Geographic and temporal stability of HIV seroprevalence among pregnant women in Bujumbura, Burundi.

OBJECTIVE: To establish whether HIV seroprevalence in Bujumbura is stable or continuing to increase. METHODS: HIV seroprevalence data among pregnant women from 1986 were compared with comparable data from 1991-1992. RESULTS: HIV seroprevalence among antenatal clinic attendees at three sites was 10.5, 28.0 and 11.9% in 1986, compared with 7.7, 25.6 and 12.4%, respectively, in 1991-1992. A weighted least squares analysis showed significant differences in HIV seroprevalence between the different sites (chi 2, 71.71; P > 0.0001), but no evidence of any differences between the 1986 and the 1991-1992 prevalence levels (chi 2, 0.51; P = 0.6). CONCLUSIONS: Bujumbura appears to be in the endemic phase of the spread of HIV. The stable geographic variation among clinic populations in Bujumbura suggests the need for focused interventions, and a general need for surveillance data to be gathered from numerous sites so to identify those with the highest incidence of HIV infection.

PIP: The authors compared HIV seroprevalence data among pregnant women from 1986 with comparable data from 1991-92 to establish whether HIV seroprevalence in Bujumbura is stable or continuing to increase. They found HIV seroprevalence among antenatal clinic attendees at 3 sites to be 10.5%, 28.9%, and 11.9% in 1986, compared with 7.7%, 25.6%, and 12.4%, respectively, in 1991-92. Significant differences were found between the different sites in HIV seroprevalence, but not between the 1986 and 1991-92 prevalence levels. HIV therefore appears to be endemic in Bujumbura. The stable geographic variation among clinic populations suggests the need for and appropriateness of focused interventions, as well as a general need for surveillance data to be gathered from numerous sites in order to identify those with the highest incidence of HIV infection.

Exocrine pancreatic secretion in normal controls and chronic calcifying pancreatitis patients from Burundi: possible dietary influences.

Pure pancreatic juice composition was studied, after secretin and cerulein stimulation in 29 people from Burundi (Central Africa): 17 controls and 12 alcoholic chronic pancreatitis (CP) patients. Results were compared to similar data in France. African controls had a similar pancreatic response to hormones apart from a much lower lipase secretion than French controls. In the early non-calcified stage of African CP water and bicarbonate secretion were markedly diminished while protein and lipase concentrations were enhanced. In the late stage, secretion was exhausted except that of calcium. Nutritional data were obtained under the same conditions in 40 African controls and in 34 CP patients (including all patients tested for secretion). African controls had a very low fat intake (35.2 +/- 2.6 g/day), and patients had a higher protein and fat intake (144.7 +/- 5.9 and 66.2 +/- 4.8 g/day, respectively) than local controls: as in other countries, CP was associated with a diet enriched in alcohol, fat and protein.

Rapid, early and specific diagnosis of tuberculosis and other mycobacterial diseases in Burundi.

The potential usefulness of ELISA based serological tests to assist in rapid, early and specific diagnosis of tuberculosis was investigated. The materials were selected, based on published data and on our preliminary findings. Initially screening tests were performed using crude antigens such as Purified Protein Derivate (PPD) and a BCG-filtrate. Unfortunately, the results with these antigens were not promising. The specificity of both antigens using sera from 94 healthy controls was 64%. As a consequence of these findings, the crude antigens were excluded from further tests, and the study was continued with purified antigens. The work focused on 2 purified proteins: Antigen 60 (A60), a lipopolysaccharide-protein complex, and P32, a stress protein produced in zinc deprived cultures, identified as Antigen 85 A in the BCG reference system, both isolated from Mycobacterium bovis BCG. The commercial A60 based ELISA and our own P32 based ELISA were used to test a total of 300 sera from HIV positive, negative and unscreened individuals, mainly originating from Burundi. These sera were collected from clinical established cases of pulmonary TB, extrapulmonary TB, and patients with non-tuberculous tropical diseases such as salmonellosis, trypanosomiasis, malaria, etc. and healthy individuals. The A60 based ELISA had a sensitivity of 76.8% for the proven cases of active pulmonary tuberculosis and 61.9% for the extrapulmonary tuberculosis cases. No difference was shown between HIV positive and HIV negative patients. Specificity reached 95.2% for healthy individuals, but dropped to 68.1% when persons with active non-tuberculous tropical diseases were included. Eighty-six percent of the pulmonary cases and 87.7% of the extrapulmonary cases were detected by the ELISA-P32. These findings suggest that this test might be useful as a confirmatory test for the diagnosis of extrapulmonary tuberculosis. Again no difference was noticed between HIV negative and positive patients. The main contraindication for the use of the ELISA-P32 for the diagnosis of tuberculosis is its low specificity: 70.2% with sera from healthy controls and 22.2% for hospitalised patients and persons with non-tuberculous tropical diseases. In a small recent prospective study 4 out of 10 HIV+ persons with no evidence for TB yielded a positive result for the ELISA-P32. Two of them developed pulmonary tuberculosis within 6 months, whereas 2 P32-positives and 6 P32-negatives remained up to now without any manifestations of tuberculosis. The difference was not significant, but the number of cases was limited.(ABSTRACT TRUNCATED AT 400 WORDS)

