Extrapulmonary and disseminated tuberculosis in HIV-1-seropositive patients presenting to the acute medical services in Nairobi.

We studied 506 consecutive adult acute medical admissions to hospital in Nairobi; 95 (18.8%) were seropositive for HIV-1, and 43 new cases of active tuberculosis (TB) were identified. TB was clearly associated with HIV infection, occurring in 17.9% of seropositive patients compared with 6.3% of seronegatives [odds ratio (OR) 3.2; 95% confidence limits (CL) 1.6-6.5]. Extrapulmonary disease was more common in seropositive than seronegative TB patients (nine out of 17 versus five out of 26; OR 4.7; 95% CL 1.01-23.6); this accounted for most of the excess cases of TB seen in seropositive patients. Mycobacteraemia was demonstrated in two of eight seropositive TB patients but in none of 11 seronegative TB patients. No atypical mycobacteria were isolated. The World Health Organization (WHO) clinical case definition for African AIDS did not discriminate well between seropositive and seronegative TB cases. Five out of seven seropositive women with active tuberculosis had delivered children in the preceding 6 months and were lactating, compared with only one out of eight seronegative tuberculous women. An association between recent childbirth, HIV immunosuppression and the development of TB is suggested.

Hydatid disease: research and control in Turkana, III. Albendazole in the treatment of inoperable hydatid disease in Kenya--a report on 12 cases.

The results of treatment of 12 cases of inoperable hydatid disease in Kenya using albendazole at a dose of 10 mg/kg body-weight for eight weeks are reported. In all the cases there was marked regression and collapse of the cysts but a further four weeks course of treatment at a higher dose of 15 mg/kg was given to two cases because they both still had a large number of demonstrable cysts on ultrasonography at eight weeks. No side effects of the drug were noted. Albendazole is likely to play an important role in the control programme in Turkana.

New foci of cutaneous leishmaniasis in central Kenya and the Rift Valley.

Active case detection and investigations of sandfly resting places in suspected transmission sites of cutaneous leishmaniasis in central Kenya and the Rift Valley resulted in the identification of several foci of the disease in Samburu, Isiolo, Laikipia, Nakuru and Nyandarua districts. The foci occurred in areas ranging from semi-arid lowlands at 400 m altitude to highland plateaux at 2500 m, including the floor of the Rift Valley, and were mostly inhabited by recently settled communities, nomads and migrant charcoal burners. Four species of Phlebotomus, 3 of the subgenus Larroussius (P. pedifer, P. aculeatus and P. guggisbergi) and one Paraphlebotomus (P. saevus) were collected from caves, rock crevices and tree hollows found in river valleys and in lava flows.

Suppression of T-cell proliferative response in Plasmodium falciparum malaria patients--preliminary results.

We report suppression of T-cell proliferative responses to P.falciparum specific antigen and mitogens. T-cells derived from malaria patients were co-cultured with P.falciparum antigen or mitogens and the T-cell activity determined by radioactive thymidine incorporation assay system. We found inhibition of T-cell responses to P.falciparum antigen in 13 out of 24 malaria patients studied. The suppression ranged from 4%-60%. Results of mitogenic responses of T-cells showed a wide variation. Suppression of concanavalin A (Con A) responses ranged from 48%-64% (4 out of 10 patients) while phytohaemagglutinin (PHA) responses varied from 4%-60% (8 out of 10 patients) and those of purified protein derivative (PPD) antigen from 12%-44% (3 out of 6 patients). Together, these preliminary results show a marked impairment in T-cell responses to parasite antigen and mitogens in P. falciparum infected patients.

Usefulness of indirect haemagglutination (IHA) and enzyme-linked immunosorbent assay (ELISA) in the diagnosis of human hydatidosis.

This communication reports on the usefulness of the IHA test and the ELISA in the diagnosis of human hydatid disease. The study was conducted on 40 surgically confirmed cases of hydatid disease, 40 normal individuals, and sera from individuals with various parasitic infections and other conditions namely: hook-worm-8, taeniasis-5, schistosomiasis-10, malaria-15, visceral leishmaniasis-12, multiple myeloma-3, syphilis-6, and gonorrhoea-10. The results show a sensitivity of 85% and specificity of 100%. The results indicate that it is no longer scientifically rational to hold the view that the Turkana do not mount adequate immune response against Echinococcus infections.

Blackwater fever at the Kenyatta National Hospital in Kenya: a case report.

Blackwater fever was an important cause of morbidity and mortality in the beginning of this century particularly in West and Central Africa. There has been a marked reduction in the incidence of blackwater fever since 1950 and only sporadic cases occur nowadays. At the Kenyatta National Hospital, three cases of blackwater fever have been seen in the past four years whereas not a single case had been reported between 1975 and 1988. Two of the patients fit into the classical description of blackwater fever and one was possibly due to drug induced haemolysis in a G6PD deficiency patient.

The amino acid and fatty acid composition of the thermostable lipoprotein ("Antigen 880") of hydatid cyst fluid (HCF).

