Donovanosis with auto-amputation of penis in a HIV-2 infected person.

Donovanosis is a slowly progressive, granulomatous ulcerative disease , caused by Klebsiella (Calymmatobacterium) granulomatis. The disease is known to persist for years together, leading to complications. A male patient aged 30 years with underlying HIV-2 infection presented to the department of STD with painful ulceration over the genital region of 5 months duration, with absence of penis. Tissue smear from the ulcer and histopathological examination revealed large histiocytes with intracellular Donovan bodies (Pund cell). A final diagnosis of donovanosis with auto-amputation of penis with HIV-2 infection was made. The old conventional medicines, viz. streptomycin, doxycycline and amoxycillin, were effective. Though HIV-2 infections are milder than HIV-1 infections in all aspects, donovanosis in this HIV-2 infected case presented with complications. However, since the CD4 count was 748 cells/cmm, the severity is attributed to the long standing nature and negligence by the patient, and not to possible immunodeficiency.

Seroprevalence of HIV infection among leprosy patients in Agra, India: trends and perspective.

This study compares the results of HIV seroprevalence, which was carried out in two phases, i.e., 1989 to 1993 and 1999 to 2004. Although the number of leprosy patients screened for HIV infection in the second phase is less (2125) as compared to those screened during the first phase (4025), a rise in HIV infection from 0.12% to 0.37% is certainly disturbing since this area appears to be endemic for both the infections. During the study period, the Out Patient department attendance of a few types of leprosy patients like borderline and borderline lepromatous have risen, whereas others like borderline tuberculoid and polar tuberculoid have declined in the second phase as compared to that of the first phase. The trend over a decade suggests that HIV infection is low among the leprosy patients when compared with other risk groups. Follow-up of these patients at an interval of six months, revealed that none of them downgraded into a severe form of leprosy nor developed ARC or AIDS. In this study, it appears that neither infection precipitated the other. The occurrence of downgradation as well as reversal reactions and neuritis (both chronic and acute) was not observed among the leprosy patients. None of them developed erythema nodosum leprosum reactions. Similarly, the HIV-positive leprosy cases did not develop either AIDS related complex (ARC) or full blown case of AIDS.

Serological screening for tuberculosis in the community: an evaluation of the Mycodot procedure in an African population with high HIV-2 prevalence (Republic of Guinea-Bissau).

The immuno-dot-blot assay MycoDot, which detects lipoarabinomannan (LAM) antibodies, was evaluated for the serological diagnosis of active pulmonary tuberculosis in patients in a rural community in the Republic of Guinea-Bissau. Sera from 269 adults (age > 15) and 33 children (age < 5) were assayed for antibodies in a blind manner and the results compared to the clinical status of tuberculosis. The assay had a specificity and a sensitivity of 92.4% and 63.0% respectively, when applied to the adult population. In HIV-2 infected individuals (27/269), the specificity and sensitivity of the assay were similar, 94.7% and 62.5% respectively. The assay did not provide high sensitivity for the diagnosis of tuberculosis in children. Sera from patients with leprosy cross-reacted with the antigen of the assay. It is concluded that this easily performed assay may be useful for the presumptive diagnosis of tuberculosis in adult populations in rural areas of developing countries where routine screening is not readily available.

Serological screening for tuberculosis in the community: an evaluation of the Mycodot procedure in an African population with high HIV-2 prevalence (Republic of Guinea-Bissau)

The immuno-dot-blot assay MycoDot, which detects lipoarabinomannan (LAM) antibodies, was evaluated for the serological diagnosis of active pulmonary tuberculosis in patients in a rural community in the Republic of Guinea-Bissau. Sera from 269 adults (age > 15) and 33 children (age < 5) were assayed for antibodies in a blind manner and the results compared to the clinical status of tuberculosis. The assay had a specificity and a sensitivity of 92.4 per cent and 63.0 per cent respectively, when applied to the adult population. In HIV-2 infected individuals (27/269), the specificity and sensitivity of the assay were similar, 94.7 per cent and 62.5 per cent respectively. The assay did not provide high sensitivity for the diagnosis of tuberculosis in children. Sera from patients with leprosy cross-reacted with the antigen of the assay. It is concluded that this easily performed assay may be useful for the presumptive diagnosis of tuberculosis in adult populations in rural areas of developing countries where routine screening is not readily available.

AIDS and tuberculosis/leprosy in Nigeria: the urbanisation factor.

A study was conducted between February and June 1994 on the influence of urbanisation on the seroprevalence of human immunodeficiency virus (HIV) amongst tuberculosis (TB) and leprosy patients in the 4 Primary Health Care Zones in Nigeria. Results indicate that 71.4% of all smear positive TB patients and 75% of all multibacillary (MB) leprosy patients that are HIV seropositive in this study are resident in the urban areas. This study emphasizes the need for careful sample selection in studies involving HIV and tuberculosis/leprosy, and for careful monitoring of the HIV/leprosy interactions.

Prevalence of HIV infection and high-risk characteristics among leprosy patients of south India; a case-control study.

