Nephrotic syndrome in Trinidadian children

Fifty seven children with idiopathic nephrotic syndrome who were seen at two hospitals in Trinidad between 1989 and 1995 (median follow-up period, 38 months) were classified according to their response to glucocorticoids. 27 (47 percent) were two to six years old at presentation; 37 (65 percent) were of East Indian descent, 7 (12 percent) were of African descent, and 12 (21 percent) were of mixed race. 55 (96 percent) responded to glucocorticoids. Renal biopsies in 15 patients revealed membranoproliferative glomerulonephritis and membranous nephropathy in the two patients who had not responded to glucocorticoids. Ten patients showed mesangial hypercellularity, associated with immunoglobulin deposits in 7 cases. Age, presentation with nephrotic features, mesangial hypercellularity and immunoglobulin deposits did not predict for unresponsiveness to glucocorticoids. These findings may be explained by the predominance of East Indians in the study group.(AU)

Pregnancy-induced hypertension: a predictor for the development of essential hypertension? - abstract

The burden of illness which hypertension places on the Trinidadian population is great. In an attempt to adequately plan health care delivery we examined the relationship between pregnancy-induced hypertension (PIH) and essential hypertension (EH) in our country. Ninety-eight women who had been admitted to Mount Hope Women's Hospital because of a pregnancy complicated by hypertension in 1981 were recalled to evaluate their current hypertensive status. A response rate of 34.3 per cent was obtained. We looked at predictive factors contributing to the development of EH. These included age of the patient, severity of hypertension, family history of hypertension, mother's parity and birth weight of the baby. Of the 34 women who responded, twenty-three (67.6 per cent) were not hypertensive while eleven were (32.4 per cent). Neither age nor the severity of hypertension was any indication as to the subsequent development of EH. The mother's parity, a family history of hypertension and the baby's birth weight appeared to be predictors of long-term hypertension. This study did not address other predisposing factors for the development of hypertension such as smoking or obesity. Despite similarities in the two cohorts with respect to blood pressures, more babies with birth weights < 2,500g were born to mothers who subseuqently became hypertensive. PIH was a recurring problem. Seventy-three per cent of women seen (72.7 per cent) had a previous or subsequent pregnancy that was complicated by hypertension. A prospective multicentre study in Trinidad examining this relationship between PIH and EH would substantiate these preliminary findings, albeit limited by the retrospective methodology and low recall. This information would assist future health planning (AU)

Clinical spectrum of lupus nephritis and ethnic differences on presentation at Port-of-Spain General Hospital - abstract

Over the period 1980-1989, a retrospective study of 77 patients presenting to the Renal Unit with SLE nephritis was undertaken. The overwhelming majority of patients were female (85.7 per cent) presenting at a mean age of 28 years. The ethnic distribution showed that 63 per cent of patients were of African and 19.5 per cent of East Indian descent; 1.3 per cent had a positive family history of SLE. The predominance of Africans in this study is different from the Renal Clinic population where there is equal representation of the major ethnic groups and is also different from the population of patients with significant proteinuria attending the Renal Clinic. The difference in presentation between the two major ethnic groups in this study should be further evaluated in a prospective study, using case controls (AU)

The prevalence of leptospiral antibodies in a health Tobago community - abstract

Between 1976 and 1982, blood was collected from all consenting adults in a known censused area of Plymouth, Bethesda in Tobago. Serum was tested using the ELISA test. One hundred and seventeen of 532 persons showed evidence of exposure to leptospires at titres of > 1:50. The serogroup most commonly detected was Bataviae. Agricultural workers tended to have high exposure rates particularly to Pyrogenes, Syroe, Bataviae and Canicola. The presence of animals associated with the homes studied appeared to increase exposure to leptospires (AU)

Cutaneous histoplasmosis in the acquired immune deficiency syndrome: a report of three cases from Trinidad

Three cases are reported of patients with the acquired immune deficiency syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised malculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned. (AU)

Skin biopsy and cutaneous histoplasmosis in the acquired immune deficiency syndrome in Trinidad - abstract

Eighteen patients with the acquired-immunodeficiency syndrome (AIDS) presented with primary skin manifestations at the Port-of-Spain General Hospital in 1986. The lesions included local (3) and generalised (4) dermatitis, pustules, plaques (2), crateriform ulcers (2), erythematous lesions (4) and maculo-papular rashes (7). Some patients had a mixture of lesions. The maculo-papular rashes were commonest. Full-thickness skin biopsies were stained with periodic acid-Schiff and methamanine silver; yeast forms of Histoplasma capsulatum were found in 11 cases. Three of these cases had a post-mortem examination; this revealed the presence of the fungus in all the tissues sampled which included brain, liver, spleen and lymph nodes. The skin lesions were the only presenting clinical manifestations of disseminated histoplasmosis in these patients. Histoplasmosis capsulatum is endemic in Trinidad and Tobago but clinical infection was extremely rare before the advent of the AIDS epidemic. In areas endemic for H. capsulatum, clinicians should be alerted to the fact that cutaneous lesions in patients with AIDS may suggest histoplasmosis. Given the facts that cultures may be negative and unnecessarily delay treatment, that the histoplasmin skin test is of doubtful value and that serological titres are unreliable in the immunocompromised, we advocate full-thickness skin biopsy to diagnose histoplasmosis in AIDS patients (AU)

Lupus nephritis morbidity and mortality trends at the Port-of-Spain General Hospital - abstract