Staining methods for the diagnosis of cryptosporidiosis: appraisal.

Simple methods which can be used in any modest laboratory for the diagnosis of Cryptosporidiosis in human and animal faeces are described. These methods may be applied to duodenal and lung aspirations. The Ziehl-Nelseen and Köster modified methods were found to be suitable in the diagnosis of Cryptosporidium due to their specificity and simplicity as compared to other staining methods. Köster modified method is more specific in demonstrating the sporozoïtes.

AIDS-associated cryptococcosis in Bujumbura, Burundi: an epidemiological study.

Cryptococcus neoformans var. neoformans was isolated from domestic dust in 54% of houses occupied or recently occupied by AIDS+ cryptococcosis patients and in 20% of control houses randomly chosen in Bujumbura, Burundi. It was not isolated from wards of similar patients in the University Hospital. This seems to prove that patients could not contaminate their own environment and that the presence of C. neoformans var. neoformans had another origin. In 40% of the cases, patients admitted contact with pigeons in the city and pigeon coops are frequently positive. We are convinced that the pigeon coops of the city play a part in the contamination of HIV+/AIDS patients; however, some patients denied any contact with pigeons and in these cases, the only possible source of contamination identified thus far is domestic dust, although the origin of the yeast remains unknown.

PIP: Researchers took 800 samples from the environment in Bujumbura, Burundi to examine the role of Cryptococcus neoformans var. neoformans in HIV positive/AIDS patients. Specifically they took 375 dust samples from 25 houses of 24 AIDS patients with cryptococcosis (1 patient had 2 homes). 5 of the these patients lived in 1 area. So the researchers also took control samples from the same area. They also obtained contact plate samples from 10 internal medicine wards (4 with AIDS/Cryptococcosis patients, 2 AIDS patients who did not have cryptococcosis, and 4 vacant wards) in Kamenge University Hospital. The researchers isolated C. neoformans var. neoformans in the dust of 54% of the homes either occupied or recently occupied by the patients and in the dust of 20% of the control homes. Further 40% of the patients reported contact with pigeons. In fact, the researchers were able to sample the avian source of 25% (6) of all patients. They detected high doses of C. neoformans in 5 of the 6 pigeon coops. In those patients who did not report contact with pigeons, the researchers assumed these patients contracted cryptococcosis from spores in domestic dust. No spores were evident in the hospital wards including those with AIDS patients with cryptococcosis. Even though the researchers experiments with dissemination of spores did not reveal the extent of contamination they expected, they were sure that pigeon coops do play a contributory role in contaminating HIV positive and AIDS patients. Further they were concerned that AIDS patients who have received successful cryptococcosis treatment could be reinfected by returning to a home contaminated with dust harboring spores.

[Cryptococcosis in Bujumbura, Burundi. Apropos of 80 observed cases in 42 months]. / La cryptococcose à Bujumbura, Burundi. A propos de 80 cas observés en42 mois.