With the observation of the occurrence of the human immunodeficiency virus (HIV) infection among leprosy patients in our pilot study carried out in Tamil Nadu, South India, a case-control study was planned to explore whether HIV infection is a risk factor for leprosy and to understand the characteristics of HIV infection and high-risk behaviors among leprosy patients. We screened 556 patients and 1004 nonleprosy controls (matching 502 cases for age, sex and area of residence) for HIV-1 and HIV-2 antibodies. They also were interviewed for personal information on history of blood transfusion, intravenous drug abuse, high-risk sexual behavior, and sexually transmitted diseases. Of the 1019 total cases screened (of both pilot and extended studies), 5 were found to be position for HIV antibodies (HIV-1 = 4, HIV-2 = 1); of the 1019 nonleprosy controls, 6 were positive for HIV-1 antibodies. An analysis by odds ratio revealed no association between leprosy and HIV infection (OR = 0.824, 95% CI = 0.201-3.593). A strong association was found only between high-risk behavior and HIV infection (OR = 5.186, 95% CI = 1.717-15.667). However, unmarried, unmarried after 30 years of age, exposure to spouses of the leprosy patients, and a history of surgery were all observed to be significantly more common among leprosy patients than the controls.

HIV infection amongst leprosy patients in south India.

In a pilot study, 463 leprosy patients (374 males and 89 females) were investigated for HIV-1 and HIV-2 antibodies by screening tests. Sera positive by the screening tests were subjected to confirmatory tests. Three cases were confirmed to be positive for HIV, two for HIV-1 and one for HIV-2. All the three positive cases were young males, who had visited commercial sex workers. No correlation was found between the type of leprosy and HIV infection. This is the first report of HIV infection amongst leprosy patients from South India.

PIP: Screening for HIV-1 and HIV-2 was performed on 463 leprosy patients (374 males and 89 females) from south India because of concerns about the possible adverse effects of HIV infection on the clinical course of leprosy as well as on leprosy vaccine trials. The first ELISA test was positive in sera from 30 patients. HIV was detected in 14 of these by a second ELISA, but confirmation was found for only three cases (two by gelatin particle agglutination test, solid phase enzyme immunoassay, and Western blot tests and the third by Immunocomb test). These three cases were all young adult men whose only risk factor was that they frequented prostitutes. The presence of HIV-1 in two patients and HIV-2 in the third points to the necessity to screen for both types of infection. No correlation appeared between type of leprosy and infection. These findings have led to the initiation of a larger study.

Leprosy reversal reaction in HIV-positive patients.

We report two cases of leprosy in HIV-infected patients who, by their clinical, histological and immunological features, enhance the evidence that HIV-positive leprosy does not differ from nonHIV-positive leprosy. Moreover, extensive studies of reversal reactions in HIV-positive patients might be of great interest in determining the exact pathogenesis of this leprosy reactional state.

[Epidemiological study of HIV seroprevalence in a leprosy patient population in Senegal]. / Etude épidémiologique de la séroprévalence de l'infection par le VIH dans une population hansénienne au Sénégal.

We report the findings of an epidemiological study conducted between June 1989 and February 1990 on a population of leprosy patients in southern Senegal (Bignona major endemic disease sector). Two types of population were studied: patients living in urban areas and inmates of leprosaria. The global HIV seroprevalence (HIV 2 in all cases) of the leprosy-patient population was 1.15% (3/257): 0.8% (1/130) for the urban group and 1.5% (2/127) for the leprosaria. The seroprevalence rate does not differ significantly from that for the control group studied and for blood donors (1/221). The diagnosis of leprosy in the seropositive subjects had been established before 1980. None of them showed any sign of relapse. The immunodepression associated with the presence of HIV was only moderate: it was reflected in a lowering of the CD4 count and of the CD4/CD8 ratio, but with no clinical sign of AIDS.

Low prevalence of human immunodeficiency virus-1 (HIV-1), HIV-2, and human T cell lymphotropic virus-1 infection in Somalia.

A seroepidemiologic survey was conducted to determine the prevalence of human immunodeficiency virus type 1 (HIV-1), HIV-2, human T cell lymphotropic virus type I (HTLV-I), and Treponema pallidum infection among southern Somalis. Sera were collected from 1,269 study subjects in the urban area of the capital city, Mogadishu, and in the rural towns of Merka, Qoryoley, and Kismayo. The subjects included 57 prostitutes, 79 sexually transmitted disease (STD) patients, and 1,133 others, including outpatient and hospitalized patients with leprosy, tuberculosis, other infectious diseases, individuals from rehabilitation camps and secondary schools, and Ethiopian immigrants. Results indicated that none of the sera were positive for HIV-1 and HIV-2 by Western blot, but one was positive for HTLV-I. The prostitutes had a significantly higher prevalence of treponemal antibody (50.8%; P less than 0.0001) than either the STD patients (12.6%) or the other subjects (5.2%). Epidemiologic data indicated that 94% of the males and females were circumcised and only 2.6% of the males used condoms. Overall, the results of this study suggested a very low prevalence of HIV-1, HIV-2, and HTLV-I infections, especially among prostitutes and STD patients, who were considered at greatest risk of contracting these retroviral infections.