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.

[Rickettsial arteritis due to Coxiella Burnetii]. / Artérite rickettsienne due a Coxiella burnetii

Case of an 48 year old man who has presented from 1968 to 1973 a lot of diseases such as: --mitral incompletence discovered in 1968 in Madagascar island in spite of many previous clinical examinations; --acute pneumonia and heart failure in January 1973. Serological reactions of Ricketsia were quite positive; --acute thrombosis of right humeral artery in May 1973. It has been treated by surgical way, bay "desobstruction" and by pass and medical treatment chloramphenicol). Pathologic endartery has been inoculated to an hamster, cobaye. These animal became feverish, and presented an inflammation of testis. A least serological reaction of Ricketsia became positive for all of them; --few weeks, thrombosis of left femoral and posterior tibial arteries treated by surgical and medical ways. Some commens are exposed about evolution of Coxiella Burneti infections, about the frequency of arterial and cardiac lesions, and about the effect of tifomycine which seems to be decreasing and the action of cycline (doxicycline).

[Abdominal forms of Castleman's disease]. / Formes abdominales de la maladie de Castleman.

Two cases of Castleman's disease (angiofollicular lymphoid hyperplasia) with abdominal localisation are reported. The first case was a mesenteric localisation with compressive symptoms in a sixty year-old patient; its histological type was hyalino-vascular; the evolution was favorable one year later following cobaltherapy; but ultimately pathological examination of a peripheral lymph node led to the discovery of a malignant nodular lymphoma of the follicular center cell type. The second case involved the retroperitoneal space with multiple lymph nodes and IgA dysglobulinemia in a 49 year-old patient; its evolution was favorable as judged six months after surgical resection. Twenty cases of mesenteric and thirty one of retroperitoneal involvement of Castleman's diseases have been previously reported. The nosology and pathogenesis of this disease remain unclear.

[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.

[Treatment of leishmaniasis (author's transl)]. / Therapeutique des leishmanioses.

Review of the drugs at our disposal to treat leishmaniasis, according to the geographical and clinical aspects of the disease. Dosages, cautions for use and side-effects are indicated, as well as associated treatments required in visceral leishmaniasis to get full effect of the specific drug and avoid therapeutic incidents.

[Pathogenesis of chronic hemolysis in drepanocytemia (author's transl)]. / L'hémolyse chronique et ses mécanismes dans la drépanocytose.

Frequently chronic hemolysis is not obvious in drepanocytemia and must be looked for with proper technics. Its origin lies chiefly in the corpuscular process of sickling but extra-corpuscular factors must be considered, and among them the role of spleen seems prevailing.

[Etiological factors in Burkitt's disease]. / Circonstances étiologiques de la maladie de Burkitt.

Different aetiological factors of Burkitt's disease, or Burkitt's lymphoma (BL) are considered in an analytical, then synthetical point of view, according to present admitted facts. Epidemiologic data are recalled in order to assign a place to the disease. Relations with Epstein-Barr virus (E.B.V.) are well-known by comparative pathology (connections between animal tumors and herpetic virus), virologic and serologic studies; the role of E.B.V. is based on the presence of viral genomas and nuclear antigens in tumoral cells of B.L.; there are B.L. without E.B.V., but constantly improved study of anti-E.B.V. antibodies, and viral markers, will may be decrease their number. Connections with malaria caused by Plasmodium falciparum are recognized. Discovery of chromosomal aberrations is a new important stage. At the present time, it is generally guessed that: a) the initiation of malignant process might be induced by E.B.V. b) an external agent might cause the promotion of cellular division. c) chromosomal abnormality might be responsible for the malignant transformation.

[Pathophysiology of drepanocytemia (author's transl)]. / La drépanocytose: étude physiopathologique.

The mutational molecular processes are reminded with recent advances in the understanding of the sickling phenomenon and the pathogenesy of the thrombotic complications. New therapeutic prospects are considered.

[Typhoid fever in adult patients in Ouagadougou (analytic study of 124 cases) (author's transl)]. / La fièvre typhoïde de l'adulte à Ouagadougou. Etude analytique de 124 observations.

The authors study clinical and evolutive aspects of 124 cases of typho-paratyphoïdic fever carried out in Ouagadougou. Main features are emphasized and compared to series previously recorded in other tropical countries: -the most frequent form is the conventional one with fever-diarrhoea-vomiting, headache and abdominal pain; -10,4 p. 100 of the cases present further complication, with 13 fatal issues, mostly due to acute encephalitis and to the delay reporting to the hospital; -treatment raised no special problem, Eberth bacillus which is the most frequently detected germ, being still very sensible to phenicoles derivatives.

[Medical treatment of schistosomiasis (author's transl)]. / Thérapeutique médicale des bilharzioses.

After a brief reassessment of the pathogenic problem, the authors review the presently available drugs and their respective dosage and side-effects. Then they consider each of the four parasitological types of schistosomiasis and indicate the most active treatment.

