Asunto(s)
Hipofisitis/diagnóstico , Adulto , Cefalea/etiología , Humanos , Hipofisitis/complicaciones , MasculinoRESUMEN
PIP: During an 8-month period in 1991-92, in Abidjan, Ivory Coast, autopsies were conducted on 156 cadavers of children (76 HIV-1 positive cadavers, 2 HIV-2 positive cadavers, and 77 HIV-negative cadavers) located in the morgue of Treichville University Hospital Center. Morgue personnel had screened 417 dead children 1 month to 14 years old for HIV-1 or HIV-2 during the same period, 80 (19%) of whom were HIV-1 or HIV-2 positive. Among the dead children younger than 18 months, 81% had HIV IgA antibodies. The age ranged from 1 to 96 months for all the HIV-infected dead children and 1 to 144 months for the HIV-negative dead children. Specific diseases found only among HIV-infected dead children included, in order of prevalence, pneumocystis pneumonia (15 months only), toxoplasmosis, herpes simplex, multinucleate giant cell encephalitis, and lymphocytic interstitial pneumonitis. Only 2 HIV-positive dead children had tuberculosis; they were older than 15 months. In both HIV-positive and HIV-negative dead children, the most common cause of death was pyogenic pneumonia. The prevalence of pneumocystis pneumonia in the HIV-positive dead children younger than 15 months was higher than it was for HIV-positive adults (31% vs. 3%).^ieng
Asunto(s)
Seropositividad para VIH/patología , VIH-1 , VIH-2 , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adolescente , Autopsia , Niño , Preescolar , Comorbilidad , Côte d'Ivoire , Femenino , Seronegatividad para VIH , Humanos , Lactante , Recién Nacido , Masculino , PrevalenciaRESUMEN
Based on autopsy findings in 70 patients infected by human immunodeficiency virus (HIV) who died in the Pulmonology Department of the Treichville University Hospital Center in Abidjan, Ivory Coast. the authors assess the incidence of tuberculosis as the cause of death and analyze the clinical, bacteriologic, and histologic features of the disease. in this population. Pulmonary tuberculosis was the first cause of death in this series accounting for 31 cases (44.2%). In 12 cases (38.7%), microscopic identification failed during hospitalization and the disease had been misdiagnosed as common bacterial pneumonia. In 29 cases (93.5%) pulmonary tuberculosis was associated with abdominal involvement. In 17 cases (54.8%) involvement of more than two organs was observed. Of the 60 abdominal sites detected during the autopsy of the 31 patients with pulmonary tuberculosis, there were 19 (31.3%) in lymph nodes, 18 (30%) in the liver, 14 (23.3%) in the spleen, and 9 (14.9%) in the kidneys. Histologic features were remarkable by the absence of typical tuberculous granulomas. The findings of this study confirm the high incidence of disseminated tuberculosis in patient infected by HIV as noted in a number of previous studies.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Tuberculosis/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adolescente , Adulto , Autopsia , Causas de Muerte , Côte d'Ivoire , Errores Diagnósticos , Femenino , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tuberculosis/patologíaRESUMEN
HIV infection predisposes to the development of non-Hodgkin lymphoma (NHL). The frequency of NHL among HIV-positive adults and children in sub-Saharan Africa is not known. In 1991-1992, a representative autopsy study of HIV infection was performed in Abidjan, Côte d'Ivoire. Of 247 HIV-positive adult (> 14 years) medical patients dying in hospital, 2.8% had NHL, 1.6% with visceral NHL and 1.2% with primary cerebral lymphoma. The estimated crude incidence of NHL among HIV-positive adults in Abidjan was 84/100,000 per year, 10-fold greater than the expected pre-AIDS incidence of NHL but less than the incidence observed among HIV-positive adults in industrialised countries. None of 78 autopsied HIV-positive children (median age = 17 months) had NHL. HIV infection augments the incidence of NHL among adults in Africa, but short survival with advanced HIV disease probably prevents the major increase in HIV-associated NHL seen in industrialised countries. Survival of HIV-positive children in Africa appears too short to permit the significant development of additional NHL; classic Burkitt lymphoma is not an AIDS-associated tumour in Africa.
