Unusual cutaneous cytomegalovirus involvement in patients with acquired immunodeficiency syndrome.

Two patients with acquired immunodeficiency syndrome presented unusual keratotic cutaneous lesions with a protracted course. Pathologic examination in both patients, cultures, and DNA hybridization techniques of skin biopsy specimens in the second patient were characteristic of cytomegalovirus cutaneous infection. Cytomegalovirus skin lesions are rarely described in acquired immunodeficiency syndrome in contrast with the high frequency of ocular and visceral involvement. Skin biopsy specimens may lead to early diagnosis of cytomegalovirus disseminated disease and to specific treatment.

[African histoplasmosis in Mali]. / L'histoplasmose africaine au Mali.

Twenty-four cases of histoplasmosis have been diagnosed since 1945 in native Malians (20 cases) or Europeans living in Mali (4 cases). Seventeen cases have already been published and 7 other cases diagnosed recently in Bamako or Marseille are reported here. Mali is within the African histoplasmosis zone and the Kayes district may be a particularly endemic zone. The disease affected the skin (62 p. 100), lymph nodes (46 p. 100), bones (21 p. 100), gastrointestinal tract (26 p. 100) and lungs (4 p. 100). A rare lesion of the uvula is also reported. Direct fungal and histopathological techniques are the easiest and the most effective diagnostic investigations. All cases were due to Histoplasma duboisii. Amphotericin B was used in over 60 p. 100 of cases for an average period of 3 months. The total recovery rate was 66 p. 100.

[Development of drug resistance in cases of P. falciparum malaria of African origin in a Parisian hospital. Comparison with field data and therapeutic consequences]. / Evolution de la chimiorésistance des cas de paludisme a P. falciparum d'origine africaine dans un hôpital parisien. Comparaison avec les données observées sur le terrain et conséquences thérapeutiques.

The number of P. falciparum malaria cases, contracted in Africa, diagnosed by the department of Parasitology and Tropical diseases of the Pitié-Salpêtrière Hospital Group has shown a significant increase in 1985-1986 when compared with the 15 past years (+23%). This fact is related to the spread of chloroquine or amodiaquine resistant falciparum malaria from East Africa (1980-1983: 54%) to Central Africa (1985: 54.5%) and now to a country of west Africa (Benin 1986).

[Effectiveness of treatment during osteoarticular pain crises in drepanocytosis; based on the example of pentoxifylline]. / Evaluation de l'efficacité des traitements au cours des crises douloureuses ostéo-articulaires de la drépanocytose: exemple de la pentoxifylline.

Many drugs have been used for prevention and treatment of vaso-occlusive attacks in sickle cell anemia. Pentoxifylline is one of the most recent. It increases deformability and filtrability of normal or sickled red cells. In this double-blind study it is compared with a placebo for treatment of 20 osteoarticular crisis during SS or SC sickle cell anemia in Mali. Pentoxifylline did not decrease intensity nor duration of crisis. On the other hand the clinical assessment used for testing drugs efficiency over pain seemed effective and reproducible.

[Clinical and biological consequences of human immunodeficiency virus (LAV) infection in 15 Congolese subjects]. / Conséquences cliniques et biologiques de l'infection à human immunodeficiency virus (HIV) chez 15 sujets congolais.

We report 15 cases of symptomatic HIV infection seen in Paris between June 1983 and June 1985 in Congolese patients. The first signs were diarrhea, weight loss, fever, pruritus. Disseminated lymphadenopathy was frequent. Twelve patients had AIDS, and the opportunistic infections were: isosporosis, oesophageal candidiasis, cerebral toxoplasmosis, Kaposi's sarcoma, CNS' cryptococcosis, cutaneo-mucosal.

[Estimation of the impact of the principal diseases in rural Mali]. / Estimation de l'impact des principales maladies en zone rurale malienne.

The authors assess the health impact of major diseases in the circles of Kita, Bafoulabé and Kenieba (Western Mali) by measuring, for each of them, the number of healthy days of life lost through illness, disability and death. Malaria, birth diseases, infant gastro-enteritis and pneumopathies, measles, malnutrition and hemoglobinopathies account for 58.1% of healthy life lost due to all studied diseases. Parasitic diseases (except malaria), tuberculosis, leprosy are less important than usually said; on the contrary, the impact of hepatic, cardiovascular, and eyes diseases is great. In developing countries assessing the number of healthy days lost by the community due to different diseases is usefull to choose the health priorities and to compare the cost/effectiveness ratio of different health programs.

[Importance of proctological examination in tropical environment. Apropos of 1000 rectoscopies performed at the Hospital of Bamako]. / Intérêt de l'examen proctologique en milieu tropical. A propos de 1,000 rectoscopies effectuées à l'Hôpital de Bamako.

Analysing the results of 1,000 procto-sigmoidoscopies done in Bamako (Mali), the authors asses the major indications of this examination in Africa: rectal biopsy is quite efficient for the diagnosis of schistosomiasis; hemorroides and proctitis are frequent while tumors seem rare.

[Cytodiagnosis of hepatoma. Apropos of 100 fine needle punctures of primary cancers of the liver]. / Cytodiagnostic des hépatomes. A propos de 100 ponctions à l'aiguille fine de cancers primitifs du foie.

