RESUMO
Fungal agents are not common cause of pneumonia. In favorables conditions mycosis can cause atypical clinical and radiographic figures. Authors report the observation of a 45 years and VIH-positive patient presenting a persistant and excavating pneumonia probably caused by Candida albicans.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Candidíase/diagnóstico , Erros de Diagnóstico , HIV-1 , Pneumopatias Fúngicas/diagnóstico , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Candidíase/tratamento farmacológico , Côte d'Ivoire , Países em Desenvolvimento , Diagnóstico Diferencial , Humanos , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico , Tuberculose Pulmonar/diagnósticoRESUMO
Clinical, radiographic, biological, histological and pathological data from thirty HIV-infected patients with tuberculous pleural effusion were prospectively collected at the pulmonary disease clinic at the University teaching hospital of Treichville in Abidjan from April to December 1999. Patients mean age was 35 years, ranging from 16 to 79. The white cell count in the serous effusion pleural fluid was high with predominant lymphocytes. Microscopy examination of the aspirate did not show AFB. The Tuberculin Skin Test remained negative for 16 patients (53%). Multiple pleural biopsies showed typical tuberculous follicles in 19 patients (63%) and a non-typical inflammatory reactions in eleven patients (37%).
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções por HIV/epidemiologia , Derrame Pleural/epidemiologia , Tuberculose Pleural/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Côte d'Ivoire/epidemiologia , Quimioterapia Combinada , Feminino , Infecções por HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Prevalência , Estudos Prospectivos , Fatores Sexuais , Fatores de Tempo , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/tratamento farmacológicoRESUMO
From December 1995 to March 1996 a cross sectional study was carried out in the pulmonary Medicine Unit of Treichville in Abidjan. In order to specify the main aetiologies of pleural effusion, an investigation was conducted among 35 adult patients (19 men and 16 women) suffering from pleuritis. Overall, the mean age was 32.2 years (range: 19-53 years). All the patients underwent a standard chest x-ray a skin test with 10 units of tuberculin, a whole blood cells count with CD4 T cells count and HIV test. The following analysis were performed on the pleural fluid for all patients: cytological, bacteriological and mycobacteriological examination. Some patients underwent as well a pleural biopsy performed by Abram's needle. Pleural fluid was clear in 24 cases (69%). Empyema was found in 8 cases (23%) and hemorrhagic fluid in 3 cases (9%). Tuberculosis was the dominant aetiology of pleuritis noted in 29 patients (83%), followed by far by non-tuberculous bacterial infections in 6 patients (17%). Tuberculosis associated with common bacterial infections was noted in 3 cases.
Assuntos
Infecções por HIV/complicações , Derrame Pleural/etiologia , Adulto , Côte d'Ivoire , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A cohort study was carried out from October 2001 to March 2002, in order to analyze the main characteristics of 53 adults patients (38 HIV-positive and 15 HIV-negative), who had a relapse of pulmonary tuberculosis. The observance in the first period of the treatment of tuberculosis was regular in 79% of tuberculous patients infected by the HIV (30/38) and in 87% of tuberculous patients who where HIV-negative (13/15) (p = 0.7). The relapse occurred before one year after recovery in 74% among the HIV-positive (28/38) and in 33% among the HIV-negative patients (5/15) (p = 0.00). Most of the HIV-positive patients (74%) had CD4 counts under 200/mm3 and 80% of the HIV-negative patients had more than 500 CD4 counts/mm3 (p = 0.00). After two months of retreatment following the relapse diagnosis, the rate of improvement in patients was about 16% in HIV infected (6/38) and about 67% in HIV-negative patients (10/15) (p = 0.00).
