University of Zambia Medical Library
AIDS-Related Complexes -- ARCs Continued (AIDS in Zambia Bibliography #68-84)
- (#68) "A Study to Determine Factors Related to Poor Delivery of Nursing Care of
AIDS Patients"
Kaluba, P. (1990) unpublished
Geographical area: Chipata, Eastern Province; Key words: Health care delivery
Location: unknown
The problem of poor AIDS patient care in health institutions is evident since nurses seem
to be reluctant to care for these patients. The aim of this study was to identify factors
related to the poor delivery of nursing care to AIDS patients in health institutions
especially at Chipata General Hospital in the Eastern Province of Zambia. A sample of
thirty nurses was selected and questionnaires were used to collect data. A research survey
was designed to get opinions of nurses on the problem under study.
The results showed
that 70 per cent of the subjects had never attended any in-service education on the care
of AIDS patients and attributed their poor care to lack of knowledge. All the subjects
(100 per cent) acknowledged that protective clothing were necessary when caring for
AIDS patients, but the hospital did not always provide them. All the subjects (100 per
cent) also felt that lack of risk allowance and compensation policy influenced the way
they cared for AIDS patients. It was recommended that the government should introduce
risk allowance and develop a compensation policy to cover nurses in cases of occupation
hazards. -
- (#69) The Pathology of Lymphadenopathy in Lusaka
Bem, C. (1990) Association of Surgeons of East Africa; Vol.l3; l990; pp 62- 65
Geographical area: Lusaka;
Key words: Lymphadenopathy, tuberculosis;
Location: UNZA Medical Library
The adversity of the HIV epidemic has changed the pathology in lymphadenopathy in
many parts of Africa. HIV infection is often accompanied by enlarged nodes and at the
same time it predisposes illness such as tuberculosis, Kaposi's sarcoma and lymphoma
that themselves cause lymph node enlargement. This paper reports initial findings of a
study of the pathology, clinical presentation and association with HIV infection of
lymphadenopathy in Zambia and describes the history of primary HIV lymphadenopathy.
Prior to surgery, the distribution, size and character of lymph node enlargement for each
patient was recorded. At surgery, the microscopic appearance of the transacted node was
noted and later compared with histology. HIV-1 serology was tested with the consent of
the patient by competitive Elisa Assay (Wellcome) and antiglobulin recombinant Elisa
(Du Pont). Seropositivity was defined by two positive results. Of 99 patients who
consented for HIV testing, 83 were HIV seropositive. The histopathology of primary HIV
lymphadenopathy is described. The strong association of tuberculosis lymphadenitis with
HIV infection is confirmed. It was recommended that while the histology of a lymph
node may be strongly suspicious of HIV infection, HIV serology is necessary to confirm
the diagnosis as similar histology may occasionally be observed in other viral infections.
-
- (#70) Clinical and epidemiological features of HIV infection at a referral clinic in Zambia
Hira, S.K. (1990) Journal of AIDS; Vol.(3);1990; pp 87-91
Geographical area: Lusaka;
Key words: AIDS-related complex;
Location: UNZA Medical Library
Among 1,350 patients with serologically confirmed HIV-1 infection evaluated at the
Dermatovenerealogy Clinic, University Teaching Hospital, Lusaka, through March 1987,
125 (9.3 per cent) had AIDS, 1,178 (87.3 per cent) had an AIDS-related complex, and 46
(3.5 per cent) were asymptomatic. The male to female ratio of cases was 1.5:1 and
women were younger (mean age of 26.2 years) than were men (mean age of 31.2 years).
-
- (#71) Bacteraemias in HIV-positive patients
Perera, C.U., Luo, N.P., Zumla, A. (1990) The Lancet, Vol 336, p877
Geographical area: Lusaka;
Keywords: Bacteraemias, chemotherapy;
Location: UNZA Medical Library
Objectives:
To determine the effect of bacterial infections on patients infected with HIV.
Methods:
Select clinical samples from patients with focal sepsis or pyrexia of unknown origin were examined microbiologically. We looked for clinical details, including HIV serology, in the case records of patients admitted to the University Teaching Hospital (UTH) from whose clinical specimens non-typhoid salmonella spp had been cultured between June, 1988, and December, 1989. Where an HIV result was not available
attempts were made to retrieve stored sera for anti-HIV testing. For 20 patients from
whom non-typhoid salmonella were isolated 16 sets of case notes were available. No
patient had evidence of schistosomiasis, chronic liver disease, or Sickle-cell anaemia.
