Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa
Identifieur interne : 000278 ( Istex/Corpus ); précédent : 000277; suivant : 000279Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa
Auteurs : D. T. Mcleod ; P. Neill ; V. J. Robertson ; A. S. Latif ; J. C. Emmanuel ; J. E. Els ; L. K. Z. Gwanzura ; F. E. J. Trijssenaar ; P. Nziramasanga ; G. R. Jongeling ; D. A. Katzenstein ; N. Nkanza ; S. B. LucasSource :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 1989.
Abstract
During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. ‘Tru-cut’ lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.
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DOI: 10.1016/0035-9203(89)90400-8
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<front><div type="abstract" xml:lang="en">During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. ‘Tru-cut’ lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.</div>
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<abstract xml:lang="en"><p>During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. ‘Tru-cut’ lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.</p>
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<head><ce:title>Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa</ce:title>
<ce:author-group><ce:author><ce:given-name>D.T.</ce:given-name>
<ce:surname>McLeod</ce:surname>
<ce:cross-ref refid="COR1"><ce:sup>∗</ce:sup>
</ce:cross-ref>
<ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup>
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<ce:author><ce:given-name>P.</ce:given-name>
<ce:surname>Neill</ce:surname>
<ce:cross-ref refid="AFF2"><ce:sup>2</ce:sup>
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</ce:author>
<ce:author><ce:given-name>V.J.</ce:given-name>
<ce:surname>Robertson</ce:surname>
<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>A.S.</ce:given-name>
<ce:surname>Latif</ce:surname>
<ce:cross-ref refid="AFF1"><ce:sup>1</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>J.C.</ce:given-name>
<ce:surname>Emmanuel</ce:surname>
<ce:cross-ref refid="AFF5"><ce:sup>5</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>J.E.</ce:given-name>
<ce:surname>Els</ce:surname>
<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>L.K.Z.</ce:given-name>
<ce:surname>Gwanzura</ce:surname>
<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
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<ce:author><ce:given-name>F.E.J.</ce:given-name>
<ce:surname>Trijssenaar</ce:surname>
<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
</ce:cross-ref>
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<ce:author><ce:given-name>P.</ce:given-name>
<ce:surname>Nziramasanga</ce:surname>
<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
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<ce:author><ce:given-name>G.R.</ce:given-name>
<ce:surname>Jongeling</ce:surname>
<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
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<ce:author><ce:given-name>D.A.</ce:given-name>
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<ce:cross-ref refid="AFF3"><ce:sup>3</ce:sup>
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</ce:author>
<ce:author><ce:given-name>N.</ce:given-name>
<ce:surname>Nkanza</ce:surname>
<ce:cross-ref refid="AFF4"><ce:sup>4</ce:sup>
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</ce:author>
<ce:author><ce:given-name>S.B.</ce:given-name>
<ce:surname>Lucas</ce:surname>
<ce:cross-ref refid="AFF6"><ce:sup>6</ce:sup>
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<ce:affiliation id="AFF1"><ce:label>1</ce:label>
<ce:textfn>Department of Medicine, University of Zimbabwe Zimbabwe</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF2"><ce:label>2</ce:label>
<ce:textfn>Department of Clinical Pharmacology, University of Zimbabwe Zimbabwe</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF3"><ce:label>3</ce:label>
<ce:textfn>Department of Medical Microbiology, University of Zimbabwe Zimbabwe</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF4"><ce:label>4</ce:label>
<ce:textfn>Department of Histopathology of the Medical School, University of Zimbabwe Zimbabwe</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF5"><ce:label>5</ce:label>
<ce:textfn>The Blood Transfusion Service, Harare, Zimbabwe</ce:textfn>
</ce:affiliation>
<ce:affiliation id="AFF6"><ce:label>6</ce:label>
<ce:textfn>The Wolfson Tropical Pathology Unit, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK</ce:textfn>
</ce:affiliation>
<ce:correspondence id="COR1"><ce:label>∗</ce:label>
<ce:text>Address for correspondence: Dr D. T. McLeod, General Medicine, Sandwell District General Hospital, West Bromwich, West Midlands, B71 4HJ, UK.</ce:text>
</ce:correspondence>
</ce:author-group>
<ce:date-received day="8" month="11" year="1988"></ce:date-received>
<ce:date-revised day="19" month="1" year="1989"></ce:date-revised>
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<ce:abstract><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para>During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. ‘Tru-cut’ lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). <ce:italic>Mycobacterium tuberculosis</ce:italic>
was cultured from 4; the remainder of the plates were contaminated. <ce:italic>Pneumocystis carinii</ce:italic>
was present in 8 patients: as the sole pathogen in 3, with <ce:italic>Streptococcus pneumoniae</ce:italic>
in 4, <ce:italic>Staphylococcus aureus</ce:italic>
in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included <ce:italic>Staph. aureus</ce:italic>
(5), <ce:italic>S. pneumoniae</ce:italic>
(5), <ce:italic>Klebsiella pneumoniae</ce:italic>
(2), <ce:italic>Haemophilus influenzae</ce:italic>
(2), <ce:italic>H. parainfluenzae</ce:italic>
(1) and <ce:italic>Pseudomonas aeruginosa</ce:italic>
(1). Invading <ce:italic>Aspergillus fumigatus</ce:italic>
was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. <ce:italic>M. tuberculosis</ce:italic>
is probably the commonest pathogen. This study has confirmed that <ce:italic>P. carinii</ce:italic>
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<abstract lang="en">During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. ‘Tru-cut’ lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.</abstract>
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