Assuntos
Infecções por HIV/complicações , Tuberculose Pulmonar/complicações , Adolescente , Adulto , Contagem de Linfócito CD4 , Côte d'Ivoire , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
A retrospective study from 1989 to 1993 was carried out on eighty patients out of 106 cases of tuberculosis treatment failure; representing 2.2% of persons with active pulmonary tuberculosis followed at the tuberculosis screening center of Abidjan. The rate of HIV seropositivity was 43.7%. At the beginning of the therapy, 80% of HIV-positive and 89% of HIV-negative had diffuse pulmonary lesions (no significant difference: P > 0.05. At the end of second month therapy, 49% of co-infected and 51% of HIV-negative patients showed bacteriological negative sputum. The treatment administered after reporting failure, led to 63% of recovery among the HIV-positive (22/35) and 62% among the HIV-negative (28/45). On the other hand, the rate of patients out of touch was high in both populations; respectively 29% of HIV infected and 31% of HIV-negative spreading the risk of contamination of neighbourhood by probably resistant bacilli.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adolescente , Adulto , Idoso , Côte d'Ivoire/epidemiologia , Feminino , Soronegatividade para HIV , Soroprevalência de HIV , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Escarro/microbiologia , Falha de Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologiaRESUMO
Entamoeba histolytica has been separated in recent years into 2 morphologically identical species: the apathogenic E. dispar and the pathogenic E. histolytica, only the latter being pathogenic. Although various laboratory techniques allow discrimination between the 2 species there is a lack of field data about the suitability of available diagnostic tests for use in epidemiological studies and few epidemiological studies using species-specific diagnosis have been performed at community level in endemic areas, especially in sub-Saharan Africa. We conducted a repeated cross-sectional study of 967 schoolchildren in central Côte d'Ivoire to compare and evaluate light microscopy, 2 different antigen detection assays, and one polymerase chain reaction (PCR) assay. Microscopy and a non-specific antigen capture Entamoeba enzyme-linked immunosorbent assay (ELISA) were used for the primary screening of all children (time t0). The prevalence of the E. histolytica/E. dispar species complex at t0 was 18.8% by single microscopical examination and 31.4% using the non-specific ELISA. Approximately 2 months after the initial screening, fresh stool specimens were collected on 2 consecutive days (t1 and t2) from (i) all the children who were positive by microscopy at t0 (n = 182) and (ii) 155 randomly selected children who were negative at the primary screening. These samples were tested with a second antigen detection ELISA specific for E. histolytica (n = 238) and with a species-specific PCR assay (n = 193). The second and third examinations (t1 and t2) revealed an additional 43 infections with the species complex E. histolytica/E. dispar, so that the cumulative microscopical prevalence for t1 and t2 was 27.7%. The overall prevalence of E. histolytica by species-specific ELISA antigen detection was low (0.83%), while the prevalence of E. dispar was 15%. When analysing only microscopically positive samples by PCR (n = 129), the ratio E. histolytica: E. dispar was very low (1:46), suggesting that the vast majority of Entamoeba infections in this area were apathogenic. Both species-specific tests performed well but the ELISA was easier to use for large-scale field screening.
Assuntos
Entamebíase/parasitologia , Adolescente , Animais , Anti-Helmínticos/uso terapêutico , Criança , Côte d'Ivoire/epidemiologia , Estudos Transversais , Entamoeba , Entamoeba histolytica , Entamebíase/tratamento farmacológico , Entamebíase/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Giardíase/tratamento farmacológico , Humanos , Masculino , Metronidazol/uso terapêutico , Reação em Cadeia da Polimerase , Praziquantel/uso terapêutico , Prevalência , Esquistossomose mansoni/tratamento farmacológico , Especificidade da EspécieRESUMO
The aim of this retrospective study was to evaluate the yield of bronchial endoscopy for the diagnosis of tuberculous mediastinal adenopathies. We analyzed the results in 200 procedures in patients with tuberculous mediastinal adenopathies. Mediastinal tuberculous adenopathies were found in 6% of the patients with tuberculosis diagnosed during the same period. Mean age of the patients was 30.5 years, and the sex ratio was 1.5. Bronchial endoscopy improved the diagnostic yield of the bronchial aspiration fluid (22% versus 11% without endoscopy). This method allowed positive diagnosis of tuberculosis in 164 patients (82%) by visualizing specific lesions such as compressions, granulations, and gangliobronchial fistulae. Histological confirmation was obtained in 72 (79%) patients among 91 biopsy specimens. Bronchial endoscopy remains a crucial exploration for the diagnosis of mediastinal tuberculous adenopathy, even in HIV-infected patients, because in our series, among 101 treated patients, 99 were HIV positive (98%).
