Bone marrow morphological features and diagnostic value in paediatric disseminated tuberculosis in the setting of increased HIV prevalence.

BACKGROUND: Disseminated tuberculosis (TB) is a life-threatening condition which is often a challenge to diagnose. When to use bone marrow biopsies to diagnose disseminated TB in paediatrics is always a dilemma, from both a clinical and laboratory perspective, as there are no clear guidelines. Our study primarily aims to evaluate the role of routine bone marrow biopsies, and to compare peripheral blood cultures to aspirate cultures in the diagnosis of disseminated TB, in a paediatric population at Tygerberg Hospital. In addition, we set out to assess the morphology of bone marrow biopsies in this study. METHODS: A prospective study, consisting of 35 paediatric patients, was conducted from October 2007 to November 2008. Bone marrow aspirate and trephine biopsies were performed on all patients and examined. Granulomas with Ziehl-Neelsen (ZN) positivity were sought on the trephine biopsy for the presence of acid-fast bacilli (AFB). RESULTS: Of the 35 children in this study, 25 were eventually diagnosed with TB on the basis of a multitude of clinical and laboratory parameters. The remaining 10 had alternative diagnoses. Peripheral blood TB cultures were positive in less than 1%. Bone marrow aspirate cultures were positive in less than 5%. Bone marrow trephine biopsies showed granulomas with ZN positivity in 11% of the 35 patients. CONCLUSION: Our results, generally, agree with the current evidence. Bone marrow biopsies in children should be performed if there is a strong clinical suspicion of disseminated TB, when no alternative non-invasive confirmatory test is available.

Prevalence and spectrum of head and neck lymphomas at Tygerberg Hospital, South Africa, 2003 to 2007.

AIM: The aim of the study was to investigate trends of prevalence and the pathological spectrum of head and neck lymphomas (HNL) at Tygerberg Referral Hospital over five years from 2003 to 2007, and to ascertain a possible relationship with HIV infection. This study will also provide a source of baseline data for a further project that will include the last ten years at Tygerberg Hospita i.e. 2003 to 2012. OBJECTIVES: To establish the incidence and trends of prevalence of HNL; to describe the pathological spectrum of all HNICs diagnosed from 2003 to 2007. METHOD: A retrospective study was conducted using the case records of all newly diagnosed HNL specimens from 2003 to 2007. RESULTS: A statistically significant increase was noted in the number of patients presenting with HNL. An increase from 17% to 33% was also noted in the number of HIV-positive HNL patients during the same period. The average age of disease presentation in the HIV-positive group of patients was significantly lower Diffuse large cell lymphoma (DLBCL) was the largest category of HNL (32%), followed by Hodgkin lymphomas (HL) 27%, Folicular lymphoma (FL) 10% and Plasmablastic lymphoma (PBL) at 8%. PBL and Burkitt's lymphoma (BL) were seen only in HIV-positive patients. CONCLUSION: There was an increase in the number of HNLs diagnosed each year.

Impact of the HIV epidemic and Anti-Retroviral Treatment policy on lymphoma incidence and subtypes seen in the Western Cape of South Africa, 2002-2009: preliminary findings of the Tygerberg Lymphoma Study Group.

The Tygerberg Lymphoma Study Group was constituted in 2007 to quantify the impact of HIV on the pattern and burden of lymphoma cases in the Western Cape of South Africa which currently has an HIV prevalence of 15%. South Africa has had an Anti-Retroviral Treatment (ART) policy and a roll-out plan since 2004 attaining 31% effective coverage in 2009. This study is designed to qualify and establish the impact of HIV epidemic and the ARV roll-out treatment program on the incidence of HIV Related Lymphoma (HRL). Early data document that despite the ART roll out, cases of HRL are increasing in this geographical location, now accounting for 37% of all lymphomas seen in 2009 which is an increase from 5% in 2002. This is in contrast to trends seen in developed environments following the introduction of ART. Also noted are the emergence of subtypes not previously seen in this location such as Burkitt and plasmablastic lymphomas. Burkitt lymphoma is now the commonest HRL seen in this population followed by diffuse large B-cell lymphoma subtypes. The reasons for this observed increase in HRL are not ascribable to improved diagnostic capacity as the tertiary institute in which these diagnoses are made has had significant expertise in this regard for over a decade. We ascribe this paradoxical finding to an ART treatment environment that is ineffective for a diversity of reasons, paramount of which are poor coverage, late commencement of ART and incomplete viral suppression.

Aids is now the commonest clinical condition associated with multilineage blood cytopenia in a central referral hospital in Zimbabwe.

