RESUMEN
Dermato-venereal manifestations in HIV infection and its severe evolution stage, AIDS, is of particular importance in tropical zones: We may be suspicious of the viral infection and consequently to request serologic tests to confirm it. We get an explanation of the virus transmission during heterosexual relations by the frequent occurrence and importance of the genital manifestations, leading to consider AIDS as a true sexually transmitted disease. Beside the classical opportunistic infections, the authors draw the attention to three types of manifestations: prurigo, already well known in Haïti and Africa capillary dystrophies, already reported in Haïti donovanosis that, because its epidemiological and etiopathological peculiarities, should be listed within the possible opportunistic infection if we take into consideration the regional pathological environment. In an other correction, syphilis, lepra and cutaneous leishmaniasis have to be carefully monitored, because they are capable to evaluate unexpectedly in some immunodepressive diathesis. Importance of dermato-venereal pathology in black people in tropical zone is explained by the weakness of cutaneous corneal stratum, immunologic disorders linked up to accumulated parasitic pathologies, socio-cultural life with a sexuality without complex.
PIP: Cutaneous manifestations of AIDS in the 1st 91 cases diagnosed in French Guiana between 1982-October 1987 included 40 cases of candidiasis, 29 of prurigo, 13 of herpes simplex, 5 of trichomoniasis, 7 of human papilloma virus, 3 of shingles, 3 of donovanoses, and 1 of Kaposi's sarcoma. There were also 7 cases of seborrheic dermatitis, 6 of capillary dystrophies, and 1 of leucoplasia. 26 of the 40 cases of candidiasis were buccal or buccopharyngeal and 14 were vaginal. Such infections are intense, chronic, and easy to diagnose. Local treatment with Nystatin or Amphotericin B in solution for buccal cases and with imidazole derivatives for vaginal cases should be supplemented with systemic medications such as ketoconazole. Most herpes simplex cases are type 2 genital infections which may be chronic and extensive. A perfusion of Aciclovir usually gives good results in 5 or 6 days. Shingles during AIDS often has nonthoracic localizations; involves itching, pain, and burning sensations; is recurrent, perhaps on the contralateral side; and may leave scars. Sensitivity to Aciclovir is less than for herpes simplex. Human papilloma virus lesions that are not too large are treated locally. Although tuberculosis is in 2nd place after candidiasis among opportunistic infections in AIDS patients in French Guiana. Only 2 cases of cutaneous tuberculosis were observed. 3 cases of Donovanosis due to Calymmatobacterium granulomatis were observed, with 2 cases with 1 couple. Chronic prurigo has been observed frequently in AIDS patients in Africa and Haiti. Along with asthenia, polyadenopathies, and shingles, it is often an early sign of AIDS. The pruritus becomes more and more intense and the only treatment providing some relief is local corticotherapy. The dermatovenereal signs of AIDS in tropical environments should raise suspicions of the disease in undiagnosed cases, and they also provide an explanation for the high rate of heterosexual transmission in individuals with various disorders involving genital lesions. Some dermatological disorders common in French Guiana have not been observed in AIDS patients to date.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Infecciones Bacterianas/complicaciones , Niño , Femenino , Guyana Francesa , Humanos , Masculino , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/epidemiología , Enfermedades Parasitarias/complicaciones , Sarcoma de Kaposi/complicaciones , Enfermedades de la Piel/complicaciones , Virosis/complicacionesRESUMEN
The French Guyana is an Overseas French Department in South America, with 100,000 inhabitants among them are 20% of Haitian immigrants. At 31 December 1987, 103 AIDS cases have been recorded, 86% by heterosexual transmission. The first case dated May 1979 was retroactively diagnosed in an Haitian parturient, thank to her serum kept in the Pasteur institute of Cayenne. 44 women got their pregnancy during their HIV infection: 5 with clinical and biological evidence of AIDS, 7 developed AIDS after getting pregnant, and 10 out of these 12 women died. All of them were from a rather low social group and, generally, were not married. 43 are black (40 Haitians and 3 Guyanese Creoles), one is Indian and presented some psychic disorders. The mean age was 32 1/2 (from 15 to 51 years old). 55 babies were born: 12 developed AIDS (6 died during the first 15 months of their life); 14 are HIV +, 3 stillborns, 4 never tested and 22 developed negative reaction (with ELISA and Western-Blot) between 7.5 and 10 months of their life. Two Hutchinson's triads were observed. Prurigo is the most commonly skin manifestation observed.