Assuntos
Broncoscopia/métodos , Doenças do Mediastino/patologia , Tuberculose dos Linfonodos/patologia , Adolescente , Adulto , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Percentages of primary and acquired resistance to anti-tuberculosis drugs provide an epidemiological indicator useful for assessing national anti-tuberculosis programs. Rifampicin and isoniazide are widely used in countries with a high prevalence of tuberculosis. In tropical Africa, these drugs are the mainstay treatment for tuberculosis, used both in the initial and long-term regimens. Simultaneous resistance to these two antibiotics would seriously jeopardize therapeutic efficacy. We studied simultaneous rifampicin and isoniazide resistance in patients hospitalized for tuberculosis in the respiratory disease unit of the Treichville University hospital in Abidjan, Ivory Coast. Mycobacterium tuberculosis was isolated in 8 patients. All the strains isolated were resistant to streptomycin. History taking revealed that resistance was observed at the initial prescription in 6 cases. A notion of contagion was present in 4 cases. Six patients were HIV-positive. Surveillance of resistance to anti-tuberculosis drugs is helpful in detecting early changes which could compromise the efficacy of the therapeutic scheme.
Assuntos
Antibióticos Antituberculose/uso terapêutico , Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Rifampina/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adolescente , Adulto , Côte d'Ivoire , Etambutol/uso terapêutico , Feminino , Humanos , Masculino , Anamnese , Mycobacterium tuberculosis/efeitos dos fármacos , Estreptomicina/uso terapêuticoRESUMO
SETTING: Tuberculin skin test (TST) survey of health care workers (HCWs) in selected clinical services in Abidjan, Côte d'Ivoire. OBJECTIVE: To assess whether HCWs in Abidjan are at increased risk for occupationally acquired Mycobacterium tuberculosis infection. DESIGN: From October 1996 to January 1997, consenting HCWs from four services where tuberculosis (TB) prevalence among patients was high and two services where it was low were evaluated with a questionnaire, TST (including evaluation of anergy) and chest radiograph. RESULTS: Of the 512 participants, 405 (79%) had a TST reaction of > or =10 mm, eight (2%) were anergic, five (1%) had a radiograph compatible with TB, and two had confirmed TB. Using a cut-off of 10 mm, we found a higher prevalence of TST positivity in services with high TB prevalence than in those with low TB prevalence (92% vs 72%; odds ratio [OR] 4.3; 95% confidence interval [CI] 2.3-8.0]) and among HCWs with direct (87%; OR 2.9; 95%CI 1.6-5.1) and indirect patient contact (80%, OR 1.7; 95%CI 1.0-2.3) than among those with minimal patient contact (69%). CONCLUSION: These findings indicate that TST positivity among HCWs is related to level of exposure to TB patients, and suggest that HCWs in Abidjan are at risk for the nosocomial transmission of TB.
Assuntos
Pessoal de Saúde/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Programas de Rastreamento/métodos , Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Teste Tuberculínico , Tuberculose/epidemiologia , Adulto , Análise de Variância , Côte d'Ivoire/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Prevalência , Fatores de Risco , Inquéritos e Questionários , Tuberculose/diagnóstico , Tuberculose/transmissão , Saúde da População Urbana/estatística & dados numéricosRESUMO
Several diaza-analogs of phenanthrene derived from 3-amino, 5-amino, 6-amino, 8-aminoquinolines, and 5-aminoisoquinoline were prepared to evaluate their antiplasmodial activities. All compounds showed mild to good activitiy in vitro, both on a Nigerian chloroquino-sensitive strain and on the chloroquino-resistant FcB1-Columbia and FcM29 strains. The position of the intracyclic nitrogen atom is shown to be crucial for the activities (best results are obtained with a 1,10-phenanthroline skeleton). In regard to the particular properties of this structure (metalloprotease inhibition activitiy by chelating divalent metal ions), the potential chelating site of the molecule was blocked. In this case, the biological activity of the compound was greatly enhanced, showing that the mechanism of action of such a compound is probably not correlated to metalloprotease inhibition activity.