Asunto(s)
Linfoma Relacionado con SIDA/epidemiología , Adolescente , Adulto , Autopsia , Niño , Preescolar , Côte d'Ivoire , Femenino , Seropositividad para VIH , Humanos , Lactante , Linfoma Relacionado con SIDA/patología , MasculinoRESUMEN
BACKGROUND: There are many reports of nocardiosis associated with HIV infection in industrialized and developing countries, but its true prevalence is unknown. MATERIALS AND METHODS: An autopsy study was performed of HIV-positive and HIV-negative patients dying on the general medical wards of a large hospital in Abidjan, Ivory Coast, in 1991. RESULTS: 247 HIV-positive adult cadavers were examined. 10 (4%) had nocardiosis of the lung, of whom 6 showed disseminated disease. 8 patients had one or more AIDS-defining pathologies, and 5 had nocardiosis as the main cause of death. Pulmonary tuberculosis was found in 87 cadavers (35%), giving a ratio of pulmonary nocardial to tuberculous disease of 1:9. No nocardiosis was seen in 42 HIV-negative cadavers. CONCLUSIONS: This is the highest recorded prevalence of HIV-associated nocardiosis in a representative sample. The prevalence of nocardiosis varies geographically, and in zones where HIV-associated tuberculosis is common, it is possible that some patients diagnosed as smear-negative pulmonary tuberculosis actually have nocardiosis. A revised strategy of sputum examination with gram stain is suggested to detect nocardia.
Asunto(s)
Seropositividad para VIH/complicaciones , Nocardiosis/complicaciones , Nocardia asteroides , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adulto , Autopsia , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico , Nocardiosis/patología , Tuberculosis Pulmonar/diagnósticoRESUMEN
OBJECTIVES: To assess the contribution of tuberculosis to the aetiology of the HIV wasting syndrome (slim) in Africa, a condition usually considered an enteropathy. METHODS: Clinical examination and representative necropsy study of adult patients positive for HIV. SETTING: Hospital medical wards in Abidjan, Ivory Coast. SUBJECTS: Adults positive for HIV. MAIN OUTCOME MEASURES: CD4 T lymphocyte counts before death, clinical and anthropometric data, and gross and microscopic pathology. RESULTS: Necropsy was done on 212 HIV positive adults. Tuberculosis was found in 41 of 93 with the clinical HIV wasting syndrome and in 32 of 119 without (odds ratio 2.1, 95% confidence interval 1.2 to 4.0). A significant association existed between the prevalence of tuberculosis at necropsy and the degree of cadaveric wasting (no wasting 25% (15/59); moderate wasting 40% (23/58); skeletal wasting 44% (42/95); P = 0.02). Wasting was also associated with a history of chronic diarrhoea, but no association existed between diarrhoea and tuberculosis. Median CD4 T lymphocyte counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhoea (< 60 x 10(6)/l). CONCLUSION: Wasting and chronic diarrhoea are late stage manifestations of HIV disease in Africa. The importance of tuberculosis as a contributing factor in the pathogenesis of the slim syndrome has been underestimated. In nearly half of patients dying with severe wasting, tuberculosis was the dominant pathological finding.
PIP: The authors explore the contribution of tuberculosis (TB) to the etiology of HIV wasting syndrome in Africa, usually considered to be an enteropathy. Clinical examinations and necropsy were performed upon 212 HIV positive adults in the medical wards of the largest hospital in Abidjan, Cote d'Ivoire. TB was found in 41 of 93 patients with the clinical wasting syndrome and in 32 of 119 without. Significant associations were found between the prevalence of TB at necropsy and the degree of cadaveric wasting, moderate wasting, and skeletal wasting. Wasting was also associated with a history of chronic diarrhea, but no association existed between diarrhea and TB. Median CD4 counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhea. The authors note that wasting and chronic diarrhea are late stage manifestations of HIV disease in Africa and argue that researchers and practitioners have underestimated the importance of TB as a contributing factor in the pathogenesis of slim disease.
Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Emaciación/inmunología , Infecciones por VIH/inmunología , Tuberculosis/inmunología , Adolescente , Adulto , Autopsia , Enfermedad Crónica , Diarrea/etiología , Diarrea/inmunología , Emaciación/etiología , Femenino , Infecciones por VIH/complicaciones , Humanos , Recuento de Leucocitos , Masculino , Síndrome , Tuberculosis/complicaciones , Tuberculosis/patologíaAsunto(s)
Osteosarcoma/patología , Neoplasias Pélvicas/patología , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Côte d'Ivoire , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Resultado Fatal , Femenino , Asignación de Recursos para la Atención de Salud , Humanos , Metotrexato/administración & dosificación , Metotrexato/economía , Osteosarcoma/tratamiento farmacológico , Neoplasias Pélvicas/tratamiento farmacológico , Prednisolona/administración & dosificaciónAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Criptococosis , Enfermedades Pulmonares Fúngicas , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Côte d'Ivoire/epidemiología , Criptococosis/epidemiología , Humanos , Enfermedades Pulmonares Fúngicas/epidemiología , MasculinoRESUMEN
BACKGROUND: HIV disease is epidemic in Africa, but associated mortality, underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Côte d'Ivoire, and the pathology of HIV-2 infection in Africa is unclear. METHODS: Consecutive adult medical admissions to a large city hospital in Côte d'Ivoire were studied in 1991, and a sample of HIV-positive deaths autopsied. RESULTS: Of 5401 patients evaluated, 50% were HIV-positive; 38% of these died, with a median survival of 1 week. At autopsy (n = 294, including 24% of HIV-positive deaths in hospital), tuberculosis (TB), bacteraemia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was < 90 x 10(6)/l. Compared with HIV-1-positives, patients with HIV-2-positivity had a greater frequency of severe cytomegalovirus infection, HIV encephalitis and cholangitis. CONCLUSIONS: In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality. The three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable. TB is an underestimated cause of the 'slim' syndrome in Africa. The patterns of pathology in HIV-2-positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries.
