Generalized papular pruritic eruption in African patients with human immunodeficiency virus infection.

Of 284 patients hospitalized with HIV infection, 52 (18%) presented with a generalized pruritic papular eruption. No significant association between this eruption and other HIV manifestations or any opportunistic infection was found. Fifty-three of 61 (87%) consecutive African patients referred for a generalized papular pruritic eruption of unknown etiology of at least 1 month's duration were HIV seropositive, including 15 (65%) of 23 in good general condition. Thirty-seven (95%) of 38 patients with this eruption and severe weight loss (greater than 10% of normal body weight) were seropositive. The initial skin lesions were small, firm, intensely pruritic papules which released a small drop of clear fluid when scratched. Scratched papules became later hyperpigmented macules. Lesions were symmetrically distributed over the body and were most frequently found on the extensor surfaces of the arm, the dorsal surface of the hands, the inferior part of the legs, the ankles and the dorsum of the feet. Histologic examination showed a non-specific inflammatory reaction. Thirty-three (51%) patients reported that the skin eruption was their initial disease manifestation. In African patients, the presence of an unexplained generalized pruritic papular eruption is highly indicative of HIV infection.

Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection.

A recent episode or a history of herpes zoster was found in 30 (11%) of 284 patients hospitalized with human immunodeficiency virus (HIV) infection at Mama Yemo Hospital, Kinshasa, Zaire. Of 146 African patients with a history of herpes zoster who were referred to us by physicians at the Mama Yemo Hospital, 133 (91%) were HIV seropositive. The clinical characteristics of the herpes zoster episodes did not differ between HIV-seropositive and -seronegative individuals, except that 23% of the HIV-seropositive patients experienced recurrences compared with none of the HIV-seronegative patients (P = .05). No patient developed a generalized herpes zoster eruption, and only patients with ophthalmic zoster developed related complications. Patients who experienced severe pain during their herpes zoster attack lost more weight than did those who had only minor pain (P = .0003).

Evaluation of a clinical case-definition of acquired immunodeficiency syndrome in Africa.

A provisional clinical case-definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organisation (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case-definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. These results support the use of the WHO clinical definition for AIDS in Africa. However, since HIV prevalence and disease expression vary, similar evaluations should be carried out in different regions.

PIP: A provisional clinical case definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organization (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. According to this definition, the diagnosis of AIDS requires the existence of at least 2 of the major signs (weight loss greater than 10% of body weight, chronic diarrhea for more than 1 month) in association with at least 1 minor sign (persistent cough for more than 1 month, general pruritic dermatitis, recurrent herpes zpster, oopharyngeal candidiasis, chronic progressive and disseminated herpes simplex infection, general lymphadenopathy) in the absence of other known causes of immunosuppression. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. Among the major symptoms and signs of the case definition, chronic diarrhea was the most specific. Of the 12 HIV-seronegative patients meeting the criteria of the AIDS case difinition, 6 had tuberculosis and 3 had suspected tuberculosis. Tuberculosis is the most common differential diagnosis problem in the design of a clinical case definition of African AIDS. When the criteria of persistent cough for longer than 1 month or general lymphadenopathy were not used for patients with proven tuberculosis, the WHO clinical definition was 93% specific, 55% sensitive, and had a positive predictive value for HIV seroprevalence and disease expression require that similar evaluations be carried out in other regions.