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.

[Pulmonary tuberculosis and HIV seropositivity at the Principal Hospital of Dakar (Senegal)]. / Tuberculose pulmonaire et séropositivité HIV à l'hôpital principal de Dakar (Sénégal).

In a prospective survey conducted in 1990 in the Principal Hospital of Dakar, pulmonary tuberculosis was 2.3 times more frequent in HIV seropositive patients (12.5%) than in HIV seronegative patients. We studied 22 cases of pulmonary tuberculosis in HIV+ patients and compared them with a control group of HIV- patients admitted for pulmonary tuberculosis. Tuberculosis occurred in 6 out of 22 asymptomatic HIV+ patients, in 15 out of 22 patients with clinical AIDS and in 1 patient with ARC syndrome. Clinical signs were the same as in controls, except for patients with advanced AIDS who developed cardinal signs. TB intra-dermal reactions were more often negative in HIV+ patients, notably those with HDV1, expressing immunodepression. Radiological images were typical in 81% of patients and in 86% of controls. However, concomitant infections were common in both groups, with atypical radiology and hyperleukocytosis. At light microscopy, there was no difference in the frequency of acid and alcohol fast bacilli between the two groups. The mortality rate was increased in HIV+ patients, but this was not due to tuberculosis. Relapses were frequent in both groups, due to poor compliance with treatment.

[From suspicion to diagnosis. Clinical, epidemiological, radiological and endoscopic aspects of bronchopulmonary cancer in Senegal. Apropos of 700 endoscopies performed at the Principle Hospital of Dakar from 1987 to 1990]. / De la suspicion au diagnostic. Aspects clinique épidémiologique, radiologique et endoscopique du cancer bronchopulmonaire au Sénégal. A propos de 700 endoscopies effectuées à l'Hôpital Principal de Dakar de 1987 à 1990.

700 bronchial endoscopies were performed over a period of three years at the Dakar "Hôpital Principal". 40 bronchopulmonary cancers were identified (34 epidermoid, 4 adenocarcinoma, 2 with "small cells") out of 80 suspect cases. When we examine the clinical, radiological, endoscopic features, we are able to classify the following as the most established facts: 1. Higher radiological frequency of the pulmonary retractile condensation syndrome (40 cases). 2. Main frequency of proximal granulated tumors (45) in comparison with endoscopic bronchial stenosis (22). 3. Identification almost exclusive of bronchial epidermoid cancer in that series (34). 4. Male sex and smoking are two unequivocal elements of that pathology. Bronchial endoscopy, absolutely necessary test easy to perform and to get, enables to visualize a lesion and to bring forward the indisputable histological evidence through the biopsy either alone or associated with endoscopic brushing and alveolar washing.

[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.

[Mucous diaphragm of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the General Hospital of Dakar. Relationship with the Kelly-Paterson or the Plummer-Vinson syndrome]. / Diaphragme muqueux de l'oesophage cervical a propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Kelly-Paterson ou de Plummer-Vinson.

At the occasion of 15,000 high endoscopies performed during the past 5 years at the general Hospital of Dakar (Senegal) 38 mucous diaphragms of cervical esophagus were discovered. 36 patients are Black Senegalese; 29 females and 9 males with a mean age of 37. Dysphagia was present 29 times and anemia 22 times. Endoscopies diagnosis is easy, putting into light a mucous diaphragm at the level or immediately below Killian mouth. 18 of these cases have been classified as Kelly-Paterson syndrome. Performed in 30 patients, the treatment consists in breaking down the mucous diaphragm with an endoscope. It is difficult to keep on endoscopic monitoring, although it is essential because the risk of cancerisation.

[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]

[Diagnosis of tuberculosis by specific DNA amplification directly in samples]. / Diagnostic de la tuberculose par amplification d'ADN spécifique directement dans les échantillons.

The polymerase chain reaction (PCR was used to identify M. tuberculosis in specimens from patients with suspected pulmonary tuberculosis. A segment of the IS 6110 sequence and of the Cro EL gene were amplified and identified by hybridization with specific probes labeled with peroxidase. The results are in agreement with those obtained using standard microbiological techniques or clinical criteria. The PCR method allowed the detection of M. tuberculosis in 22 out of 58 samples that were acid fast staining negative. The number of patients with at least one positive sample by PCR was much higher in the group with suspicion of tuberculosis (14/28) than in the control group (3/23). This demonstrates the possibility of using PCR technology in endemic areas for tuberculosis.

