[Surgery and HIV in Bangui (Central African Republic)]. / Chirurgie et VIH: impact de l'infection chez les malades opérés à Bangui (République centrafricaine).

UNLABELLED: Routine presurgical testing for HIV is a matter of controversy. The risk of intraoperative contamination and postoperative complications, especially opportunistic infections, justifies this practice. OBJECTIVE: To assess the real prevalence of HIV in surgical departments in the Central African Republic (CAR) and, more precisely, its impact on surgery patients and staff, as well as measures of prevention. METHOD: This exploratory study took place from September 1st, 2001, through October 31st, 2002, in the general surgery departments of Amitié Hospital in Bangui (CAR). The patients tested were randomly selected after surgery, and their serum tested at the hospital laboratory by ELISA methods. RESULTS: The sample included 207 patients, 58.9% of whom were women. Their average age was 32 years (range: 15-72 years. Surgery was elective for 111 patients (53.6%) (for example, for uncomplicated hernias or gynecological problems) and performed on an emergency basis for 96 (46.4%). The latter included appendectomies (20.3%), laparotomies (14%), and strangulated hernias (12%). Overall, 49 patients (23.6%) were HIV-positive. Wound infection (51 cases) and septic shock (4 cases) were significantly more frequent in HIV-positive than in HIV-negative patients, as was mortality. COMMENTS: Patients with HIV developed postoperative complications, but so did HIV-negative patients. Practitioners should stress specific care for HIV-positive patients without insisting on discriminatory testing. Especially important are sterilization of medical and surgical materials, and universal precautions and asepsis, including personal prevention measures for healthcare staff.

[Intracranial tuberculoma in Africa, with no available neuroimaging. Case report and review of the literature]. / Tuberculome intracrânien en milieu africain sans neuro-imagerie. A propos d'un cas et revue de la littérature.

The numerous extrapulmonary manifestations of tuberculosis have been well described. Intracranial localizations, including brain stem tuberculoma, are very rare. The authors report a case of brain tuberculoma in a patient with a history of primary pulmonary tuberculosis successfully treated more than twenty years earlier. The patient presented with signs of infection, although the fever disappeared temporarily after successive treatments for malaria (confirmed Plasmodium faiciparum), as well as neurological signs with left hemiparesis. Chest radiographs showed no signs of progressive pulmonary tuberculosis, and blood tests, cerebrospinal fluid testing, and HIV serology were all negative. Treatments for maxillary sinusitis, the malaria, bacterial meningitis, and cerebral abscess were equally ineffective. Brain stem tuberculoma was diagnosed only when the patient was transferred to a hospital equipped with neuroimaging equipment and was confirmed after histopathological examination of the intracranial lesion biopsies and the detection of mycobacterium DNA by polymerase chain reaction (PCR) in the cerebrospinal fluid. A review of 147 cases of intracranial tuberculoma reported in Africa between 1985 and 2001 points out the difficulties of both the differential diagnosis (tuberculoma or other intracranial space-occupying lesions) and treatment in African areas where neuroimaging is unavailable. Our patient's brainstem tuberculoma probably resulted from reactivation of latent tuberculosis.