Three cases are recorded to show the unusual features on non-typhoid salmonella
infection in HIV-infected patients in Africa.
Results: - Case 1 (29, M). Admitted with cough, chest pain, fever, night sweats, and
weight loss. He was toxic, febrile, normotensive, and had clinical signs of pericardial
effusion, with cardiomegaly and a large effusion. A pericardial tap yielded 1200 ml of
brownish aspirate. Despite intravenous antibiotics and intensive care, the patient died
the next day. The pericardial fluid grew S typhimurium phage type 1. Mycobacterial
cultures were negative. Retrospectively he was found to be HIV seropositive.
- Case 2 (31, M). Admitted with severe abdominal pain and non-bloody diarrhoea. He
was febrile, thin, and normotensive. He had clinical and radiological signs of small
bowel obtrusion. Laparotomy revealed large para-aortic and mesenteric lymph nodes
which were necrotic with caseation and abscess formation. Ziehl-Neilson staining of
nodes revealed acid-fast bacilli (later identified as Mycobacterium tuberculosis).
further pockets of pus were found in the small intestine. Culture yielded S typhimurium
phage type 135. Stool cultures were sterile. He was HIV-positive. He died a week
later despite chloramphenicol and anti-tuberculosis chemotherapy.
- Case 3 (18, F). Admitted with a painful right groin and fever. Apart from clinical
evidence of psoas muscle spasm, examination was normal. Abdominal X-ray revealed
a shadow in the region of the right psoas muscle. An abscess was drained but the pus
grew no organisms. She was treated with ampicillin and gentamicin. 6 weeks after
discharge she was readmitted with recurrence of the abscess. Pus grew S boon. She
was treated with ampicillin. HIV serology was positive. 3 months after discharge she
was clinically well.
Conclusions:
- Non-typhoid salmonella infection can present a life-threatening illness
in young African adults.
- Our findings suggest that other non-typhoid salmonella spp,
other than S typhimurium, may also be important opportunists.
- Extraintestinal sepsis
due to non-typhoid salmonellae may be an underestimated contributor to the acute
bacterial complications of AIDS.
-
- (#72) HIV and cerebral malaria
Leaver, R.J., Haile, Z., Watters, D.A.K. (1990) Transactions of the Royal
Society of Tropical Medicine and Hygiene 84, p201
Geographical Area: Lusaka;
Keywords: Malaria;
Location: UNZA Medical Library
A recent clinical study from Zambia has shown that HIV status did not affect the
incidence or outcome of uncomplicated malaria (Simooya et al., 1988). We carried out
a prospective study of cases of adult cerebral malaria admitted to the intensive care unit
(ICU) at UTH, Lusaka to ascertain the impact of HIV on cerebral malaria. ELISA test
was performed on 27 of the 40 confirmed cerebral malaria patients: it was positive in 8
patients (30 per cent): 1 of four patients in 1986, 1 of seven in 1987, and 6 of 16 patients
in 1988. Overall there were 2 deaths in the seronegative group and 2 in the seropositive
group. A control group of 396 patients admitted to the ICU in 1987 had a seropositivity
rate of 20.5 per cent (Watters et al., 1988). In 1988 this has risen to 33 per cent. Our
results suggest that the outcome of adult cerebral malaria in the Lusaka area is not
affected by HIV status.
-
- (#73) The Impact of HIV Infection on Orthopaedic Practice
Ellis, J.E., Regisford, C. (1990) Proceedings of the Association of Surgeons
of East Africa; vol.13; 1990 pp 44-50
Geographical area: Lusaka;
Key words: Health care delivery;
Location: UNZA Medical Library
HIV disease is having a profound effect on the care of orthopaedic patients. Infection,
both early and late, around metal implants has increased. This paper reviews the current
situation at the University Teaching Hospital, Lusaka, where a considerable proportion
of patients presenting to the orthopaedic unit are HIV-positive. The researchers concluded
that adverse reactions and complications may follow standard orthopaedic operations and
new pathologies related to HIV disease should be recognised in the region.