Assuntos
Antimaláricos/síntese química , Fenantrenos/farmacologia , Animais , Antimaláricos/química , Antimaláricos/farmacologia , Quelantes/química , Avaliação Pré-Clínica de Medicamentos , Células HeLa , Humanos , Concentração Inibidora 50 , Fenantrenos/síntese química , Fenantrenos/química , Fenantrolinas/química , Plasmodium falciparum/efeitos dos fármacosRESUMO
BACKGROUND: There is a high incidence of opportunistic infection among HIV-1-infected patients with tuberculosis in Africa and, consequently, high mortality. We assessed the safety and efficacy of trimethoprim-sulphamethoxazole 800 mg/160 mg (co-trimoxazole) prophylaxis in prevention of such infections and in decrease of morbidity and mortality. METHODS: Between October, 1995, and April, 1998, we enrolled 771 HIV-1 seropositive and HIV-1 and HIV-2 dually seroreactive patients who had sputum-smear-positive pulmonary tuberculosis (median age 32 years [range 18-64], median CD4-cell count 317 cells/microL) attending Abidjan's four largest outpatient tuberculosis treatment centres. Patients were randomly assigned one daily tablet of co-trimoxazole (n=386) or placebo (n=385) 1 month after the start of a standard 6-month tuberculosis regimen. We assessed adherence to study drug and tolerance monthly for 5 months and every 3 months thereafter, as well as rates of admission to hospital. FINDINGS: Rates of laboratory and clinical adverse events were similar in the two groups. 51 patients in the co-trimoxazole group (13.8/100 person-years) and 86 in the placebo group (25.4/100 person-years) died (decrease In risk 46% [95% CI 23-62], p<0.001). 29 patients on co-trimoxazole (8.2/100 person-years) and 47 on placebo (15.0/100 person-years) were admitted to hospital at least once after randomisation (decrease 43% [10-64]), p=0.02). There were significantly fewer admissions for septicaemia and enteritis in the co-trimoxazole group than in the placebo group. INTERPRETATION: In HIV-1-infected patients with tuberculosis, daily co-trimoxazole prophylaxis was well tolerated and significantly decreased mortality and hospital admission rates. Our findings may have important implications for improvement of clinical care for such patients in Africa.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Anti-Infecciosos/uso terapêutico , HIV-1 , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Côte d'Ivoire/epidemiologia , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , HIV-2 , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Tuberculose/epidemiologia , Tuberculose/mortalidadeRESUMO
SETTING: Respiratory medicine wards of the University Teaching Hospital, Abidjan, Côte d'Ivoire. OBJECTIVES: To describe the spectrum of opportunistic infection among human immunodeficiency virus (HIV) infected adults hospitalised in the respiratory medicine unit in Abidjan, and the level of immunosuppression at which these diseases occur. DESIGN: Cross-sectional study. RESULTS: Overall, 75% of patients were HIV-positive: among these patients, the most frequent diagnosis was tuberculosis, in 61%, followed by bacterial pneumonia (15%), Gram-negative septicaemia (particularly non-typhoid Salmonella) (9%) and empyema (5%). Atypical pneumonias appeared to be rare. Most HIV-positive patients had CD4 counts indicative of advanced immunosuppression: 36% had CD4 counts below 100 x 10(6)/l, 19% between 100 and 199 x 10(6)/l, 29% between 200 and 499 x 10(6)/l, and 16% above 500 x 10(6)/l. Overall in-hospital mortality was 27% for HIV-positive patients and 22% for HIV-negative patients (P = 0.5). In a multivariate analysis, the strongest independent risk factors for death were cachexia (odds ratio [OR] 7.4, 95% confidence interval [CI] 2.1-26.3), male sex (OR 4.5, 95% CI 1.2-17.4) and age over 40 (OR 4.1, 95% CI 1.0-17.2). CONCLUSIONS: Tuberculosis and bacterial infections are the major causes of respiratory morbidity in immunosuppressed HIV-infected adults in this population. Efforts to improve the management of HIV-related disease need to focus on prevention and treatment of these infections.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções por HIV/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Contagem de Linfócito CD4 , Côte d'Ivoire/epidemiologia , Estudos Transversais , Empiema/epidemiologia , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por HIV/imunologia , Infecções por HIV/mortalidade , Hospitalização , Humanos , Terapia de Imunossupressão , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/epidemiologia , Unidades de Cuidados Respiratórios , Sepse/epidemiologia , Tuberculose/epidemiologiaRESUMO
