Risk factors associated with HIV infection in Uganda.

Risk factor data were collected in 1,328 inpatients and outpatients in 1987 in 15 hospitals throughout Uganda; 42% were positive for HIV antibodies by ELISA. Seropositivity was associated with urban residence, sexually transmitted diseases (STD), number of sex partners, and sex for payment or with a person with an AIDS-like illness. Homosexuality and intravenous drug abuse, recognized risk factors in western countries, were not seen as risk factors. By multivariate analysis, urban residence and sex for payment were not independently associated with infection. Among females, number of sex partners, sex with a person with an AIDS-like illness, and numbers of episodes of STDs were significantly associated with seropositivity. In males, similar associations were seen, although number of reported sex partners was not independently associated with infection. These findings support the view that heterosexual contact is the predominant mode of transmission in Uganda and suggest that the main risk factors relate to high-risk heterosexual behavior.

Evaluation of the WHO clinical case definition for AIDS in Uganda.

Infections with human immunodeficiency virus are common in areas of the world where laboratory testing and sophisticated diagnostic facilities are unavailable. A World Health Organization clinical case definition for acquired immunodeficiency syndrome was developed in 1985 for use in such areas. In 1987, we tested this definition on 1328 inpatients and outpatients in 15 hospitals throughout Uganda. Five hundred sixty-two patients (42%) were positive by enzyme-linked immunosorbent assay for human immunodeficiency virus antibody. The World Health Organization definition had a sensitivity of 55%, a specificity of 85%, and a positive predictive value of 73%. Modification of the case definition by excluding a known cough from tuberculosis as a minor criteria decreased sensitivity slightly to 52%, but specificity and positive predictive value increased to 92% and 83%, respectively. Amenorrhea, although not specifically asked about, was a symptom noted by many female patients (26% of females who were positive by enzyme-linked immunosorbent assay); as a symptom indicative of human immunodeficiency virus infection, amenorrhea had a specificity of 99%, with a positive predictive value of 89%. These findings support the generalizability of the World Health Organization clinical acquired immunodeficiency syndrome definition and its use (especially the modified version) in areas of Uganda without sophisticated facilities.

Surveillance and control of resurgent yaws in the African region.

Yaws, once one of the most common infections in Africa, was expected to be eliminated in some countries and controlled in others after the mass treatment campaigns sponsored by the World Health Organization and the United Nations Children's Fund during the 1950s and 1960s and the implementation of improvements in education, sanitation, and other health-promoting activities. However, the curtailment of yaws control activity allowed the reservoir of untreated yaws to grow unchecked, and the number of reported cases of active yaws has increased in certain parts of Africa, especially in West Africa. In the Central African Republic, the prevalence of yaws is notably high among the Pygmies. Renewed programs for yaws control are under consideration. Mass campaigns are still necessary in some developing countries for the control of certain diseases but should be complementary to the development of general health services and should not be limited to the administrative borders of a given country.

[Monkey pox virus infection in humans in the Central African Republic]. / Orthopoxvirose simienne de l'homme en République Centrafricaine.

A human monkeypox outbreak is reported which occurred in January 1984 in the extreme south-west areas of the Central African Republic. Six persons were found to be affected in a Pygmy camp with an estimated population of 50 residents. In the two affected families, out of 11 members, only unvaccinated children and a 22 year old unvaccinated woman contracted the disease. The disease was of moderate severity in two patients and very mild in the other four. The clinical diagnosis was confirmed by virus isolation from skin lesions of 4 patients and by sero-immunologic tests in all of them. The clinically apparent monkeypox case reported in the Central African Republic in 1983, the presently described outbreak, as well as information on the disease obtained from Pygmies and missionary paramedical staff who are in frequent contact with them, suggest that monkeypox is enzootic in the tropical rain forest in the south-west areas of the Central African Republic.

Treatment of gonorrhoea in males in the Central African Republic with spectinomycin and procaine penicillin.

Gonorrhoea has become a problem in most parts of the world, and valid recommendations for treatment are important for control of the disease. In this study in Bangui, Central African Republic, 460 male patients with gonorrhoea were randomly assigned to treatment with either 4.0 x 10(6) units of procaine penicillin plus 1 g of probenecid, or 2 g of spectinomycin. Of these patients, 91% returned for follow-up; the failure rate was 4.8% with the penicillin schedule and 6.2% with spectinomycin (difference not statistically significant). Concomitant Chlamydia trachomatis infection was found in 5% of patients, and almost all of this group developed postgonococcal urethritis.Of the 460 patients, 7 (1.5%) were infected with penicillinase-producing Neisseria gonorrhoeae (PPNG) strains. Penicillin treatment failed in these cases, while spectinomycin was highly efficacious. The failure rate for penicillin was considerably higher in infections with strains that were less sensitive to penicillin in vitro. The failure rate for spectinomycin treatment was higher in patients who were infected with a strain that was highly sensitive to penicillin.It is concluded that, once PPNG strains have been found in a country, treatment of gonorrhoea should be based on an antibiotic that cures PPNG infections. Tetracycline can be used as second-line treatment, since it will also cure C. trachomatis infection, which is much less frequently associated with gonorrhoea in Africa than in industrial countries.

Antimicrobial susceptibility of gonococci isolated in the Central African Republic.

Using agar dilution techniques, we determined the minimum inhibitory concentrations (MIC) of 11 antimicrobials for 70 isolates of Neisseria gonorrhoeae obtained in Bangui, Central African Republic. These gonococci were found to be fairly susceptible to commonly used antibiotics: only 3 isolates (4%) had a penicillin MIC >/= 1.0 mug/ml and 6 (9%) had a tetracycline MIC >/= 2.0 mug/ml. With regard to other antibiotics, 54 isolates (77%) had an erythromycin MIC >/= 0.25 mug/ml, all had a spectinomycin MIC /= 9.5/0.5 mug/ml. None of these isolates produced penicillinase.This study has helped to provide a rational basis for establishing national gonorrhoea treatment recommendations in the Central African Republic.

Gonococcal drug resistance and treatment of gonorrhoea in Nairobi.

PIP: The in vitro antibiotic sensitivities of 108 isolates of Neisseria gonorrhoeae from a Nairobi clinic were determined by the agar dilution method. The results indicate that the majority of gonococci were relatively resistant to penicillin (86%) and to tetracycline (85%). By using the relationship between the in vitro antibiotic sensitivity of gonococci and treatment failure of gonorrhea in US patients, we predict that the minimum treatment failure rate for the gonorrhea treatment schemes used in the US would be 5.6% for aqueous procaine penicillin G, 4.8 megaunits intramuscularly together with 1.0 g probenecid by mouth; 6.9% for oral tetracycline HC1, given 500 mg 4 times daily for 5 days; 10.4% for a single oral dose of ampicillin, 3.5 g together with 1.0 g of oral probenecid; and 6.2% for a single dose of spectinomycin, 2.0 g intramuscularly. Gonococcal drug resistance and morbidity will likely continue to increase in Kenya in the absence of a gonorrhea control program.^ieng