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- (#74) HIV-related enteropathy in Zambia: a clinical, microbiological and histological study
Conlon, C.P., Pinching, A., Perera, C.U., Moody, A., Luo, N.P., Lucas, S.
(1990) American Journal of Tropical Medicine, 42(1), pp 83-88
Geographical area: Lusaka;
Keywords: Enteropathy, diarrhoea;
Location: UNZA Medical Library
To investigate the aetiology of chronic diarrhoea associated with human
immunodeficiency virus (HIV) infection in Lusaka, we studied 63 HIV-positive patients
and 36 seronegative controls clinically and endoscopially. Stools were studied for
morphology and for opportunist infections. Fifty-five per cent of patients seropositive for
HIV who presented with a history of chronic diarrhoea had parasites; the most common
were cryptosporidium (32 per cent), Isospora belli (16 per cent) and Strongyloides
stercolaris (6 per cent). As indicated by villous blunting and inflammation on duodenal
histology, those with diarrhoea and parasites showed the most severe damage. We could
not implicate mycobacteria overgrowth as causes for the enteropathy associated with
HIV.
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- (#75) Haematuria Frequency syndrome in patients with positive HIV serology: observation in Zambia
Elem, B. (1991) British Journal of Urology; Vol.67(2);1991 pp 146-9.
Geographical area: Lusaka;
Keywords: Haematuria, cytomegalovirus;
Location: UNZA Medical Library
Observations are presented on nine patients who were recently treated in the University
Teaching Hospital, Lusaka, Zambia, for painful urinary frequency, suprapubic pain and
microscopic and/or macroscopic haematuria without any demonstrable urinary tract
infection. At cystoscopy the bladder mucosa of all patients depicted a highly
characteristic, uniformly congested appearance with no demonstrable ulcers; there was
no significant reduction in bladder capacity. The histological appearance was essentially
non-specific in type with an apparent resemblance to that of interstitial cystitis; mast cells were, however, absent in all specimens.
An important feature common to all patients was
an associated HIV infection; cytochemistry of the bladder tissue did not reveal an
associated cytomegalovirus cystitis. No such case was observed in Zambia prior to the
advent of HIV infection and the phenomenon was observed only in seropositive patients.
It has been suggested that the virus is likely to be associated with the genesis of the
bladder symptoms. The natural history of the disorder, its incidence among the
seropositive individuals and its pathogenesis remain unclear. It has been suggested that
the virus is likely to be associated with the genesis of the bladder symptoms. The natural
history of the disorder, its incidence among the seropositive individuals and its
pathogenesis remain unclear.
-
- (#76) Toxoplasma Serology in Zambian and Ugandan Patients Infected with the Human Immunodeficiency Virus
Zumla, A., Johnson, J.D., Holliman, R. (1991) Transactions of the Royal
Society for Tropical Medicine and Hygiene; Vol.85(2);1991; pp 227-9
Geographical area: NA;
Key words: Toxoplasma serology, morbidity, mortality;
Location: UNZA Medical Library
The seroprevalence rates of toxoplasmosis in Zambian and Ugandan patients were
determined using the dye test (DT) and the latex agglutination test (LAT). The
geographical variation in seroprevalence rates noted in western countries was also found
in these African countries, with Zambia showing significantly lower rates than Uganda.
34 per cent of Ugandan (64/186) and 4 per cent of Zambian (8/187) patients infected with
HIV, compared with 27 per cent of Ugandan (26/93) and 11 per cent of Zambian (20/189)
HIV-negative persons, had anti-Toxoplasma immunoglobulin G antibodies. With the
LAT, 13 of the Ugandan and 7 of the Zambian sera gave a false positive results. The
relevance of toxoplasma serology in Africa is discussed. Zambian (20/189) HIV-negative
persons, had anti-toxoplasma immunoglobulin G antibodies. With the LAT, 13 of the
Ugandan and 7 of the Zambian sera gave a false positive result. The relevance of
toxoplasma serology in Africa is discussed.
-
- (#77) Severe falciparum malaria and the acquired immunodeficiency syndrome (AIDS) in Zambia
Simooya, O.O., Mwendapole, R.M., Sikateyo, B.M. (1991) Annals of Tropical
Medicine and Parasitology, Vol 85, No, 2 pp 269-270
Geographical area: Ndola;
Key words: Malaria;
Location: UNZA Medical Library
Objectives:
To show the relationship between severe malaria and AIDS.