From December 1992 to February 1993, 104 newly diagnosed pulmonary tuberculosis patients were enrolled in a prospective cohort study to assess the response to the 6 month-short-course regimen implemented in Cote d'Ivoire. This treatment encompassed the daily intake of Rifampicin and Pyrazinamide for 2 months followed by Rifampicin and Isoniazid for the remaining 4 months. All the patients were enrolled at the Treichville Tuberculosis Treatment Centre in Abidjan, and a follow-up of 6 months was observed for each patient. All in all, 41 patients were HIV-positive whereas 63 where HIV-negative. No statistical difference was noted between HIV-positive and HIV-negative patients with regard to the completion of therapy (85% versus 87%). The cure rate after an effective 6 month-therapy was similar among HIV-positive and HIV-negative patients (83% versus 84%) as well as the treatment failure rate which was 2.4% and 3% respectively. The results clearly indicate that the 6 month-short-course regimen policy implemented in Côte d'Ivoire is as effective for the treatment of HIV-associated tuberculosis as for the treatment of tuberculosis.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Antituberculosos/administração & dosagem , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/uso terapêutico , Estudos de Coortes , Côte d'Ivoire , Feminino , Humanos , Isoniazida/administração & dosagem , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pirazinamida/administração & dosagem , Pirazinamida/uso terapêutico , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Tuberculose/complicaçõesRESUMO
Based on a selection of articles published in the literature and reports from international AIDS conferences, we present the main pulmonary complications of HIV-infection observed in sub-Saharan Africa. The different clinical studies demonstrate the predominance of infectious complications, mainly tuberculosis (29 to 44%) and bacterial pneumonia (21 to 35%). The frequency of Pneumocystis carinii pneumonia remains low (5 to 19%). Other complications (mycobacterial infection, cytomegalovirus, toxoplasmosis, cryptococcus, aspergillosis, interstitial lymphoid pneumonia, Kaposi sarcoma) are less frequent. The autopsy studies report similar results and mention the predominance of tuberculosis and pneumonia due to common germs as well as the low frequency of pneumocystosis. This analysis of work conducted in sub-Saharan Africa clearly indicate that tuberculosis remains the leading cause of morbidity and mortality in HIV-infected patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Pneumopatias/epidemiologia , África Subsaariana/epidemiologia , Humanos , Pneumopatias/etiologia , Pneumopatias/microbiologia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/etiologiaRESUMO
This article reviews the main clinical aspects and progression of HIV-related tuberculosis in Abidjan. HIV prevalence in tuberculosis patients is high, estimated at 46.2% in 1992, with a clear predominance of HIV-1 over HIV-2. More than 61% of co-infected tuberculous patients meet the WHO's clinical definition of AIDS (the Bangui definition) at the time of diagnosis of tuberculosis. This rates falls to 46-51% when cough is excluded from the definition. On X-rays, the signs of pulmonary tuberculosis in co-infected tuberculous patients are atypical in the advanced stages of HIV infection, when extra-pulmonary localization, mainly mediastinal adenopathy, is frequent. Short-course chemotherapy consisting of 2 months' unsupervised daily treatment with rifampicin/isoniazid/pyrazinamide, followed by 4 months of a daily combination of rifampicin/isoniazid, applied in the Ivory Coast since 15 July 1985, has proved successful in HIV-associated tuberculosis, with treatment effectiveness rates of more than 90%.
