extent of the disease. The patients received different therapeutic schedules, particularly the combination of a betalactamic and aminoglucoside antibiotics. Follow up was characterized by common recurrences, and one patient died. The importance of early diagnosis and treatment to prevent the extension and recurrence of MEO are discussed. Cranial neuropathy is considered as a poor prognostic finding.