[Human immunodeficiency virus associated arthritis in Congo Brazzaville]. / Les arthrites liées au virus de l'immunodéficience humaine au Congo Brazzaville.

OBJECTIVE: The authors report epidemiologic, clinical, para clinical, and evolutive aspects of arthritis related to HIV in an AIDS endemic country. MATERIAL AND METHODS: A retrospective study was made in the rheumatology department of the Brazzaville University Teaching Hospital during 15 years and 6 months, on 3.042 in-patients among whom 306 (10%) were positive for HIV, 220 (7.2%) presented with a rheumatologic manifestation, and 158 (71.8%) with HIV related arthritis. RESULTS: The 158 patients included 91 men (57.6%), 67 women (42.4%), average 34.5 years of age, ranging from 15 to 61, all heterosexual. 99 patients (62.7%) were in the B stage, 40 (25.3%) in the C stage, and 19 (12.2%) in the A stage. Arthritis was polyarthritis (83.5%) or oligoarthritis (16.5%), symmetrical (97.5%), prevailing on the lower limbs (99.3%) with involvement of the great toe in 23% of cases. There was an important inflammatory syndrome with an erythrocyte sedimentation rate exceeding 100 mm for the 1st hour in 63.3% of the cases. Rhumatoid factors were negative. Synovial fluid was sterile, without microcrystals, and inflammatory. X-rays were normal. This non-destructive arthritis, evolved by successive bouts, and resolved in 2 to 5 weeks with NSAIDs and did not meet Amor nor European spondyloarthropathy criteria. CONCLUSION: Arthritis related to HIV represents the principal expression of nonseptic rheumatologic HIV manifestations in Congo.

[Septic arthritis in tropical environment. 176 cases report in Brazzaville]. / Les arthrites septiques en zone tropicale. a propos de 176 cas observes a Brazzaville.

OBJECTIVE: We report epidemiologic, clinic, para clinic, therapeutic and evolution aspects of septic arthritis in African tropical zone. MATERIAL AND METHODS: Retrospective survey in rheumatologic department of Brazzaville University Teaching Hospital over a period of 15 years and 6 months carrying on 176 septic arthritis observed among 3042 hospitalized patients. RESULTS: 70 men (39.77%) and 106 women (60.23%) average 35.25 years old, extremes 6 and 81 years. It was 158 cases of banal germ arthritis (89%) and 18 cases of tuberculosis arthritis (11%). The arthritis localised on knee in 42% of cases, hip 30%, sacroiliac joint 17% and shoulder 7%. Localization was multiple in 12%. A portal of entry was identified in 54% of cases. It was cutaneous in 21.5% and obstetrical in 16.5%. Risk factors were alcohol and tobacco (5.6%), diabetes mellitus (4%), sickle cell anaemia (4%) and HIV (3%). The diagnosis delay beyond of one month has been noted in 2/3 of cases. The causal germ can be isolated only in 30% of cases. It was staphylococcus aureus in 46.4% of cases, streptococcus in 10,7% and enterobacteria in 10.7% of cases. Koch bacillus has been isolated in 32% of cases. Inflammatory syndrome was important with an erythrocyte sedimentation rate upper 50 mm in 71% of cases. On X-ray, we noted in 64% of cases cartilaginous destruction signs and erosions in mirror. Antibiotics treatment associated to plastered immobilization were successful in 78% of cases but with functional prognostic in half of cases. The middle length of hospitalization was 25 days. Four patients died. CONCLUSION: Septic arthritis are very frequent in African tropical environment, localized to knee, hip and sacroiliac joint. Staphylococcus is recovered in the half of cases and Koch bacillus in 1/3 of cases. Late diagnosis explains cartilaginous destructions and ulterior functional prognostic.