Assuntos
Infecções por HIV/complicações , Tuberculose/complicações , Adulto , Antituberculosos/uso terapêutico , Contagem de Linfócito CD4 , Criança , Côte d'Ivoire/epidemiologia , Quimioterapia Combinada , Soroprevalência de HIV , HIV-1 , HIV-2 , Humanos , Radiografia , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
We present a review of epidemiologic data collected by Projet RETRO-CI between 1987 and 1993 on trends in human immunodeficiency virus type 1 (HIV-1) and HIV-2 infections and on cases of AIDS in Abidjan, Côte d'Ivoire. Overall rates of HIV infection in pregnant women had already reached 10% in 1987, and have increased only modestly since then. In contrast, in 1992-1993, rates in men with sexually transmitted diseases and in female commercial sex workers reached 27 and 86%, respectively. The increases in infection rates have been largely due to transmission of HIV-1, whereas rates of HIV-2 have remained stable or have declined. Among persons with tuberculosis and hospitalized patients, rates of 46-71% have been reached, increases in recent years again being largely attributable to HIV-1. Among the 15,245 AIDS cases reported by Projet RETRO-CI, a steady decline in the male:female sex ratio has occurred over time, from 4.8:1 in 1988 to 1.9:1 in 1993. It is likely that AIDS cases were initially concentrated among a core group of female commercial sex workers and their male clients. A substantial proportion of sex workers and their clients originate from neighboring countries, and migration is likely to have contributed to the spread of HIV infection in West Africa. Including HIV-associated pulmonary tuberculosis as an AIDS-defining illness increased AIDS cases reported by Projet RETRO-CI by 13% in 1993. Despite a need for interventional research, careful description of the evolution of HIV/AIDS in this region remains essential.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Surtos de Doenças , Infecções por HIV/epidemiologia , HIV-1 , HIV-2 , Síndrome da Imunodeficiência Adquirida/transmissão , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Côte d'Ivoire/epidemiologia , Transmissão de Doença Infecciosa , Feminino , Anticorpos Anti-HIV/análise , Infecções por HIV/transmissão , Soroprevalência de HIV , HIV-1/imunologia , HIV-2/imunologia , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Masculino , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Estudos Soroepidemiológicos , Trabalho Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Tuberculose Pulmonar/transmissãoRESUMO
We present the results of a retrospective study of 127 cases of empyema admitted to the pneumophtisiology department of the Centre hospitalier universitaire de Treichville (Abidjan), between January 1985 and December 1989. We present the pathogens identified in the pleural fluid and the course of the disease during treatment by repeat thoraco-centesis and systemic antibiotics. During the study period, pleural empyema represented 2.7% of all admissions to the pneumophtisiology department, and 20.5% of those presenting with pleural effusions. Bacteriological examination was recovered in 88 of the 127 patients, and was positive in 57 cases (64.7% of those examined). Of those with positive bacteriology, 50 (56.8%) had non-tuberculous bacterial infections, and 7 (7.9%) had tuberculous infection. Among the non-tuberculous bacterial infections, Gram-negative bacilli were most common (72%), and Pseudomonas was the species most frequently identified (48%). The mean stay in hospital was 47 days (range 10-143) and in 82 patients (64.6%), the outcome was favourable. The presentation was complicated by encystment in 36 cases (28.4%) and 9 patients (7%) died in hospital.
Assuntos
Pleurisia/etiologia , Pleurisia/terapia , Côte d'Ivoire , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Derrame Pleural/microbiologia , Pleurisia/microbiologia , Pseudomonas/isolamento & purificação , Estudos RetrospectivosRESUMO
Based on autopsy findings in 70 patients infected by human immunodeficiency virus (HIV) who died in the Pulmonology Department of the Treichville University Hospital Center in Abidjan, Ivory Coast. the authors assess the incidence of tuberculosis as the cause of death and analyze the clinical, bacteriologic, and histologic features of the disease. in this population. Pulmonary tuberculosis was the first cause of death in this series accounting for 31 cases (44.2%). In 12 cases (38.7%), microscopic identification failed during hospitalization and the disease had been misdiagnosed as common bacterial pneumonia. In 29 cases (93.5%) pulmonary tuberculosis was associated with abdominal involvement. In 17 cases (54.8%) involvement of more than two organs was observed. Of the 60 abdominal sites detected during the autopsy of the 31 patients with pulmonary tuberculosis, there were 19 (31.3%) in lymph nodes, 18 (30%) in the liver, 14 (23.3%) in the spleen, and 9 (14.9%) in the kidneys. Histologic features were remarkable by the absence of typical tuberculous granulomas. The findings of this study confirm the high incidence of disseminated tuberculosis in patient infected by HIV as noted in a number of previous studies.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Tuberculose/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adolescente , Adulto , Autopsia , Causas de Morte , Côte d'Ivoire , Erros de Diagnóstico , Feminino , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tuberculose/patologiaRESUMO
