HIV-2 and HIV-1 AIDS cases in Senegal: clinical patterns and immunological perturbations.

The serological and immunological parameters, disease patterns, and social characteristics of 39 human immunodeficiency virus type 2 (HIV-2) seropositive CDCIV cases seen in Dakar, Senegal were studied. These data were compared with those obtained from 48 HIV-1 seropositive CDC stage IV patients. Social characteristics of populations infected with HIV-1 or HIV-2 were clearly different. A patient sex ratio of three men to one woman was found for both viruses. In addition, the immune status of nonsymptomatic HIV-1 and HIV-2 seropositive people was evaluated. The correlation between abnormalities of the immune system and clinical status was similar for the two infections. Clinical symptoms of both diseases were the same, but this cross-sectional study could not address the questions of differences between the two infections in latency and development of disease or specific manifestations of HIV-2 infection. This study suggests that HIV-2 infection may contribute to the present AIDS epidemic in West Africa.

[Prevalence of Helicobacter pylori infection in Tananarive, Madagascar]. / Prévalence de l'infection à Helicobacter pylori à Tananarive, Madagascar.

During a 8-month period, Helicobacter pylori infection has been studied in 140 patients who presented upper gastrointestinal symptoms. Helicobacter pylori was searched in antral biopsy specimens using standard bacteriological methods (Gram-staining, urea-test, culture) and histological staining techniques (hematoxylin-eosin-saffron, undifferentiated Giemsa). The global prevalence of H. pylori infection was 59%. The prevalence rates did not seem to differ with age and sex but H. pylori infection was significantly more frequent in patients with an active duodenal ulceration (30 of 41) compared with those with a normal endoscopy (21 of 47) (p < 0.02).

[Toxoplasma serology in HIV infected patients and suspected cerebral toxoplasmosis at the Central Hospital of Bobo-Dioulasso (Burkina Faso)]. / Sérologie toxoplasmique chez les patients infectés par le VIH et suspects de toxoplasmose cérébrale au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

A study was conducted in the Internal Medicine unit of Bobo-Dioulasso Hospital. Of the 1828 HIV positive patients admitted in medical wards, 268 presented neurological symptoms. 25.4% had positive Toxoplasma gondii serology. Encephalitis was associated with 12.5% of this latter group and intracranial hypertension with focal neurological defects affected a further 47.5% of them. Presumptive treatment of toxoplasmosis led to significant clinical improvement in 60% of cases. Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.

[Perihepatitis and HIV/AIDS infection. Apropos of 13 cases at the National Hospital of Bobo-Dioulasso]. / Périhépatite et infection par le VIH/sida. A propos de 13 cas à l'Hôpital national de Bobo-Dioulasso.

Perihepatitis or Fitz-Hugh syndrome, peritonitis located in the right hypochondriasis (RH), is a relatively rare affectation. However, the HIV-AIDS pandemic has brought about the emergence and re-emergence of disease-states either uncommon or formerly on the decline as well as the appearance of opportunistic illness. We report the results of a retrospective study conducted in the National Hospital of Bobo-Dioulasso (Burkina-Faso) between 1 June 1997 and 31 December 1999 in an effort to contribute to a wider vision of diseases associated with HIV-AIDS. We based our study on 130 laparoscopies carried out for unexplained pain linked to RH (with or without fever), as well as abdominal-pelvian or diffuse abdominal pain. Thirteen cases (11 women, 2 men) of perihepatitis were diagnosed. The mean age for women and men was respectively 31.4 and 39.5. HIV serology was systematically carried out for all patients and, in case of perihepatitis, cultures were taken. All patients were infected with HIV and some presented signs of AIDS according to the WHO classification. In clinical terms, a shalking pain for RH was noted for 5 patients, abdominal sensitivity in 8 cases as well as gynaecological anomalies: cul-de-sac moving pain (4 cases), leuchorrea (3 cases) and mucosic vulvovaginitis (1 case). Paraclinical tests revealed a slight hepatic cytolysis for only 3 patients (1.5 N). 6 patients tested positive for Chlamydia trachomatis; the 7 others could not be tested, but this aetiology was assumed for evaluating the efficacy of the treatment under study. The high frequency of perihepatitis in these patients, all of whom were suffering from HIV-AIDS, and its presence in the 2 male cases, suggest that immunodepression is conducive to the appearance of this disease.