Asunto(s)
Infecciones por VIH/mortalidad , Infecciones por VIH/patología , VIH-1 , VIH-2 , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Adolescente , Adulto , África Occidental , Infecciones Bacterianas/complicaciones , Encéfalo/patología , Linfocitos T CD4-Positivos , Enfermedades del Sistema Nervioso Central/etiología , Enfermedades del Sistema Nervioso Central/patología , Encefalitis/etiología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Humanos , Recuento de Leucocitos , Masculino , Toxoplasmosis Cerebral/etiología , Tuberculosis/complicaciones , Tuberculosis/patologíaRESUMEN
The authors report 9 cases of rhinosporidiosis observed in Côte d'Ivoire. Young subjects are generally concerned with E.N.T. and eye manifestations. There is a male preponderance. Pathological aspects are classical. Surgery has been the only treatment with good results.
Asunto(s)
Rinosporidiosis/patología , Adolescente , Adulto , Niño , Côte d'Ivoire/epidemiología , Femenino , Humanos , Masculino , Estudios Retrospectivos , Rinosporidiosis/epidemiologíaRESUMEN
A necroscopic study, conducted in the Pathology Department of the Centre Hospitalier Universitaire (CHU) de Treichville in Abidjan, included 70 seropositive subjects who died in the Pneumophtisiology Department. We attempted to determine the different pulmonary affections occurring during infection with the human immunodeficiency virus (HIV). This study demonstrated the predominant role of tuberculosis (44%) and bacterial pneumonia (30%) which remain the predominant aetiologies. Other opportunistic affections were rare including: Pneumocystises, Mycobacteriaceae, and Cytomegalovirus infection and the Kaposi sarcoma. The absence of pulmonary cryptococcosis and non-Hodgkin lymphoma were also noted. Necroscopic examinations do not necessarily provide evidence of the in vivo pathologies, the autopsy being able to identify only the causal diseases or those present at death.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/patología , Infecciones por VIH/complicaciones , Enfermedades Pulmonares/patología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Adulto , Autopsia , Côte d'Ivoire/epidemiología , Femenino , Humanos , Enfermedades Pulmonares/etiología , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/patología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/patologíaRESUMEN
Cerebral tuberculous abscess is exceptional. We report on the case of a H.I.V. positive 29 year-old man suffering from high intracranial pressure together with a cerebellar syndrome. The CT scan revealed a voluminous abscess of the left cerebellar hemisphere. Anatomical and pathological examination of the extracted mass showed a tuberculous abscess. 16 months after surgery and antituberculous treatment, the patient's symptoms have disappeared and he has resumed his professional activities. Though controversial, a pathogenic continuum between a tuberculoma and a tuberculous abscess may be assumed to exist. The A.I.D.S. pandemic reactivates the tuberculous foci, increases the risks of contagion reduced the effectiveness of treatment, and justifies a systematic search for the bacillus of Koch, after puncture, in any cerebral abscess.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Enfermedades Cerebelosas/etiología , Infecciones por VIH/complicaciones , Tuberculoma Intracraneal/etiología , Tuberculosis/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Adulto , Enfermedades Cerebelosas/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Masculino , Seudotumor Cerebral/etiología , Tomografía Computarizada por Rayos X , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculosis/diagnósticoRESUMEN
Admissions and deaths in a pulmonary medicine ward in Abidjan, Cote d'Ivoire, West Africa, were evaluated over a 6-month period in 1989 with systematic autopsies on all patients who died. Of 473 patients admitted, 38% were HIV-1 seropositive, 4% were HIV-2 seropositive, and 14% reacted to both viruses. A total of 100 patients (21%) died, and deaths were twice as frequent in HIV-seropositive compared with HIV-negative patients. The pathology of 78 autopsies showed that the predominant cause of death in HIV-seropositive patients was disseminated tuberculosis (40%). Cancer was the cause of death in 64% of HIV-negative patients. Pneumocystosis was found in only 9% of HIV-seropositive autopsies. Since Pneumocystis carinii is an uncommon cause of death in this population, prophylaxis for P. carinii pneumonia is not warranted for HIV-infected patients in Africa. In contrast, research on chemoprophylaxis for tuberculosis is urgently required.