Methods:
1. Historical sera obtained in 1982-1983 from 39 adults with cerebral
malaria (CM) and sera obtained in 1986-1987 from 19 CM patients, were analysed for:
- HIV-1 seropositivity (Wellcozyme immunoassay), positivity being confirmed by a
Hoffman La Roche immunoassay, and (b) specific antibodies to Plasmodium
falciparum, by the indirect fluorescent antibody (IFA) technique. Schizonts of P.
falciparum served as antigens, and titres of >1:80 were considered positive.
- In addition, 42 patients admitted to the Ndola Central Hospital in 1986-1987 with clinical AIDS were classified for: (a) malaria parasitaemia, and (b) HIV-1 seropositivity and antibodies to P. falciparum as above.
Results:
- Of the 39 CM patients seen in 1982-1983 only one (3 per cent) was HIV-1
seropositive; and subsequently died. The IFA was positive in 36 (92 per cent) patients,
including the deceased individual. In 1986-1987 series, 3 (16 per cent) patients were
HIV-1 seropositive and 17 (90 per cent) had a positive humoral response to malaria.
- Among the 42 patients with the diagnosis of AIDS, 35 (83 per cent) were HIV-1
seropositive and 4 of these had falciparum parasitaemia as well. Of the confirmed
AIDS cases 14 (40 per cent) had negative IFA titres. No significant association was
found between presence or absence of malaria parasites and HIV-1 seropositivity, or
between the result of IFA and HIV-1 seropositivity. No clinical signs of severe malaria
were evident in the four patients with parasitaemia, and all responded well to a
standard chloroquine regimen.
- Of the 35 confirmed AIDS cases 4 (11 per cent) had
falciparum parasitaemia while 14 (40 per cent) had a negative IFA.
Conclusions: Although there is no evidence for an increased risk of infection with
malaria in AIDS patients, there is a low humoral response to malaria.
-
- (#78) The Seroprevalence of Human Immunodeficiency Virus and Hepatitis B
Infection in Patients with Sickle-cell Anaemia at the University Teaching
Hospital
Mbewe, A.L. (1992) unpublished
Geographical area: Lusaka;
Key words: Sickle-cell Anaemia, HBV, blood transfusion;
Location: UNZA Medical Library
The aims of the thesis were to determine the seroprevalence of Human Immunodeficiency
Virus (HIV-1) and Hepatitis B Virus (HBV) in patients with Sickle-cell anaemia (SCA)
and to determine the role of blood transfusions and herbal skin scarification in the
transmission of HIV-1 and laboratory results were recorded on the questionnaire. 154
SCA patients were included in the study between March, 1990 and March, 1991. The Chi
Square and the Fisher's Exact Test were used for significance testing. A p value of less
than 0.05 was taken to be significant. Overall, 22 (14.3 per cent) were positive for HIV-1
antibodies using both Elisa (Recombigen and Wellcozyme) 9 (5.8 per cent) were positive
for HBS Abse using Haemagglutination tests. 95 per cent of sickle-cell anaemia patients
who are found positive for HIV-1 antibodies had received blood and were older than 14
years.
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- (#79) Clinical observations on Leprosy Patients with HIV - infection in Zambia
Vreeburg, A.E.M. (1992) Leprosy Review; Vol.(63);1992; pp 134-140
Geographical area: Chikankata, Southern Province;
Key words: Leprosy;
Location: UNZA Medical Library
The clinical observations carried out on 100 leprosy patients with HIV-1 infection,
admitted between 1st January 1986 and 1st May 1988 to the Salvation Army Hospital at
Chikankata, Mazabuka, Zambia are described. A total of eight of this group were newly-diagnosed borderline leprosy patients. Their clinical data were compared with those of
34 newly-diagnosed borderline leprosy patients, admitted in the same period-50 were
men, 50 women. The clinical presentation, with respect to leprosy, on admission, did not
differ very much in both groups. The incidence of neuritis in both groups was 5 per cent
and 17 per cent. The outcome of specific therapy of neuritis was worse in the HIV-1
patients than in the other group: only partial recovery in four out of five and no response
in one, compared with a complete recovery in ten cases, and a partial recovery in seven
cases in the other group. A total of 6 patients of the HIV-1 group admitted to have had
multiple heterosexual contacts, 5 had a history of sexually transmitted disease, 7 had
generalised lymphadenopathy and 4 presented with another disease in addition to leprosy.