[Neurologic manifestations associated with HIV infections at the Bobo-Dioulasso Hospital Center (Burkina Faso)]. / Manifestations neurologiques associées à l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.

[Peritoneal tuberculosis and HIV infection. Reflection apropos of 22 cases at the National Hospital of Bobo Dioulasso]. / Tuberculose péritonéale et infection par le VIH. Réflexion à propos de 22 cas à l'Hôpital national de Bobo Dioulasso.

Peritonitis tuberculosis is still a frequently encountered pathology in our hospital. Since the AIDS pandemic, cases of peritonitis tuberculosis present increasingly atypical characteristics, largely diverging from classical descriptions. The authors report on 22 cases of peritonitis tuberculosis associated with HIV infection. The study was carried out from June 1997 to December 1999 in the National Hospital Centre Souro SANOU of the Bobo Dioulasso internal office. It concerned 10 women and 12 men of a mean age of 37.9 years. The sex-ratio was 1.2 in favour of men. Diagnosis was established by laparoscopy. Peritonitis tuberculosis associated with HIV accounted for 78.5% of peritonitis tuberculosis cases. The clinical picture was dominated by isolated ascite (100%) associated with an oscillating high fever in 68.2% of cases. Negative results for IDR seemed to reflect poor prognosis. Response to treatment was slow but acceptable. The general prognosis was poor with a mortality rate of 18%.

[Madagascar: from Isoavinandriana to Soavinandriana or the remarkable history of the Girard and Robic Hospital]. / Madagascar: d'Isoavinandriana à Soavinandriana ou la belle histoire de l'Hôpital Girard et Robic.

The history of the Soavinandriana Hospital is remarkable for several reasons. The oldest hospital on the island, this institution is the product of the combined efforts of English Christian missionaries, French colonists, and native Madagascans. Its history has always been closely linked to political events in Madagascar and the successive names often reflect Franco-Malagasy relations. The hospital which was long the crown jewel of the "colonial" health corps still provides a framework for harmonious cooperation between French and Malagasy military physicians. The institution has always been on the forefront of medicine in Madagascar and, despite current problems, is still the best-equipped health facility on the island. Thanks to the quality of care and the dedication and competence of its staff, the hospital has succeeded in maintaining patient attendance from all classes of society. The hospital which in its over 100-year history has witnessed two momentous occasions with the visits of the last Queen and the first President of the Republic now stands on the threshold of a renaissance and could become a model for successful Franco-Malagasy cooperation.

[Liver needle biopsy in evolutive tuberculosis of adult Africans. Report on 142 cases (author's transl)]. / Ponction biopsie hépatique au cours des tuberculoses evolutives de l'adulte africain. A propos de 142 cas.

Liver needle-biopsy has been routinely performed in 142 Africans, above 10 years, and affected by tuberculosis with various localizations. It gave evidence of specific tuberculous lesions in more than 28,8 p. 100 of the cases and isolated non specific lesions in 40,8 p. 100, the liver parenchyme being normal in 33 p. 100 of the cases. These data are not much different from those obtained in Europe and Senegal in similar conditions of study. This extension of the tuberculous infection has two origins: the much most frequent is relevant to a secundary localization, the other includes the very rare primitive and autonomous forms.

[Present aspects of peritoneal tuberculosis in Africa (study of 77 cases) (author's transl)]. / Les aspects actuels de la tuberculose péritonéale en Afrique: étude de 77 observations.

77 cases of peritoneal tuberculosis recorded in Africa are reported. Ascitic peritonitis is the most frequent clinical form (64 cases). Laparoscopy is the main way, especially in tropical countries, to establish rapidly the diagnosis. Peritoneal white granulations, associated or not to adherences or to a vascular congestion, supported that diagnosis in 68 cases. Laparoscopy allows peritoneal and hepatic biopsies. Systematic peritoneal biopsy was not possible and was performed in 25 patients only with typical tuberculous pathologic lesions in 88 p. 100 of these cases. Hepatic needle biopsy demonstrated the existence of tuberculous follicles in 29.8 p. 100 of the cases and in 12 cases associated lesions such as a macronodular cirrhosis were observed. In spite of a specific treatment 2 patients died of tuberculous dissemination. Control after a long delay was not possible.