OBJECTIVE: To assess the frequency of CD4+ T-lymphocyte depletion in selected populations in West Africa and to determine whether an association exists between AIDS-like illnesses and CD4+ T-lymphocytopenia in HIV-negative individuals. DESIGN: Retrospective review of databases and prospective case-control study. SETTING: Project RETRO-CI, an AIDS research project in Abidjan, Côte d'Ivoire, a University Hospital and tuberculosis treatment and maternal and child health centres in Abidjan. METHODS: We conducted a retrospective review of CD4+ T-lymphocyte counts performed between 1991 and 1992 on hospitalized medical patients, outpatients with tuberculosis, and women participating in a study of HIV-1 and HIV-2 mother-to-child transmission. A prospective case-control study was conducted in 1992 to examine the relationship between HIV-negative CD4+ T-lymphocyte depletion and wasting syndrome (wasting and chronic diarrhoea and/or chronic fever). RESULTS: In the retrospective data review, CD4+ T-lymphocyte counts < 300 x 10(6)/l were found in 9.6% of 115 HIV-negative hospitalized patients, in 4.2% of 312 ambulatory tuberculosis patients, and in 0.4% of 263 healthy women after delivery. In the case-control study, no association was found between CD4+ T-lymphocyte depletion in HIV-negative individuals and the presence of wasting syndrome. Increased mortality in HIV-negative individuals was associated with wasting but not with reduced CD4+ T-lymphocyte counts. In contrast, a trend existed for increased mortality with increasingly severe CD4+ T-lymphocyte depletion in HIV-positive patients. Tuberculosis was the most frequently proven or suspected diagnosis in HIV-negative individuals with wasting and CD4+ T-lymphocytopenia. CONCLUSIONS: In the absence of HIV infection, CD4+ T-lymphocytopenia is uncommon (< 1%) in West African asymptomatic individuals but is more frequent in those with tuberculosis (4%) and hospitalized patients (10%). CD4+ T-lymphocytopenia in HIV-negative individuals was not associated with wasting syndrome or increased mortality. There was no evidence for frequent, clinically relevant immune deficiency other than that associated with HIV infection.
Assuntos
Linfócitos T CD4-Positivos , Soronegatividade para HIV , Linfopenia/epidemiologia , Adulto , África Ocidental/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Contagem de Leucócitos , Masculino , Estudos Prospectivos , Estudos RetrospectivosRESUMO
The aim of this prospective study was to investigate the main features of standard chest X-ray in patients with concomitant tuberculosis and HIV infection. From 21 December 1992 to 21 February 1993, we compared 45 chest X-rays of HIV+patients with pulmonary tuberculosis with those of 73 HIV negative patients with pulmonary tuberculosis. Our results revealed that extrapulmonary thoracic localizations were remarkably frequent in HIV+tuberculosis patients (57.8% versus 22% in HIV-patients; P < 0.05). Extrapulmonary localizations were frequently mediastinal lymph nodes (82.7%). Parenchymal involvement was often extensive including frequent miliary images (20% versus 38.3% in HIV-patients). Thus despite the lack of CD4 counts in our study, we were able to observe that about one half the co-infected tuberculosis patients had reached the stage of AIDS as defined by the CDC in 1987. These findings are in agreement with those reported in the literature and would suggest that thoracic manifestations of tuberculosis is a good marker of the state of immunodepression.
PIP: In the Ivory Coast, pneumologists examined 188 chest X-rays of patients with pulmonary tuberculosis (TB) treated at the Treichville Antituberculosis Center to compare the principal X-ray characteristics of patients with only TB with those of patients infected with TB and HIV. They did not conduct CD4 counts. 45 TB patients were also infected with HIV for an HIV prevalence rate of 38%. 73.3% of HIV infected TB patients were infected with HIV-1. 4.4% were infected with HIV-2. 22.3% were infected with both HIV-1 and HIV-2. Men predominated in both the TB only group and the TB-HIV group (67.1% and 77.7%, respectively). HIV infected patients were more likely to have thoracic extrapulmonary TB lesions than HIV seronegative patients (57.8% vs. 22%; P 0.05). Thus, 57.8% of co-infected patients had AIDS as defined by the CDC in 1987. Among co-infected patients, lesions on the mediastinal lymph nodes predominated (80.7%). Involvement of the parenchyma, demonstrated by miliary X-rays, was rather common (22.3% vs. 38.3% for HIV negative patients). The X-ray of 84.6% of patients with caseous pneumonia were infected with HIV and TB. These findings parallel those in the literature. They suggest that thoracic manifestations of TB indicate the state of immunodepression.