Cryptococcosis is a systemic fungal disease and meningeal or meningoencephalitis involvement is the most serious complication. This is a retrospective analysis of 80 patients admitted from December 1983 to October 1985 (30 cases) and June 1987 to December 1988 (50 cases) in hospital of Bujumbura, Burundi, Central Africa. All patients have an AIDS. Clinically, the meningeal and meningoencephalitis attack prevails in 87% cases. The diagnosis in our study is essentially based on the examination of the CRL. Before the new antifungals, the treatment involved the association of amphotericin B and 5-fluorocytosine, during 6 to 8 weeks. This treatment was badly tolerated and the second falls, when the therapy was stopped, were frequent. Presently, the fluconazole is the best treatment of this affection (ailment?): it enables maintenance therapy for a disease in which the risks of recurrence and reinfection by the environment are not negligible in Africa.

[Epidemiologic aspects of gastroduodenal ulcer in Burundi. Apropos of 1,476 new cases seen in 3 years]. / Aspects épidémiologiques de l'ulcère gastroduodénal au Burundi. A propos de 1,476 cas nouveaux observés en 3 ans.

The objective of this study is to evaluate the main epidemiological characteristics of gastroduodenal ulcer in Burundi, from 3,282 high gastrointestinal endoscopies, performed over a 3-year period, permitting the diagnosis of 1,476 ulcers (45%): the duodenal ulcer is predominant, almost 93 p. cent. The sex-ratio is 2.75/1. There is a peak of maximum frequency between the ages of 20 and 29 years for duodenal ulcer. The results of this study are consistent with the series published in Africa regarding the location of the ulcer, sex and age. The frequency is high in relation with the series coming from West Africa. Two provinces in the 15 which form Burundi, share between them 50% of ulcer patients. These are the highest regions of the country (average attitude = 1,800 meters), but where the socio-cultural and dietary customs are the same as in the other provinces.

Isolation of Cryptococcus neoformans from houses of AIDS-associated cryptococcosis patients in Bujumbura (Burundi).

Cryptococcus neoformans var. neoformans, which is responsible for AIDS-associated cryptococcosis in Bujumbura, was isolated in the domestic environment of seven out of 20 patients with AIDS-associated cryptococcosis. The findings prove that in his own domestic environment, the HIV-positive patient in central Africa is frequently exposed to the yeast and these observations lead us to insist on the suitability of carrying out a systematic survey by means of soluble antigens-sensitized latex in every HIV-positive patient. This also proves the importance of a follow-up of the 'cured' patients who easily can be recontaminated after their return home.

PIP: Soil, pigeon droppings, and dust were collected from 20 houses in Bujumbura which were inhabited by AIDS-associated cryptococcosis patients. Cryptocococcus neoformans variant neoformans was isolated from samples in 7 of the houses. This finding suggests that all HIV-positive patients should be tested for cryptococcal antigen and that patients cured of cryptococcosis may be reinfected on their return home.

The association of tuberculosis and HIV infection in Burundi.

AIDS and tuberculosis (TB) are both endemic in Bujumbura, Burundi. An 11% failure rate to standard antituberculosis treatment (n = 173) was observed at the Tuberculosis Treatment Center of Bujumbura (CATB) in 1985-1986. All resistant cases (n = 19) were HIV seropositive. Among 328 consecutive cases with tuberculosis at the CATB during a 3 month period in 1986, 54.5% were HIV seropositive, which is five times higher than the prevalence in the general population in Bujumbura. More female patients than male cases were HIV antibody positive (62 versus 49%, respectively; p less than 0.02). Persistent weight loss, cough, and an anergic tuberculin test were more common in the HIV-seropositive group. Among 48 household members of HIV-seropositive patients with tuberculosis, 6 (12.5%) new cases of tuberculosis were identified, compared with none among 28 household members of HIV-seronegative patients with tuberculosis (odds ratio, 3.8; 95% confidence interval, 0.43-33.2). HIV infection is a new risk factor for tuberculosis in Africa, and HIV-infected cases of tuberculosis may be more infectious than HIV-negative patients. The AIDS epidemic may drastically complicate the diagnosis, management, and control of tuberculosis in populations in which both infections are endemic.

[Infectious diarrhea in African acquired immunodepression syndrome (AIDS). Apropos of 100 patients studied in Bujumbura (Burundi)]. / Diarrhées infectieuses au cours du syndrome d'immunodépression acquise africain (SIDA). A propos de 100 malades étudiés à Bujumbura (Burundi).