[Early congenital syphilis (7 cases observed in Bangui Hospital Central African Empire) (author's transl)]. / La syphilis congenitale precoce. A propos de 7 observations recueillies a l'hopital de Bangui (Empire Centrafricain).

In an infant of good condition, skin changes, anemia, hepato-splenomegalia and more over radiological osseous changes are symptoms of great value which are to be confirmed by a serological test of the baby and its mother. Treatment is very effective but it would be better to protect the foetus by an early detection and treatment of the syphilitic pregnant woman.

[Pseudomembranous colitis after antibiotic therapy associated with the presence of Entamoeba histolytica histolytica. Apropos of 2 cases]. / Colites pseudo-membraneuses post-antibiotiques associées à la présence d'Entamoeba histolytica histolytica. A propos de deux observations.

The authors report on two cases of pseudomembranous colitis (P.M.C.) developed in two Senegalese women of 38 and 36 years, and discovered at the 4th and 5th day respectively of an antibiotherapy based on ampicillin. In these two observations, cysts of Entamoeba histolytica histolytica were found in both feces and biopsies. They recall the circumstances of the occurrence, diagnosis techniques and treatment. They underline the unfrequency of this disease in Africa south of Sahara and they discuss the correlation with amoebiasis colitis. One has to keep in mind the possibility of a P.M.C. during any antibiotherapy, and consequently to have a rectoscopy to perform. Such an exploration is enough to pose a diagnosis. In day to day practice it is not necessary to show clearly the specific germ Clostridium difficile or its entero-toxin. To stop any antibiotherapy is required and beneficial. Metronidazole or Vancomycin are the best drugs in this case.

[Rectocolonic polyps in Senegal. Results of 1500 lower endoscopies carried out at the Dakar General Hospital]. / Les polypes recto-coliques au Sénegal. Résultat de 1,500 endoscopies basses effectuées à l'Hôpital Principal de Dakar.

57 polyps were discovered during 1,500 low endoscopies, and 24 of them were adenoma. In the same period of time, 26 proctocolitic adenocarcinomas were found. Adenomatous polyps appear to be 5 times less frequent in Senegal than in industrialized countries and frequency of colitic cancer should be of the same frequency, that is far less negligible. Even if proctocolitic cancer does not set up any Public Health problems one could envisage systematic screening of polyadenoma in every patient aged more than 40. Proctosigmoid being the seat of most adenoma, fibrosigmoidoscopy appears well adapted to this kind of screening because it does not require any preparation, it is easy to perform and well accepted.

[Madagascar: esophagogastroduodenoscopy. Descriptive analysis of 12,000 examinations and problems encountered in the tropics]. / Madagascar : la fibroscopie oeso-gastro-duodénale. Analyse descriptive de 12000 examens et problèmes rencontrés sous les tropiques.

The experience of the Digestive Endoscopy Center of the Soavinandriana Hospital in Antananarivo provides insight into not only esogastroduodenal disease in Madagascar but also technical problems involved in performing esophago-gastro-duodenoscopy in tropical areas. From September 1990 to March 1995 a total of 12000 esophago-gastro-duodenoscopy procedures were performed without complication. The main finding was duodenal ulcer which observed in 3580 cases (29.8% of patients) followed by peptic esophagitis due to gastroesophageal reflux in 555 cases and gastric ulcer in 460 cases. Esophageal cancer was detected in 16 cases and malignant gastroduodenal tumor in 82 cases including 63 adenocarcinomas and 5 digestive lymphomas. Overall 4156 procedures (34.6%) were normal and 1130 procedures (9.4%) were performed to investigate digestive tract hemorrhage. These findings document the high incidence of duodenal ulcer in Madagascar where treatment of this condition is difficult due to the high cost. This study underlines the problems encountered in operating an endoscopy department in tropical areas especially with regard to desinfection of equipment and training of endoscopists.

[Incidence of biliary lithiasis in African urban areas (Abidjan): a little known pathology?]. / Incidence de la lithiase biliaire en milieu urbain africain (Abidjan): une pathologie méconnue?

