Pathology of paediatric human immunodeficiency virus infections in Cote d'Ivoire.

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

[Autopsy findings in 70 AIDS patients who died in a department of pneumology in Ivory Coast: impact of tuberculosis]. / Données fournies par l'autopsie de 70 sujets décédés de SIDA en milieu pneumologique ivoirien: impact de la tuberculose.

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.

HIV-associated lymphoma in Africa: an autopsy study in Cote d'Ivoire.

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.

Nocardiosis in HIV-positive patients: an autopsy study in West Africa.

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.

Contribution of tuberculosis to slim disease in Africa.

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.

The mortality and pathology of HIV infection in a west African city.

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.

[Clinico-pathologic aspects of rhinosporidiosis in the Ivory Coast. Report of 9 cases observed over 18 years]. / Aspects anatomo-cliniques de la rhinosporidiose en Cote d'Ivoire. A propos de 9 cas observés en 18 ans.

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.