[Adults with sickle cell anemia in Senegal. Clinical study of 40 homozygote subjects]. / L'adulte drépanocytaire au Sénégal. Etude clinique de 40 sujets homozygotes.

While the well-documented life expectancy of patients with homozygous sickle cell anemia (SS) is 40 years in industrialized countries, this question remains unanswered in black Africa. The purpose of this prospective study was to establish the clinical phenotype for Senegal. A severity score based on 12 clinical, laboratory, radiological, and prognostic findings was calculated and correlated with age and hemoglobin F level. A total of 40 SS homozygotes over 15 years of age (mean age: 25 years) were hospitalized between January 1996 and January 1998 at the Principal Hospital in Dakar. The most common events requiring hospitalization were vasoocclusive phenomena (n = 26) but the incidence of these complications declined significantly with age (p < 0.05). The mean hemoglobin level was 4.4 mmol/l and the mean hemoglobin F level was 6.2 p. 100. The incidence of visceral involvement was low (lithiasic vesicules in 17 cases, necrosis of the head of the femur in 7, and abnormal cardiac ultrasound findings in 10). Only one patient died during the study. No correlation was found between severity score and either age or hemoglobin F level. These findings confirm that the phenotype is less severe in Senegal. However they also show that organ damage is common by the time that patients reach adulthood and thus underline the need for prevention and education to improve survival of SS homozygotes in Senegal.

[Five cases of non-typhoid salmonellosis in patients infected with the human immunodeficiency virus in Senegal]. / A propos de cinq cas de salmonelloses non typhiques au cours de l'infection par le virus de l'immunodéficience humaine au Sénégal.

Among the opportunistic infections observed during infection with human immunodeficiency virus, recurrent non-typhoid salmonella bacteriemia has not been widely documented in Black Africa. This retrospective study identified 5 cases of non-typhoid salmonellosis in a series of 27 seropositive patients, i.e. 18.5%, hospitalized over a two-year period in an internal medicine department in Senegal. All 27 patients presented general or digestive manifestations and were in the stage of full-blown AIDS. The diagnosis was salmonella septicemia in 60% of cases. The incidence of salmonella is higher in immunocompromised patients than in healthy subjects, particularly in Africa. These infections frequently lead to bacteriemia, have a strong tendency to recur, and are highly indicative of immunodeficiency. Salmonellosis which is curable should be suspected in seropositive African patients presenting general and/or digestive manifestations.

[Difficulties in diagnosing idiopathic hypereosinophilic syndrome in Black Africa. A case report observed in Senegal]. / Difficultés diagnostiques du syndrome hyperéosinophilique essentiel en Afrique Noire. A propos d'un cas observé au Sénégal.

A combination of febrile malaise with adenopathy, massive hypereosinophilia (62678 components/mm3) and visceral, cutaneous, central nervous and digestive infiltration suggesting essential hypereosinophilic syndrome was observed in a 42-year-old male Senegalese. Diagnosis was confirmed after excluding all other possible causes in particular parasitic infection and by the rapidly fatal outcome. To our knowledge, this is the first reported case of essential hypereosinophilic syndrome in West Africa. Because of the high incidence of parasitic hypereosinophilia in this region and the non-specific nature of the symptoms, diagnosis of this syndrome can be difficult. In Africa more than elsewhere, diagnosis must be made after elimination of all other possible causes based on the criteria of Chusid. Although uncommon, essential hypereosinophilic syndrome has an unfavorable prognosis even when immunosuppressor therapy is administered.

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.