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.

[Epidemiology of cancer of the digestive tract in Senegal. Review of 18,000 endoscopies performed at the Principal Hospital of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. Apport de 18.000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 alimentary tract cancers were discovered in 219 black males and 95 black females at the occasion of 18.000 endoscopies (high or low) performed during the 5 past years at the Principal Hospital (Dakar-Senegal). Mean age of the patients was 50, gastric cancer (170 cases) was the most frequent localization, then rectocolonic one (71 cases) and oesophageal one (61 cases). The more frequent utilization of endoscopy and may be a modification of diet in urban milieu might explain such a high frequency of discovery of alimentary tract cancers in Dakar.

[Crohn's disease. Apropos of 2 recent cases collected at the Dakar Central Hospital]. / Maladie de Crohn. A propos de deux observations récentes recueillies à l'Hôpital Principal de Dakar.

This report covers two cases of Crohn's Disease, one in a 27 year old Senegalese woman, the other in a 38 year old Senegalese man, both presenting abdominal pain, diarrhoea and loss of weight over several months. The ulcerated lesions were staged on the colon, respecting the rectum, and reached the ileum in one patient and the esophagus in the other. Following X-rays, endoscopy and consideration of the history, Crohn's Disease was diagnosed. Treatment with corticoids produced rapid improvement with the ulcers healing after one month. The unusualness of Crohn's Disease in Black Africans adds interest to these two observations.

[Epidemiology of digestive tube cancers in Senegal. Apropos of 18,000 endoscopies carried out at the Hospital Principal of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. A propos de 18,000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 bowel cancers were discovered in 219 men and 95 women of negroid race in the course of 18,000 upper and lower endoscopies taken over the past 5 years at Dakar's Main Hospital. The average age of the sick persons is 50 years. Gastric cancer (170 cases) is the most frequent, followed by recto-colic cancer (71 cases) and oesophagian cancer (61 cases). The use of endoscopy and perhaps dietetic changes in the urban area, explain the large number of bowel cancers discovered in Dakar.

[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]

[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.

[Campylobacter pylori and the gastric mucosa. Apropos of the detection of Campylobacter pylori in 12 patients with gastric mucosa lesions]. / Campylobacter pylori et muqueuse gastrique. A propos de la mise en évidence de Campylobacter pylori chez 12 patients porteurs de lésions muqueuses gastriques.

The authors report the results of systematic research on Campylobacter pylori during high endoscopy. Of the 60 patients examined, 12 were found to have the germ in their antral, gastric mucosa. All these patients had a history of chronic gastritis. They recall the role of this germ in creating chronic gastritis, and evoke the hypothesis that the mucosa becomes fragile facilitating the appearance of an ulcer.

[Acute leukemia in Dakar. Retrospective study apropos of 36 cases]. / Les leucémies aiguës à Dakar. Etude rétrospective à partir de 36 cas.

This study of acute leukaemia in adult at the two main hospitals in Dakar- the General Hospital from January 1980 to June 1986 and the A. Le Dantec Hospital from January 1978 to June 1986 - shows the progression of this ailment, which remains rare (0.85% of admissions - 5 cases per year). Certain clinical peculiarities are stressed (high frequency of infectious symptoms, considerable splenomegaly , adenopathy often present in acute myeloid leukaemia. More severe biological signs are evident than in series in the West, and (L.A.M.3) forms dominate. Grave developments are often the result of a shortage of diagnostic and therapeutic equipment. The authors stress the need to create a haematological clinic.

[Gelatinous disease of the peritoneum of appendiceal origin. Apropos of 2 Senegalese cases]. / Maladie gélatineuse du péritoine d'origine appendiculaire. A propos de deux observations sénégalaises.

The authors report two cases of Peritoneum Gelatinous Sickness of appendicular origin, occurring in male adults aged 65 and 57. Laparoscopy practised on an extended abdomen showing non-homogeneous dullness confirmed the diagnosis in both cases. The laparotomy highlighted the gelatinous substance and led to appendicectomy aimed at the mucocele. They take this opportunity to discuss the unusualness of this affliction in Africa, and recall the clinical and etiological means and the diagnostical difficulties that this disease evokes.

[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.

Antibodies to HIV2 in genital secretions.

In order to study the local immune response to HIV2, three exclusively heterosexual, infected West African patients were selected: one male with full blown AIDS, one female with ARC and one healthy HIV2-carrier female. Sera and genital secretions were obtained and tested for anti-HIV2 IgG and IgA antibodies by Western blotting. In semen and in vaginal secretions, IgG antibodies directed against all viral antigens were detected. In comparison with the IgG response, local IgA antibody response was less intense and heterogenous. Two out of 3 patients had local antibodies of the IgA class directed against the envelope glycoprotein GP105. Such antibodies of both the IgG and IgA classes in genital secretions could play a protective role in heterosexual transmission of HIV2.

[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.

[Geographical distribution and pathogenesis of chronic calcifying pancreatitis in tropical zones. Results of a multicenter survey in French-speaking Black Africa]. / Distribution géographique et pathogénie des pancréatites chroniques calcifiantes en zones tropicales. Résultats d'une enquête multicentrique en Afrique Noire francophone.

Chronic calcifying pancreatitis (CCP) is rare in countries with low alcohol consumption except in some tropical countries where malnutrition is widespread (southwest India) and in which CCP occurs in young non-alcoholics. In Black Africa sporadic cases of CCP have been reported in English-speaking countries (Uganda, Nigeria). The purpose of this study was to: a) assess the geographical distribution of CCP in French-speaking Africa; b) estimate the relative proportion of alcoholic CCP (ACCP) and juvenile tropical pancreatitis (JCCP). A total of 92 cases were included in this study, conducted in 16 French-speaking African countries (including Madagascar). There were no cases in countries with partly desert to climates and Moslem populations. Of these 92 cases, 86 corresponded to ACCP due to over consumption of various types of alcoholic beverages depending on the region. All were males with a mean age at diagnosis of 40.7 yrs. The remaining 6 cases were JCCP which were observed in areas of malnutrition with low intakes of animal protein and lipids. In this group the male/female ratio was 1/1 and the mean age at discovery was 15 yrs. Manioc toxicity did not appear to play any role. The "mixed" form, i.e. associating current alcohol consumption with childhood malnutrition, which has been described in young moderate drinkers in Burundi, was a possibility in 4 of the 86 cases of ACCP.