[Diagnostic suspicion. Clinical, epidemiological, radiological, and endoscopic aspects of bronchopulmonary cancer in Senegal. Apropos of 700 endoscopies performed at the Hôpital Principal de Dakar from 1987 to 1990]. / De la suspicion au diagnostic. Aspects clinique, épidémiologique, radiologique et endoscopique du cancer bronchopulmonaire au Sénégal. A propos de 700 endoscopies effectuées à l'Hôpital Principal de Dakar de 1987 à 1990.

700 bronchial fiber endoscopies were performed at Dakar Main Hospital over a period of 3 consecutive years. 40 broncho-pulmonary cancers were identified (34 epidermoids, 4 adeno-cancers, 2 small cell cancers) among the 80 suspect cases. Comparison of clinical, radiological and endoscopic data revealed the following information: 1. most frequently radiology showed retractile, pulmonary condensation syndrome (40 cases); 2. a large predominance of close, bulging tumours (45 times) in relation to endoscopic bronchial stenosis (22 times); 3. almost exclusive identification of bronchial epidermoid cancer in this series (34 times); 4. the masculine sex and use of tobacco remain 2 unavoidable elements in this pathology. Bronchial endoscopy, a simple, indispensible examination, allows the lesion to be visualized, and a biopsy, on its own or associated with endoscopic cysto-brushing and alveolus washing, can then furnish conclusive histological proof.

[Mucoid webs of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the Hôpital Principal of Dakar. Relationship to Plummer-Vinson syndrome]. / Diaphragmes muqueux de l'oesophage cervical. A propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Plummer-Vinson.

Thirty-eight cervical esophageal mucous diaphragms were discovered in the course of 15,000 high endoscopies carried out over the past 5 years at Dakar General Hospital. Thirty-six of the sufferers were Black Senegalese. The 29 women and 9 men had an average age of 37 years. Dysphagia was diagnosed 29 times, and anemia 22 times. Endoscopic diagnosis readily shows the mucous diaphragm at the level of, or immediately below, KILLIAN's mouth. PLUMMER-VINSON's syndrome affected 16 of these patients. Treatment consists in collapsing the mucous diaphragm by putting the endoscope through it: this happened to 30 of the patients. Endoscopic surveillance is indispensable because of the risk of cancer, but is difficult to perform.

[Importance of laparoscopy. Results of 600 examinations performed in the Internal Medicine Department of the Hôpital Principal of Dakar]. / Intérêt de la laparoscopie. Résultats de 600 examens effectués dans un service de Médecine Interne à l'Hôpital Principal de Dakar.

At Dakar General Hospital between 1984 and 1989, 402 men and 198 women aged between 7 and 82 years were examined by laparoscopy. This simple, rapid examination, well tolerated after simple premedication, should only be undertaken after complete diffusion of the pneumoperitoneum because of a major perforation risk: 2 deaths unfortunately occurred during the above series. CPF's and cirrhosis account for more than half the cases (52%) and Laparoscopy is most useful in exploring the peritoneal pathology. Laparoscopy led to 68 cases of tuberculosis, 28 of peritoneum carcinomatosis, and 11 of infectious peri-hepatitis being diagnosed, and remains a major examination method perfectly adapted to the hepato-peritoneal pathology so common in Black Africa.

[Pericardiac tamponade revealing a lympho-epithelial thymoma (author's transl)]. / Tamponnade péricardique révélatrice d'un thymome lympho-épithélial.

An inaugural pericardiac tamponade performed on a 39 years old man, reveals a lympho-epithelial thymoma. The anatomic diagnosis first suggested by the radiography after evacuation of the effusion, is confirmed by the swab taken during the retroxiphoidal drainage. A 57 Gray cobaltotherapy was then performed. 18 months later, a satisfactory general state, allowed the patient to return to his professional activity. The evaluation of a tumourous residue by a tomodensitometry, is discussed at the light of a comparable observation confirming the efficiency of cobaltotherapy but, at the same time, its agressivity for such an important target volume. A previous surgical reduction, whenever possible, is then considered; an unthinkable eventuality in the reported observation.