While in hospital the group of 10 HIV-1-infected patients suffered 17 episodes of
intercurrent disease against none in the other group; 1 patient (male) died with
generalised dermatitis and sepsis; 1 woman died with fulminant hepatitis.
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- (#80) Kaposi's Sarcoma and faecal-oral exposure
Matondo, P. (1992) The Lancet, Vol. 339, June 13, p1490 (letter).
Geographical area: NA;
Key words: Kaposi's sarcoma;
Location: UNZA Medical Library
Some researchers have advanced a hypothesis that non-sexual faecal contact, as
associated with inadequate sanitation, might be an important means of transmission of
Kaposi's sarcoma (KS) agent among HIV-positive heterosexuals in Africa. Should this
be construed as suggesting that, contrary to an earlier hypothesis of sexual
transmission, epidemic (AIDS-related) KS in Africa may not be sexually transmitted?
The idea, and presumed importance, of non-sexual contact with faeces in the
transmission of the putative KS agent in Africa is not consistent with epidemiology of
epidermis KS. Epidermis KS has high incidence among young heterosexual adults of
high socioeconomic class whose sanitary facilities and habits are good. The hypothesis
would predict higher incidence in low socioeconomic groups, especially squatters, with
poor sanitation. However, this is not the case. Even though endemic (non-AIDS-related) KS has a higher incidence in low socioeconomic classes, its epidemiology is
not also consistent with the hypothesis.
The hypothesis that the KS agent is transmitted
mainly by contact with faeces is rather overenthusiastic, because others have not found
evidence to support the hypothesis. Although the proponents of this hypothesis suggest
that the decline in KS among homosexuals with AIDS may be due to decline in sexual
practices involving contact with faeces, others have reported a similar decline in KS
without a corresponding reduction in practices involving contact with faeces.
Furthermore, a significant proportion of people with KS never had contact with faeces,
and a significant proportion of those without KS nevertheless have had contact with
faeces. The putative agent of KS is sexually transmitted and its transmission may not
be limited to faecal-oral route. There is no sufficient evidence for judgements about the
importance of faecal-oral route in the transmission of KS. [Editor's note: evidence now
strongly suggests that KS is caused a by a virus of the herpes family, and is sexually
transmitted].
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- (#81) Intestinal parasites in Zambian patients with AIDS
Hunter, G., Bagshawe, A.F., Baboo, K.S., Luke, R., Prociv, P. (1992)
Transactions of the Royal Society of Tropical Medicine and Hygiene, 86, pp
543-545
Geographical area: Lusaka;
Key words: Diarrhoea;
Location: UNZA Medical Library
Previous studies have found a high prevalence of Isosopora and Cryptosporidium parvum
infections in African AIDS patients with chronic diarrhoea. We aimed to determine the
prevalence of gastrointestinal parasites in AIDS patients in hospital, not only those with
diarrhoea, and to compare them with the general community. Clinically diagnosed AIDS
patients in a Zambian teaching hospital were interviewed and examined, and stool
specimens were studied for parasitic infection. A control group was recruited from adults
in a township near Lusaka. Of 90 AIDS patients (58 per cent male), 50 (56 per cent) had
chronic diarrhoea and 9 (10 per cent) had diarrhoea of shorter duration. In the control
group (105 adults; 85 per cent female) only one complained of diarrhoea. A review of
intestinal protozoa and helinths was found in 57 per cent of AIDS patients, all with
diarrhoea, but not any control. Strongyloides was found in 2 AIDS patients with
diarrhoea and one community resident. Hospital patients with AIDS had fewer
Entamoeba coli and E. histolyitica infections, probably because of previous
chemotherapy. We conclude that AIDS predisposes to isosporiasis and cryptosporidiosis,
but not to infection with extracellular intestinal parasites, such as Entamoeba species,
Blastocytis, Chilomastix, Endolimax, Ascaris and Necator.