The authors carried out a prospective survey on 100 cases of AIDS in order to find out the different etiologies of infections diarrhoea in terms of frequency and diagnosis behaviour. 84 out of 100 patients got diarrhoea. All 100 patients had their stools examined, 78 underwent high digestive fibroscopy with irrigation and aspiration of duodenal liquid (IADL), 40 duodenal biopsies. 98 infecting agents were revealed in stool exams, 50 in IADL, 7 at the occasion of histopathological exam of duodenal biopsies. All together, stool exams and IADL gave evidence that Isospora belli and Cryptosporidium are the opportunistic infecting agents most often revealed (16.2 and 13.1 p.c., respectively). The role of yeasts in diarrhoea is not evident, but esophageal candidosis is the most frequent opportunistic digestive infection (48 p.c.). Anguillula is the only intestinal worm appearing to play a role: the role of bacteria and viruses cannot be evaluated precisely, but histopathological study revealed neither an atypical mycobacteriosis nor a virus disease (herpes, cytomegalovirus). If diagnosis appears to be still difficult in 1989 when confronted with AIDS and diarrhoea, it seems highly advisable to examine the stools, to perform high digestive fibroscopy with IADL and biopsies. On the other hand, indications for colonoscopy appear to be restricted.

[Parasites, etiologic agents of diarrhea in AIDS. Significance of duodenal aspiration fluid test]. / Les parasites, agents étiologiques des diarrhées du SIDA. Intérêt de l'examen du liquide d'aspiration duodénale.

A research was made on one hundred cases of diarrhoeas in Aids-patients by stool examination including examination of duodenal aspirated liquid. Concerning the examination of duodenal fluid, we founded the parasites in almost one hundred patients of the cases. Among parasites observed, Isospora belli was the most frequent (20% of cases), followed by Cryptosporidium (15%). Strongyloides stercoralis represented 10% of the cases. The majority of other parasites was miscellaneous protozoa and some helminths.

[Principle aspects of acquired immunodeficiency syndrome (AIDS) in adults in Burundi]. / Principaux aspects du syndrome d'immunodepression acquise (SIDA) de l'adulte au Burundi.

The authors describe their experience of the infection by the virus of the human immunodeficiency HIV-1 in Burundi. The acquired immunodeficiency syndrome was brought to light in 1983 by the emergence of cryptococcal meningitis, Kaposi's sarcomas, disseminated candidiasis. 109 cases of infection by the virus of the human immunodeficiency (HIV) AIDS related complex, or acquired immunodeficiency syndromes, were observed in 8 months and are related in this paper. The authors elucidate the spread and amplify the role played by lorry drivers. The frequency of recent case history: tuberculosis, zona, sexually transmitted diseases (41%). Clinical manifestations have been studied according to their clinical stage: 28 patients are AIDS related complex (25%), 81 are acquired immunodeficiency syndrome. One have to notice the frequency of tuberculosis at the stage of acquired immunodeficiency syndrome, of digestive parasitoses, not only coccidiosis, but also strongyloidiasis and colonic amoebiasis, cryptococcal meningitis, and encephalopathies caused by the virus of human immunodeficiency (HIV) at the period of AIDS. Lethal evolution is fast: 28 out of the 81 AIDS were observed up to their end, occurring in less than 60 days, as an average. Lastly, numerous opportunistic infections cannot be diagnosed because the lack of technical facilities.

[Response of Plasmodium falciparum to quinine in a hospital environment in a chloroquine-resistant region. Bujumbura, Republic of Burundi]. / Réponse de Plasmodium falciparum à la quinine en milieu hospitalier dans une région à chloroquino-résistance. Bujumbura, République du Burundi.

Plasmodium falciparum's response to quinine (7.5 g of base in 5 days) was studied in vivo in 58 adult patients hospitalized in 1985--47% presented a pernicious malaria fever three deaths were registered during treatment, two of them attributed to late hospitalization, and the third patient was struck down by a sudden acute hepatitis. Three days after treatment started 89 of the patients did not present any asexual forms. At day 7, all patients responded favourably to the treatment. Parasitemia lowered very quickly whatever the route of administration had been. Quinine had no effect on production of gametocytes during the first four days. Clinical improvement is rapidly observed and the side effects of quinine disappeared when stopping the treatment. Despite the presence in the region of an important resistance of Plasmodium falciparum to chloroquine (80% specimens), one can conclude to a satisfying susceptibility of this parasite to quinine, provided posology and divided doses are respected.