The rarity of cholelithiasis in black Africa is a very classical concept that must be called in question again. With the exception of pigmentary lithiasis frequently found in patients with an homozygous haemoglobinopathy, genetic as well as environmental (particularly food related) factors explain in part the low frequency of cholelithiasis with cholesterol gallstones in Africa. Yet the true incidence of cholelithiasis is too often unappreciated. Before the use of ultrasonography, only symptomatic cholelithiasis were detected, usually by the surgeon (19 cases admitted during a 6 years period in the Internal Medicine Department at Treichville University Hospital, Abidjan). The practice of ultrasonography will ease the detection of asymptomatic cholelithiasis. Since ultrasonography has been set up at Treichville University Hospital, 30 cholelithiasis of which 21 were asymptomatic have been detected during an 8 months period, a high detection level of course for a so-called rare disease.

[Gastric tuberculosis. Apropos of a recent case report recorded in Abidjan]. / La tuberculose gastrique. A propos d'une observation récente recueillie à Abidjan.

The authors describe a case of gastric tuberculosis in a 23 years old African patient from Abidjan. Symptomatology included epigastralgia, post prandial vomiting, severe impoverishment of health state and dehydration. Endoscopy showed a pseudopolypoid diffuse gastritis with an infiltrated like mucosa. Endoscopic biopsy was carried out, but, because of clinical aggravation (epigastric muscular defense), the patient underwent a laparotomy before knowing the results of the biopsy. Gastrotomy showed an hypertrophied granulomatous hemorrhagic mucosa. By histological examination it was concluded in favour of a granulomatous gastritis with pan-parietal tuberculoid lesions without acid-alcohol-fast bacilli. The different causes of granulomatous gastritis were reviewed and a tuberculous etiology suspected. An antituberculous therapy was prescribed with excellent results on clinical and endoscopic standpoint one year after the treatment started.

[57 cases of infectious endocarditis: diagnosis, clinical course, prognostic factors]. / Etude de 57 cas d'endocardite infectieuse: diagnostic, évolution, facteurs du pronostic.

Through a retrospective study on 57 patients, the authors have studied the diagnosis signs, the clinical course, and the factors which affect the prognosis of bacterial endocarditis. Echocardiography has allowed them to establish a diagnosis with 72 p.c. of cases and the bacteriological investigations with 42 p.c. Out of these endocarditides, 39 were found on natural valves, 6 were associated with congenital cardiopathies, 9 followed the replacement of a valvula, and 3 were associated with endomyocardial fibrosis. Cardiac insufficiency (56 p.c.), and renal insufficiency (24 p.c.) were prevailing. The discussion turns on the diagnosis factors and the factors involved in the prognosis. Considering that the death rates were 64 p.c. with the patients who had undergone medical treatment and 14 p.c. with those who had undergone operations, the relevance of the surgical treatment has been emphasized.

[Value of ultrasonically-guided liver puncture biopsy in the diagnosis of primary liver cancer. Apropos of 84 cases]. / Valeur de la cytoponction hépatique écho-guidée dans le diagnostic de cancer primitif du foie. A propos de 84 observations.

Ultrasonographicaly guided fine needle aspiration of liver was performed in 84 patients having a confirmed HCC. This technics utilizes a CHIBA type fine needle, after blood coagulation tests have been checked. Out of 84 fine needle aspirations performed: 64 were positive (76,2%), 9 negative (10,7%), 11 (13,19%) were questionable (6) or nonanalysable (5). It is ascertained that the sensibility of this technics is over 75%. It should be possible to improve it by repeating such an exam in previously negative patients. The causes of failure are discussed. Tolerance of the technics is good. It is attraumatic, and of very easily performance. No accident, no mishap was noted.

[Human immunodeficiency virus infections (HIV-1 and HIV-2) in Dakar. Epidemiologic and clinical aspects]. / Infections par les virus de l'immunodéficience humaine (VIH1 et VIH2) à Dakar. Aspects épidémiologiques et cliniques.

The authors report on the results of an investigation carried out on 109 HIV seropositives ascertained by the Dakar Central Hospital between February 20, 1987 and May 31, 1988. These seropositives affected 44 patients with AIDS (0.78% of admitted patients) and 65 seropositive people of which 43 blood donors (1.35% of donors). Both viruses are present in about equal number: 50 HIV1 seropositives, 44 HIV2 seropositives, and 15 composite seropositives. Sex-ratio is 3,9 in favour of males; this figure is nearer to the one observed in Europe and North American than the one observed in Central Africa where there is equality between both sex. Clinical patterns are dominated by a bad general status: lost of weight, fever, diarrhea, polyadenopathiae, pneumopathiae, meningoencephalitis. Kaposi's sarcoma and cryptococcal meningitis have been observed only four times. Development of the infection lead to death for 12 patients during the 16 months of the investigation. Both viruses are responsible for an equal immunodepression, leading to the same potential severity. Immunodepression might be acquired more slowly with HIV2, so strongly suggesting an incubation apparently lasting more.