PIP: Between January-June 1989, researchers evaluated 473 admissions and 100 deaths at the Pulmonary Medicine Service at the University Hospital in Abidjan, Ivory Coast to determine prevalence of HIV-1 and HIV-2 infections, to look at death rates in relation to HIV status, and to examine the pulmonary pathology associated with these infections compared with deaths in HIV negative patients. HIV-1 seroprevalence was 38%, HIV-2 4%, and dual HIV reactive 14%. The death rate for the entire sample was 21%. It was higher in HIV seropositive patients than HIV seronegative patients (27% vs. 14%; relative risk=1.95 times). HIV seropositive patients regardless of HIV group essentially died from the same diseases: 40% from pulmonary tuberculosis (disseminated nonreactive multibacillary pattern), 34% from nonspecific pneumonia, 8% from Pneumocystis pneumonia, 6% from Kaposi's sarcoma, and 4% from lung cancer. Among only HIV-1 seropositive cases, Pneumocystis carinii was the cause of death in only 95 of cases. The leading causes of death for HIV seronegative patients included lung cancer (64%), nonspecific pneumonia (28%), and pulmonary tuberculosis (4%). Researchers should be pressed to develop more sensitive means to diagnosis tuberculosis as well as prophylaxis against reactivation of tuberculosis among HIV seropositive people in Africa. Since Pneumocystis carinii infection is uncommon among HIV seropositive people in Africa, prophylaxis for it is not needed.
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Síndrome de Inmunodeficiencia Adquirida/mortalidad , VIH-1 , VIH-2 , Infecciones Oportunistas/mortalidad , Neumonía por Pneumocystis/mortalidad , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/patología , Factores de Edad , Causas de Muerte , Côte d'Ivoire/epidemiología , Anticuerpos Anti-VIH/sangre , Seropositividad para VIH/epidemiología , Seropositividad para VIH/mortalidad , Humanos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/patología , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/patología , Prevalencia , Sarcoma de Kaposi/epidemiología , Sarcoma de Kaposi/mortalidad , Sarcoma de Kaposi/patología , Factores Sexuales , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/mortalidad , Tuberculosis Pulmonar/patologíaRESUMEN
Only a few reports have established the importance of chronic gastritis and Helicobacter pylori infection in Africa. The aim of this study was to ascertain the prevalence of chronic gastritis and Helicobacter pylori infection in a symptomatic population in Abidjan, Côte-d'Ivoire. The study included 277 consecutive patients referred for gastroscopy. Two hundred nine patients complained of abdominal pain without gastroduodenal ulcer or cancer: 26 had a duodenal ulcer, 23 had a gastric ulcer, and 6 had gastric cancer. The remaining 14 patients underwent gastroscopy for various other reasons. Chronic gastritis was present in 89 percent of cases, of which 96 percent showed signs of activity. There were four cases of lymphocytic gastritis. Patients with antral chronic gastritis were older (39.43 +/- 14.3 years) than those with normal antral mucosa (33.7 +/- 12 years, P less than 0.05). Helicobacter pylori was present in 91.3 percent of cases, representing all patients with active chronic gastritis, and 60 percent of the patients with normal gastric mucosa. Chronic gastritis was present in 86 percent of patients with abdominal pain, in 100 percent of those with duodenal of gastric ulcer, and Helicobacter pylori were observed in 90, 100, and 91 percent of the same patient groups, respectively. This study demonstrates the high prevalence of chronic gastritis and the very high level of Helicobacter pylori infection in Ivorian patients complaining of various gastrointestinal symptoms. The usefulness and feasibility of therapeutic trials still have to be investigated.
Asunto(s)
Gastritis Atrófica/epidemiología , Gastritis/epidemiología , Infecciones por Helicobacter/epidemiología , Helicobacter pylori/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Côte d'Ivoire/epidemiología , Endoscopía Gastrointestinal , Femenino , Gastritis/diagnóstico por imagen , Gastritis/microbiología , Gastritis Atrófica/diagnóstico por imagen , Gastritis Atrófica/microbiología , Infecciones por Helicobacter/diagnóstico por imagen , Infecciones por Helicobacter/microbiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , RadiografíaRESUMEN
The authors report a case of true hermaphroditism, a rare intersexual condition characterized by the coexistence of ovarian and testicular tissue in the same subject. The authors have analysed this unusual condition in clinical and paraclinical terms and draw conclusions regarding the psychological and surgical principles to be applied in its treatment.