Analysis for the amino acid composition of "Antigen 880" was carried out by use of double dimension paper chromatography and Biotronik 2,000 automatic amino acid analyzer. By the double dimension paper chromatography, leucine, phenylalanine, tyrosine and alanine were identified as amino acid components of the protein moiety of "Antigen 880". In the Biotronik 2,000 automatic amino acid analyzer showed the concentration of the various amino acids to be as follows: isoleucine, leucine, tyrosine, phenylalanine, lysine and histidine were identified as amino acid constituents of "Antigen 880". Quantitative studies in Biotronik 2,000 analyzer showed the concentration of the various amino acids to be as follows: valine -0.85 mumol/ml; leucine - 0.22 mumol/ml. /ml; iso-leucine - 0.18 mumol/ml; tyrosine - 0.04 mumol/ml, and histidine - 0.02 mumol/ml. The fatty acid composition of the lipid moiety of "Antigen 880" was investigated by use of Gas-Liquid chromatography. In this method, C8:0. C10:0, C12:0, C14:0, C16:0 and C18 were identified as the fatty acid constituents of the lipid moiety of "Antigen 880".

Purification and partial characterization of a thermo-stable lipoprotein ("antigen 880") of hydatid cyst fluid (HCF).

A purification procedure for a HCF thermo-stable lipoprotein designated as "Antigen 880" and subsequent characterization are described. The molecular weight and PI of the lipoprotein were shown to be 240,000 daltons and 4.2 respectively. The antigenic activity of "Antigen 880" was not affected by trypsinization, pepsinization and delipidization. This suggested that the antigen activity of the lipoprotein recided in both the protein and lipid moieties. Treatment of the antigen with various concentrations of iodoacetamide and dithiothreital (DTT) and subsequent assay for antigenic activity showed that the two chemicals did not affect antigenic activity. This suggested that the di-suphide bonds were not a pre-requisite to antigenic integrity of the lipoprotein. After heating HCF at temperature between 105-121 degrees C, it was shown that "Antigen 880" was the only HCF antigen which retained activity at these temperatures. Further analysis of the supernate obtained after heating concentrated HCF at a temperature of 110 degrees C for 10 minutes by use of Sephadex G-200 column showed two peaks. Antigenic activity specific for "Antigen 880" was obtained in Peak I, while no antigen activity was found in Peak II. When Peak I was analyzed using step-by-step DEAE 52 ion exchange chromatography, only one peak was eluted with 0.2M phosphate buffer, pH 8.5. This peak had antigenic activity for "Antigen 880". Analysis by disc-gel electrophoresis of the antigenic preparation obtained from the DEAE-cellulose column revealed one protein species. "Antigen 880" was shown to be stable for 10 months after incubation at pH1-11.(ABSTRACT TRUNCATED AT 250 WORDS)

Cryptococcal hepatitis and meningitis in a patient with acquired immunodeficiency syndrome: a case report.

A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.

Pharmacokinetics of albendazole in children with hydatid disease.

The pharmacokinetics of albendazole were investigated in five children who were hospitalized at the Kenyatta National Hospital for the treatment of hydatid disease. Unchanged albendazole was below detectable level in plasma. The major metabolite present was albendazole sulphoxide. In one of the patients, the concentration of albendazole sulphone in plasma was significantly high, whereas in the other four children, only trace amounts were detected. Maximum concentrations of albendazole sulphoxide in these five children were variable and generally higher than those reported in adults by other workers. Other pharmacokinetic parameters were comparable to those found in other studies.

Disseminated histoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS): a case report.

A 27 year old female with AIDS and disseminated histoplasmosis is presented. The clinical features include fever, weight loss, productive cough, splenomegaly and moderate pallor. The initial working diagnosis was pulmonary tuberculosis. The diagnosis of disseminated histoplasmosis was made terminally from bone marrow aspirate examination. Disseminated histoplasmosis with its varied clinical picture is likely to be missed in a patient with AIDS, and therefore a high index of suspicion is necessary for diagnosis.

PIP: A 27-year old female from Nairobi was admitted to the medical wards of the Kenyatta National Hospital in May 1991. She presented with a 4-week history of productive cough, fever, weight loss, and night sweats. She acknowledged a history of contact with a patient known to have pulmonary tuberculosis. She has never received a blood transfusion. She was single and para 3 + 0. Examination revealed a sick patient, with moderate pallor, fever of 38 degrees Celsius, and who was wasted with moderate dehydration and oral thrush. There was no finger clubbing, lymphadenopathy, or pedal edema. Chest examination revealed bilateral basal pneumonia. The spleen was palpable 4 cm below the costal margin; the liver was not enlarged. The rest of the examination was normal. On admission, complete blood count showed a haemoglobin of 5.4 g/dl, total white cells were 12.5 x 10-9/L, with 82% polymorphonuclear cells and 18% lymphocytes, erythrocyte sedimentation rate (ESR) was 85 mm/hour, and platelet count was normal. The anemia was normocytic, normochromic, and no malaria parasites were seen. Urea and electrolytes and liver function tests were normal. Sputum showed no acid fast bacilli on Ziel-Neelson Stain. HIV-1 antibodies were positive by enzyme-linked immunosorbent assay (ELISA) and Western blot. Bone marrow aspirate revealed a hypercellular marrow with reversed M:E ration, dyserythropoesis, reticulum cell hyperplasia, plentiful golden yellow pigment, and clumps of Histoplasma capsulatum. Chest X-ray showed bilateral basal pneumonia. She was treated with antibiotics and intravenous fluids, but she remained febrile, her general condition progressively deteriorated, and she died a week after admission. Treatment for histoplasmosis had not been commenced, and no postmortem examination was carried out.