PIP: Between February 1987-May 1988, 109 patients at the Dakar Central Hospital were diagnosed by the ELISA method and confirmed by Western Blot as seropositive for HIV infections. 44 had AIDS, including 2 blood donors and 1 child. 39 asymptomatic but seropositive subjects included 15 blood donors, 7 spouses and 2 children of seropositive individuals, 2 subjects who had spent time in Central Africa where HIV is endemic, 2 patients receiving blood transfusions in Benin and the Ivory Coast, 2 patients with a positive treponemic serology, 4 pregnant women, and 5 patients with disorders unrelated to AIDS. The remaining 26 seropositive blood donors were not examined and their risk factors and health status were unknown. Among the 109 cases there were 50 seropositivities to HIV 1, 44 to HIV 2, and 15 for both HIV 1 and 2. 83 men and 26 women were seropositive, for a sex ratio of 3.9. The average ages of AIDS patients were 33.2 for HIV 1, 41.1 for HIV 2, and 42.3 for HIV 1 and 2. Average ages of asymptomatic carriers were 30.1 for HIV 1, 29.5 for HIV 2, and 26.1 for HIV 1 and 2. Risk factors were difficult to study, but 78 records including information indicated 3 open homosexuals, 4 drug users, 25 who frequented prostitutes, 11 patients who had received transfusions, and 30 who had received injections. 21 of 35 seropositive for HIV 1, 5 of 33 seropositive for HIV 2, and 5 of 10 seropositive for both HIV 1 and 2 had lived outside Senegal and its neighboring countries in the past 10 years. Clinical signs in the 44 AIDS patients were highly varied. The most frequently noted were poor general state with weight loss, fever, diarrhea, polyadenopathic syndrome, pneumopathy, and meningoencephalitis. 9 men and 3 women died during the study period. In all cases the clinical status at hospital admission was very poor. There has as yet been no epidemic of AIDS in Senegal following observation of the 1st case in 1987. The 44 AIDS patients represented .78% of hospital admissions during the study period, while the 43 seropositive blood donors represented 1.35% of all donors. The HIV 1 and HIV 2 viruses both cause profound immunodepression. Some evidence suggests that the HIV 2 virus has a longer incubation period. The study indicates that the epidemiology of HIV is not the same in West Africa as in Central Africa.

[The value of laparoscopy. Results of 600 studies performed in an internal medicine department at the General Hospital of Dakar]. / Intérét de la laparoscopie. Résultats de 600 examens effectués dans un service de Médecine interne à l'Hôpital Principal de Dakar.

600 laparoscopic examinations were performed in an Internal Medicine Department of the general Hospital Dakar (Senegal) from 1984 to 1989 in 402 males and 198 females aged from 7 to 82 years. This examination of simple and quick procedure well tolerated under simple premedication, should be performed only after diffusion of the pneumoperitoneum, per- foration being the major risk. Even if liver cell carcinoma and cirrhosis represent more than an half of the examined cases (52%) due to their high frequency, exploration of peritoneal pathology is the best indication for laparoscopy. Thanks to laparoscopy, 68 tuberculosis, 28 peritoneal carcinomatosis and 11 infectious peri-hepatitis were diagnosed. It remains a major examination perfectly adapted to studies of the so-frequent hepato-peritoneal pathology in Black Africa]

[Acute disseminated lupus erythematosus in Ivory Coast (apropos of 9 cases)]. / Le lupus érythémateux aigu disséminé en Côte-d'Ivoire (a propos de 9 observations).

Nine cases of systemic lupus erythematosus (S.L.E.) among ivoirian Africans seen over a period of eleven years were studied. The pattern of clinical presentations is similar of that seen elsewhere. Photo-sensitivity is not described as in american Negroes. Death is usually due to severe infection. The incidence of the disease among populations of different african countries are compared. The low prevalence 0,18 p. mille may be a function of failure to diagnose the more mild cases.