OBJECTIVE: To describe the clinical features and diagnosis of patients hospitalised and found to have multilineage peripheral blood cytopenias. DESIGN: Prospective cross sectional study. SETTING: Parirenyatwa Hospital, a central referral hospital in Harare, Zimbabwe. SUBJECTS: 231 consecutive patients whose blood parameters revealed bi- or trilinneage cytopenia during a five month period in 1996. MAIN OUTCOME MEASURES: 1. Blood cytopenia was described as: (a) Haemoglobin concentration = or < 100 g/L (b) Total leucocyte count = or < 3.5 x 10(9)/L (c) Platelet count = or < 100 x 10(9)/L 2. Other clinical and diagnostic features. RESULTS: The highest percentage of multilineage blood cytopenia was in the age bracket 30 to 44 years and the male to female ratio was 1.4:1. Pancytopenia was found in 32.5% of patients, while bilineage cytopenia occurred in 67.5%. The commonest bilineage pattern was the combination of anaemia and thrombocytopenia occurring in 46.3% of all study cases or 68.5% of bilineage cytopenias. Anaemia was the most frequent cytopenia; it was found in 95.2% of all study cases. CONCLUSION: The commonest condition with which multilineage blood cytopenia was associated was AIDS which was diagnosed in 25.1% of the study cases.

Use of packed red cells in a major hospital in Harare, Zimbabwe.

OBJECTIVES: To document the current pattern of packed red cell (PC) usage and the crossmatch to transfusion ratio (C/T ratio) in a major city teaching hospital in Harare, Zimbabwe. DESIGN: Restropective, (audit). SETTING: Harare Central Hospital, a 1,200 bed multidisciplinary hospital located in Harare, Zimbabwe. MAIN OUTCOME MEASURES: Amount of PC ordered and proportion collected for the year 1995. Quantity of PC used by different medical specialties. RESULTS: In 1995 a total of 8,292 PC were collected from Harare Hospital blood bank. This translates to an average PC usage for a 1,200 bed hospital of seven units per hospital bed per year. Only 48.5% of PC crossmatched was collected with a C/T ratio of 2.1:1. Revenue loss of Z$478,434 is estimated to have occurred due to expired units and resource wastage from uncollected crossmatched units. The largest consumer of PC was the Department of Gynaecology, followed by Surgery and Paediatrics. CONCLUSION: Regular auditing of blood usage is recommended to promote the efficient use of PC in accordance with accepted international standards and local guidelines and practice.

Accidental HIV exposure.

This is a case presentation of an accidental contaminated needle stick injury from a patient known to be infected with both Human Immunodeficiency Virus (HIV) and hepatitis B. The patient was managed with prophylactic hepatitis B immune globulin, hepatitis B vaccination and the HIV retroviral drug zidovudine (AZT). At one year after treatment the patient was not infected with HIV or hepatitis B, and there was adequate immunity generated after vaccination for hepatitis B.

Primary cerebral lymphoma in Zimbabwe: a report of three patients.

Primary central nervous system lymphoma (PCNSL) is steadily increasing. Immunosuppressed individuals are at particular risk. In AIDS patients a clinical diagnosis of PCNSL is made in 0.5 to 8.4%, and a post mortem diagnosis in up to 11% of cases. In spite of the extensive HIV epidemic in parts of Africa, a literature search revealed only one African report of this condition. The reasons for this apparent infrequency are not clear. Possibilities include under diagnosis or early demise of patients due to other AIDS related illnesses of earlier onset. Three patients with primary cerebral lymphoma from Zimbabwe are presented. All were young, with tumours of high grade showing typical features.

von Willebrand factor in diabetic retinopathy.

OBJECTIVE: To elucidate the qualitative nature of elevated levels of von Willebrand factor (vWF) in diabetic microagiopathy. DESIGN: A randomized controlled study. SETTING: Oxford Health Authority, Oxfordshire, United Kingdom. SUBJECTS: Insulin dependent diabetic patients with established retinopathy, and an age, sex matched control group. MAIN OUTCOME MEASURES: Diabetic retinopathy, a modified enzyme-linked immunosorbent assay (ELISA), used to distinguish between endothelial and plasma type vWF. RESULTS: vWF is higher in patients with diabetic retinopathy mean (217u/dl) compared with normal subjects mean (8/u/dl). vWF in both patient and control are of the plasma type. CONCLUSION: vWF in diabetic retinopathy is raised and of the plasma type, suggesting it is not due to acute vascular endothelial injury.