Pneumocystis carinii pneumonia in HIV/AIDS patients at an urban district hospital in Kenya.

BACKGROUND: Pneumocystis carinii pneumonia has generally been regarded to be an uncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa. The reason for this has not been clear but postulates included a lack of suitable pathogenic types in the African environment, diagnostic difficulties and the more commonly held belief that African HIV infected individuals were dying early from common non-opportunistic pathogens before severe degrees of immunosuppression occured. Recently a trend has emerged at the Mbagathi district hospital whereby an increasing number of HIV infected patients are empirically treated for Pneumocystis carinii pneumonia (PCP) based on clinical and radiological features. OBJECTIVE: To determine the prevalence of PCP and clinical outcomes of HIV infected patients presenting at the Mbagathi District Hospital, Nairobi with the presumptive diagnosis of PCP. SETTING: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya. METHODS: Patients presenting with a sub-acute onset of cough and dyspnoea were eligible for the study if they were found to have bilateral pulmonary shadows and had negative sputum smears for AFBS. Consenting patients who had no contraindication to fiberoptic bronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopy procedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF was examined for cysts of P. carinii using toluidine blue stain and immunofluorescent antibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteria using routine procedures. Standard treatment with high dose cotrimoxazole was offered to all patients who were then followed up until discharge from hospital or death whichever came first. RESULTS: Between June 1999 and August 2000 a total of 63 patients were referred for bronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure, four died before the procedure could be done, one was judged too sick to undergo the procedure and three had been on cotrimoxazole for longer than five days. Thus 51 patients underwent bronchoscopy. Pneumocystis carinii stain was positive in 19 (37.2%) while death occured in 16 (31.4%) of the 51 patients. There were more deaths in those without PCP but this difference was not statistically significant (odds ratio 0.68 (95% CI 0.35-1.32; P=0.2). CONCLUSION: PCP was found to be common in HIV infected patients presenting with clinical and radiological features of the disease. The mortality rate for patients with a presumptive diagnosis of PCP is high. This study suggests that cotrimoxazole preventive therapy may be a useful intervention in symptomatic HIV infected patients in Kenya for the prevention of PCP and may avert deaths from this disease.

Alcoholism and diabetes mellitus: case report.

Two male patients with diabetes mellitus and alcohol dependence syndrome are presented. Both were married and in middle age. MI stayed alone in the city while his spouse and two children lived in the rural home. He showed no obvious underlying psychiatric morbidity. FWK was living with his family in the city. He was an alcoholic receiving psychiatric care for alcoholism. They both presented separately at different hospitals with decompensated diabetes following heavy alcohol consumption. The history and clinico-laboratory picture of both patients are presented and brief management programme and outcome are also given. Review of literature on alcoholism and its potential impact on the course and management of diabetes is presented.

[Virological and bacteriological study of materno-fetal infections in Brazzaville]. / Enquete virologique et bactériologique sur l'infection materno-foetale a Brazzaville.

Serological study of serum samples taken from pregnant women and umbilical cord and bacteriological study of vaginal secretions samples and cerebrospinal fluid (CSF) showed in mothers: T. pallidum antibody (Tp ab) 9%, Rubella virus antibody (Ru ab) 85%; HBs Ag 16%, HIV antibody (HIV ab) 4%. Microbe culture showed: S. aureus 18%, Streptococcus sp. 9%, E. coli 4.9%, Klebsiella 3.6%, Citrobacter 3.6%, Candida albicans 15%; direct immunofluorescence: Chlamydia 26%. In infants: IgG umbilical cord: Tp ab 4.8%, Rub ab: 80.6%, HIV ab 4/4, Hbs Ag 11.3% Microbe culture in CSF: global frequency: 5.1%; Streptococcus sp. 31.8%, Staphylococcus 20.5%, enterobacteriaceae 27.2%, other Gram negative bacilli 20.5%.