The authors report the results of 100 liver biopsies with fine needle aspiration performed in patients with primary hepatocellular carcinoma (P.H.C.). The method is simple, quick, without danger and reliable: cytodiagnosis on aspirated material shows typical P.H.C. in 69 p. 100 of cases and probable P.H.C. in an additional 21 p. 100 of cases. Peritoneoscopic or ultrasonic guidance gives even better results.

[Hepatitis B and primary cancer of the liver in intertropical Africa]. / Hépatite B et cancer primitif du foie en Afrique Intertropicale.

During the past 15 years, a growing body of evidence incriminates hepatitis B virus as the major factor in the etiology of primary liver cancer. Epidemiological studies throughout the world reported a striking correspondence between areas where the frequency of primary liver cancer is high and where HBV infection is hyperendemic. Moreover, primary liver cancer is commonly associated with cirrhosis of the postnecrotic macronodular type. Such data suggested a sequence hepatitis-cirrhosis-PLC. Such sequence was confirmed by extensive serologic testing studies which reported a high frequency of HBV markers in PLC patients compared to matched control groups. Data collected in Senegal, Mali and Burundi on 12,000 individuals stress the importance of HBV infections in these countries, as the high rate of chronic carrier state in patients suffering from liver cirrhosis or primary liver cancer (62-63%) compared to the general population (12-17%). Other HBV markers including anti-HBs, anti-HBc, HBeAg and anti-HBe had no prognostic value in the sequence hepatitis-cirrhosis-PLC. A new HBV seric marker, the HBsAg/IgM complexes, observed in HBsAg positive individuals, is more frequently detected in PLC patients (50%) and cirrhosis (40%) than in healthy HBsAg carriers (14%). These results would indicate that HBsAg carriers are more likely to develop cirrhosis or primary liver cancer when they evidence HBsAg/IgM complexes. In conclusion, the seric markers of evolution towards primary liver cancer are: HBsAg (the highest known risk factor), the presence in such individuals of HBsAg/IgM complexes, and increased values of alphafoetoprotein.

[Hemoglobin C in a hospital milieu in Bamako (Mali)]. / L'hémoglobinose C en milieu hospitalier bamakois (Mali).

An hospital survey, performed in Bamako (Mali, West Africa) showed 7.5% haemoglobin AC, 0.4% haemoglobin CC, 1.6% haemoglobin SC and 0.2% haemoglobin CA (haemoglobin C-beta+thalassaemia). Haemoglobin C was mostly prevalent among Bobo, Mossi, Senoufo, Minianka and Dogon coming from the Southern border of Mali. Haemoglobin SC and to a lesser extent haemoglobins CC and CA often induce haemolysis and vasoocclusion. Microcytosis is common, even in the absence of anaemia.

[Problems raised by the treatment of Kaposi's sarcoma in subjects with AIDS]. / Problèmes posés par les traitements du sarcome de Kaposi chez les sujets atteints de S. I. D. A.

Kaposi's Syndrome (K. S.) was defined as a virus induced immunogenic tumour responding to interferon. It can be used as a guideline for therapeutical trials in A. I. D. S. K. S. mortality is 13%. K. S. + O. I. (opportunistic infections) mortality reaches 70% and O. I. mortality is approximately 50%. Therefore treating O. I. is a must but it is not mentioned in the paper. Attempts made to modify immunodepression, usual K. S. treatments, experimental treatments based upon similar pathogenicity (like systemic lupus erythematosus, Hansen's disease, preneoplasia dyskeratosis) were unsuccessful. Trials with alpha recombinant interferon realised at the Sloan Kettering Memorial for Cancer in New York are summarized for 74 patients and are in preliminary interpretation. Our study is based upon 13 cases studied for 14 to 4 months and comes up to the same conclusions using 18 to 36 million units/day for 6 months (6 cases) and 3 to 4 months (7 cases). For 6 full treatments the results are: 2 K. S. were cleaned up after 8 and 3 months follow up, 4 K. S. with O. I.: 3 remissions and then relapses and 1 stabilization, for 7 current treatments: 2 had to be discontinued because of bad tolerance, 1 stabilization and 4 remissions. For all treatments a decrease and a lesser gravity of O. I. can be noted during treatment. Besides flu-like syndromes, main clinical side effects, are: asthenia, general condition impairment, 2 fits were observed for which I.N.F. cannot be clearly incriminated. Daily treatment compelling and surveillance are real drawbacks. Different types of better used interferon will probably yield interesting results (40% regression or improvement).

Glucose-6-phosphate dehydrogenase and hemoglobin variants in Kel Kummer Tuareg and related groups. Indirect evidence for alpha-thalassemia trait.

A field study of glucose-6-phosphate dehydrogenase (G6PD) and hemoglobin polymorphisms was performed in 327 subjects belonging to the Kel Kummer, a highly inbred Tuareg tribe of North-East Mali, and to the contact populations. In the Kel Kummer group 11% of the investigated subjects carried the nondeficient G6PD A+ variant. No other G6PD variant was found. Hemoglobin D Ouled-Rabah was found in 21% of the subjects of this group. The presence of an alpha-thalassemic trait was also inferred from indirect evidence. The contact groups (Inedän, Iklan, Kel es Suq and Dausahaq) exhibited different polymorphisms at the G6PD and globin loci, substantiating their belonging to different ethnic stock.