Assuntos
Abscesso/etiologia , Síndrome da Imunodeficiência Adquirida/complicações , Encefalite/etiologia , Toxoplasmose/etiologia , Tuberculose/etiologia , Abscesso/diagnóstico por imagem , Adulto , Feminino , Haiti/etnologia , Humanos , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico por imagemRESUMO
To study the association between mycobacterial disease and the acquired immunodeficiency syndrome, we reviewed the records of all cases of tuberculosis and all cases of the syndrome reported in Dade County, Florida, from January 1980 through June 1983. Tuberculosis was diagnosed in 27 of 45 Haitians with the syndrome, but in only 1 of 37 non-Haitians with the syndrome (p less than 0.001). Among the 27 Haitians with the syndrome and tuberculosis, 19 had extrapulmonary tuberculosis, whereas among 286 Haitian patients with tuberculosis without the syndrome, only 56 had extrapulmonary tuberculosis (p less than 0.001). Tuberculosis preceded the syndrome by 1 to 17 months (mean, 6) in 22 patients. In 10 patients with the syndrome and positive sputum cultures who were treated with conventional antituberculosis drugs, the cultures became negative within 1 to 4 months and tuberculosis did not recur. The frequency of disseminated atypical mycobacteriosis or positive sputum cultures for atypical mycobacteria was not significantly different between Haitian (11.3%) and non-Haitian (8.3%) patients with the syndrome.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium/epidemiologia , Tuberculose/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Negro ou Afro-Americano , Antituberculosos/uso terapêutico , Aspartato Aminotransferases/sangue , Cuba/etnologia , Florida , Haiti/etnologia , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Pneumonia por Pneumocystis/epidemiologia , Sarcoma de Kaposi/epidemiologia , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , População BrancaRESUMO
PIP: This paper presents clinical data on 41 patients (29 male and 12 female) from Haiti who presented with acquired immunedeficiency syndrome (AIDS). Their mean age was 32 years (range 17-61 years). 4 of thes cases were homosexual or bisexual; none was an illicit drug user or a hemophiliac. In addition, 3 of the female patients had sexual contact with a male partner with AIDS. 4 patients had received blood transfusions before their illness. The most prominent clinical symptom in this series was chronic diarrhea of 2-33 months' duration, which occurrred in 39 patients (95%). Also reporte were marked weight loss (95%), fatigue (95%), prolonger fever (90%), and nodular or maculopapular skin lesions (54%). Opportunistic infections in this series included oroesophageal candidiasis (88%) and intestinal cryptosporidiosis (31%). Tuberculosis developed in 22% of patients. Immunologic evaluation revealed profoundly depressed T-helper cells and an inverted T-helper/T-suppressor cell ratio. Biologic markers included elevated alpha-1 thymosin and beta-2 microglobulin levels, elevated immune complexes, and the presence of acid-labile interferon. Of interest were differences in the clinical expression of AIDS between this series and cases in the US. The Haitian data suggest a higher incidencs of female cases,a predominance of gastrointestinal symptoms rather than respiratory symptoms and lymphadenopathy, a frequent association with tuberculosis, and a relatively low incidence of Kaposi's sarcoma or P. carinii pneumonia compared to the situation in the US. As in the US, where most AIDS cases are concentrated in New York and California, most AIDS cases in Haiti are found in residents of Port-au-Prince and Carrefour, which are centers for male and female prostitution.^ieng
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Adolescente , Adulto , Idoso , Métodos Epidemiológicos , Feminino , Haiti , Homossexualidade , Humanos , Hipersensibilidade Tardia/imunologia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Linfócitos T , Timosina/sangue , Reação Transfusional , Microglobulina beta-2/sangueRESUMO
Twenty Haitian patients, hospitalized from 1 April 1980 to 20 June 1982, had Pneumocystis carinii pneumonia, central nervous system toxoplasmosis, esophageal candidiasis, cryptococcosis, disseminated cytomegalovirus, progressive herpes simplex virus, chronic enteric coccidiosis, or invasive Kaposi's sarcoma. Ten patients died. Opportunistic infections were frequently multiple and were recurrent in three patients. In seven patients disseminated tuberculosis preceded the other infections by 2 to 15 months. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. At least three patients probably acquired the syndrome in Haiti. Lymphadenopathy was common. Seventeen patients tested had anergy, and 18 had lymphopenia. Monoclonal antibody analysis of peripheral-blood T-cell subsets done on 11 patients showed a marked decrease in T-helper cells and an inversion of the normal ratio of T-helper cells to T-suppressor cells. This syndrome among heterosexual Haitians is strikingly similar to the syndrome of immunodeficiency described recently among American homosexuals.
Assuntos
Síndrome da Imunodeficiência Adquirida/imunologia , Sarcoma de Kaposi/imunologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Anticorpos Antibacterianos/análise , Anticorpos Antifúngicos/análise , Anticorpos Antivirais/análise , Peso Corporal , Candida/imunologia , Citomegalovirus/imunologia , Comportamento Alimentar , Feminino , Haiti , Herpesvirus Humano 4/imunologia , Humanos , Contagem de Leucócitos , Masculino , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/imunologia , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/epidemiologia , Simplexvirus/imunologia , Dobras Cutâneas , Linfócitos T/imunologia , Toxoplasma/imunologia , Treponema/imunologiaRESUMO
We describe acquired immune deficiency manifested by opportunistic infections in 10 previously healthy heterosexual Haitian men. The opportunistic pathogens included Toxoplasma gondii (in four patients), Cryptococcus neoformans (in one), Pneumocystis carinii (in four patients), and Candida albicans (in three). Six of the patients also had Mycobacterium tuberculosis. Immunologic studies of three patients showed a decrease in the numbers and activity of helper T cells, with normal or increased populations of suppressor T cells. Serologic markers for previous infections from hepatitis A, cytomegalovirus, and herpes simplex virus were detected in several patients. Six of the patients died despite specific antimicrobial therapy. The clinical and immunologic findings in these 10 Haitians are similar to those reported in drug addicts and homosexuals with the acquired immune-deficiency syndrome.