[Cutaneous leishmaniasis in Algeria (author's transl)]. / La leishmaniose cutanée en Algérie.

Report of 27 cases and comments on their epidemiological, clinical, immunological features and on the question of their treatment and prophylaxis.

[Pseudomembranous colitis after antibiotic therapy associated with the presence of Entamoeba histolytica histolytica. Apropos of 2 cases]. / Colites pseudo-membraneuses post-antibiotiques associées à la présence d'Entamoeba histolytica histolytica. A propos de deux observations.

The authors report on two cases of pseudomembranous colitis (P.M.C.) developed in two Senegalese women of 38 and 36 years, and discovered at the 4th and 5th day respectively of an antibiotherapy based on ampicillin. In these two observations, cysts of Entamoeba histolytica histolytica were found in both feces and biopsies. They recall the circumstances of the occurrence, diagnosis techniques and treatment. They underline the unfrequency of this disease in Africa south of Sahara and they discuss the correlation with amoebiasis colitis. One has to keep in mind the possibility of a P.M.C. during any antibiotherapy, and consequently to have a rectoscopy to perform. Such an exploration is enough to pose a diagnosis. In day to day practice it is not necessary to show clearly the specific germ Clostridium difficile or its entero-toxin. To stop any antibiotherapy is required and beneficial. Metronidazole or Vancomycin are the best drugs in this case.

[Rectocolonic polyps in Senegal. Results of 1500 lower endoscopies carried out at the Dakar General Hospital]. / Les polypes recto-coliques au Sénegal. Résultat de 1,500 endoscopies basses effectuées à l'Hôpital Principal de Dakar.

57 polyps were discovered during 1,500 low endoscopies, and 24 of them were adenoma. In the same period of time, 26 proctocolitic adenocarcinomas were found. Adenomatous polyps appear to be 5 times less frequent in Senegal than in industrialized countries and frequency of colitic cancer should be of the same frequency, that is far less negligible. Even if proctocolitic cancer does not set up any Public Health problems one could envisage systematic screening of polyadenoma in every patient aged more than 40. Proctosigmoid being the seat of most adenoma, fibrosigmoidoscopy appears well adapted to this kind of screening because it does not require any preparation, it is easy to perform and well accepted.

[Schistosomiasis of vulvae (case report and comments) (author's transl)]. / La bilharziose vulvaire (à propos d'une observation).

Report of a case observed in Malagasy Republic, caused by Schistosoma haematobium and associated with a urinary envolvement. A niridazol treatment lead to rapid recovery. Pathogenic processes of this localization are reviewed with regard to venous anatomy and parasitologic features. Venereal diseases, tuberculosis and cancer are the main affections capable to lead to mistaking. Pathology is a necessary and reliable control. Treatment is easy with niridazol or, in case of failure, with the various other specific drugs.

[Staphylococcal septicemias in Algiers (report of 14 cases) (author's transl)]. / Les septicémies à staphylocoques à Alger. A propose de 14 observations.

Staphyococcal septicemia is rare (0.19 p. 100 of admittances). The origin of this kind of infection could be located in all cases out of the sanitary units, and in 12 out of the 14 cases, patients under 30 years old were concerned. The main disorders were in pulmonary tract, kidneys and heart. A fatal issue occured 6 times due in most cases to a delayed admittance. A good study of sensitivity to antibiotics and a treatment associating several antibiotics are necessary.

[Current status of the physiopathology of pernicious malaria attacks]. / Actualité physiopathologique de l'accès pernicieux palustre.

The understanding of the pathophysiology of cerebral malaria has much benefited from the modern techniques of in vitro cultivation of Plasmodium falciparum and from a better knowledge of the biology of the parasite. The demonstration of the existence of "knob-like protrusions" explains some of the processes giving way to changes in the deep capillaries of viscera and particularly of brain. In a synthetic view one can say that this localized vasculopathy is the main factor of the pathologic changes observed in cerebral malaria.

[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]

[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.

[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.

[Value of ultrasonically-guided liver puncture biopsy in the diagnosis of primary liver cancer. Apropos of 84 cases]. / Valeur de la cytoponction hépatique écho-guidée dans le diagnostic de cancer primitif du foie. A propos de 84 observations.

Ultrasonographicaly guided fine needle aspiration of liver was performed in 84 patients having a confirmed HCC. This technics utilizes a CHIBA type fine needle, after blood coagulation tests have been checked. Out of 84 fine needle aspirations performed: 64 were positive (76,2%), 9 negative (10,7%), 11 (13,19%) were questionable (6) or nonanalysable (5). It is ascertained that the sensibility of this technics is over 75%. It should be possible to improve it by repeating such an exam in previously negative patients. The causes of failure are discussed. Tolerance of the technics is good. It is attraumatic, and of very easily performance. No accident, no mishap was noted.