Lupus nephritis has a high mortality and morbidity rate at the General Hospital, Port-of-Spain. We analysed 52 consecutive systemic lupus erythematosus patients with clinical nephritis, seen at the renal unit between January, 1983 and October, 1987. There were 44 females and 8 males. Evidence for nephritis was the presence of urinary casts, haematuria, proteinuria or an elevated creatinine level. In Trinidad, this is a disease of the young African female. The modal age group was 20-29 yrs. 71 percent of patients were of African descent, 15 percent Indian and 14 percent of mixed ethnicity. All the male patients were African. East Indian females presented with nephropathy late in the course of lupus. Proteinuria was the most frequent presentation (78 percent). End-stage renal failure was seen in 14 percent of patients at presentation. Such late presentation could have been avoided if patients with epilepsy, psychiatric disturbance and resolving proteinuria had been investigated for lupus. Classes II (37 percent) and V (23 percent) were the most frequent histological patterns. The 1-yr survival rate, over a 23-month follow-up period, was 66 percent. This low figure reflects defects in our renal substitution therapy rather than aggressive disease; uraemia (14), sepsis (7), extra renal activity (4) and hypoglycaemia (1) were the causes of death. During the short follow-up, we saw no vascular complications. Sixty per cent of dialysed patients died, after a mean time of 3.5 months, from uraemia or peritoneal dialysis-related sepsis. We could recommend maintenance haemodialysis (AU)

Behcet's syndrome with unusual manifestations

A patient with two uncommon manifestations of Behcet's Syndrome, oesophageal ulceration, and glomerular disease is presented. In both systems, as in all others affected by Behcet's Syndrome, there was vasculitis principally involving veins, venules, and capillaries. Response to conventional management was not successful. (AU)

Significant proteinuria: the Port-of-Spain General Hospital experience - abstract

Sixty-nine patients who had renal biopsies because of proteinuria of > 1 gm per day, oedema and normal sized kidneys were investigated. There were 58 adults and 11 children. Of the adults, 26 were male, and 32 female; of the 11 children, there were 10 males and 1 female. The modal age of the patients was 15 - 19 years. The majority of the patients (67 percent) had primary glomerular disease. The two most common histological patterns were minimal change and mesangio-capillary glomerulo-nephritis. Minimal-change nephritis was observed in 73 percent of children's kidney biopsies. The pattern was unlike that seen in tropical Africa. Mesangial-proliferative disease did not contribute remarkably (11 percent) to significant proteinuria. Membranous nephropathy, which usually accounts for the majority of idiopathic adult nephrotics in the developed countries, was rare in our Trinidadian series. Systemic lupus erythematous comprised the majority of patients (83 percent) who had secondary proteinuria. This may reflect a bias in the selection of patients for renal biopsy. Even though the incidence of the sickle-cell gene is high in Trinidad, sickle-cell disease did not contribute to the presence of nephropathy. The prognosis for patients with primary glomerular disease (21 percent mortality) was better than for thos with systemic disease (79 percent mortality). Our observations suggest that the pattern of proteinuria in Trinidad does not resemble that seen in tropical Africa but is some what similar to that observed in Jamaica (AU)

Acute renal failure due to multiple stings by Africanised bees: report of the first case in Trinidad

A case of acute renal failure in an adult who was stung by over 1,000 Africanised bees is reported. The patient has made full recovery. This is the first such case to be reported from Trinidad (AU)

Focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome

A few scattered reports have appeared in the literature in the last few years suggesting that focal and segmental glomerulosclerosis may be associated with the acquired immunodeficiency syndrome, leading to rapid deterioration of renal function with uraemia. This communication describes the first such case seen at Port-of-Spain General Hospital, Trinidad (AU)

A review of the first fifty cases of the acquired immune deficiency syndrome at Port-of-Spain General Hospital - abstract

A review of the first fifty cases of AIDS seen at the General Hospital, Port-of-Spain, is presented. There were forty-six males, one female and three children under two years of age. Forty-five patients (90 percent) were of African descent and four (8 percent) were of mixed descent. There was one East Indian child. Twenty-three males (50 percent) were homosexual, twenty bisexual (44 percent, two (4 percent) admitted only to heterosexual promiscuity and one (2 percent) was associated with a previous blood transfusion. The heterosexual population is therefore at risk because of the high incidence of bisexuality. There were no cases of transmission by intravenous drug abuse. The three infants were in the most common risk group for Paediatric Acquired Immuno-Deficiency Syndrome (PAIDS) as one or both of their parents were HTLV-III antibody positive. The spectrum of opportunistic infection is different in Trinidad from the United States. Toxoplasma gondii and Histoplasma capsulatum are more common than Mycobacterium avium intracellulare and Pneumocystis carinii. Kaposi's sarcoma is rare. Only six patients were diagnosed as having AIDS on admission. The other admission diagnoses included neuro-psychiatric disorders, renal failure, lymphoproliferative disease, viral illness, typhoid fever, malaria, pyrexia of unknown origin, failure-to-thrive, secondary syphilis and lymphogranuloma venereum. Our high mortality rate (86 percent) is probably a reflection of our inability to identify all the opportunistic infections (AU)

Paediatric acquired immune deficiency syndrome: report of the first case from Trinidad

A case of Acquired Immune Deficiency Syndrome (AIDS) in an infant at the age of 5 months is reported from Trinidad. The father who was bisexual died from AIDS before the birth of the child. The mother is HTLV-III antibody-positive and is healthy at present. This is the first report of paediatric AIDS (PAIDS) from Trinidad (AU)