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- (#82) Chemotherapy of African AIDS diarrhoea: a preliminary study
Kelly, P., Buve, A. (1993) AIDS, 1993, 7, pp 91-93.
Geographical area: Monze;
Key words: Diarrhoea, chemotherapy;
Location: UNZA Medical Library
Objective:
To determine whether combined chemotherapy with tinidazole, thiabendazole
and cotrimoxazole is more effective than placebo in treatment of AIDS diarrhoea in
Zambia.
Designs:
Single-blind prospective comparison in consecutive patients, randomised alternately to placebo or chemotherapy.
Setting:
A district hospital in Zambia.
Patients:
Sixty-four HIV seropositive patients with chronic diarrhoea were considered
for inclusion in the study. Of these, 25 patients were not eligible for randomisation (in
13 cases because of spontaneous remission); 11 were randomised, but excluded from the
analysis (seven failed to attend for a scheduled visit and four died), leaving 28 patients
who completed the study.
Main outcome measures: Proportion of diarrhoea-free days in the 7 days following
treatment, as determined by daily stool counts.
Results:
There were 38 diarrhoea-free days out of 89 (43 per cent) in the placebo group,
and 39 out of 72 (54 per cent) in the chemotherapy group; this difference was not
statistically significant.
Conclusions:
The high level of spontaneous remission probably indicates a natural
fluctuation in stool frequency and demonstrates the need for placebo-controlled studies
in any assessment of therapy for AIDS diarrhoea. Our findings do not allow us to
conclude that the chemotherapy used is ineffective, since the number of patients was low,
but will help in our understanding of natural history of the disorder and the design of
future studies.
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- (#83) HIV-1 in patients with Sickle-cell Disease in Zambia
Mbewe, A.L. (1994) Paper presented to the Xth International Conference on
AIDS, Yokohama, 1994
Geographical area: Lusaka;
Key words: Sickle-cell anaemia, blood transfusion;
Location: unknown
Objective:
To determine the seroprevalence of HIV-1 in patients with Sickle-cell disease (HBSS).
Method:
Cross sectional study involving 154 children and adults with Sickle-cell disease.
Results:
Overall, 22 patients (14 per cent; 95 per cent confidence level 9 to 19 per cent)
were positive for HIV-1 antibodies using ELISA (Wellcozyme assay). The relation of
the prevalence of HIV-1 positive patients to age group, history of receiving blood
transfusion, skin scarification, sex, past medical conditions and current medical
conditions is reported.
Conclusion:
The prevalence of HIV-1 in the patients with Sickle-cell disease (HBSS)
was lower than the prevalence in the general population in Zambia.
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- (#84) Medical problems encountered in people with HIV
Baggaley, R., Chimoto, J., Sakala , M., Kelly, M.,(1994) Paper presented to
the VIIth National Conference on AIDS in Zambia, Lusaka, 1994.
Geographical area: Lusaka;
Key words: AIDS-related complex, condoms, counselling;
Location: Kara Counselling
Objectives:
To establish the medical needs of people coming for HIV counselling and testing (c&t). To determine how many of these problems were psychological.
Method:
All people coming for HIV c&t can see a nurse or a doctor for counselling
and advice about medical problems. 992 consecutive consultations were analysed
looking at reasons for consultation, whether this was medical or psychological,
whether condoms were sold and whether the client needed referral either for further
counselling or for medical treatment.
Results:
People attending for HIV c&t often have medical worries which they want
to discuss with a counsellor or nurse. Some of these may be related to their HIV
status, for example oral thrush, many of the skin problems and some diarrhoeal
problems. 20 per cent have a significant psychological component. 10 per cent of
cases required referral for a medical opinion at the hospital or urban health clinic.
| Presenting problem | Number |
|---|
| Diarrhoea/GIT | 302 | |
|---|
| Skin problems | 247 |
|---|
| STDs | 87 |
|---|
| Cough | 150 |
|---|
| TB | 37 |
|---|
| Oral thrush | 18 |
|---|
| Malaria | 62 |
|---|
| Colds | 49 |
|---|
| General malaise | 58 |
|---|
| Psychological Problems | 194 |
|---|
Conclusions:
- Many people attending for HIV c&t have medical worries. These
are often a trigger for wanting to know their status.
- 90 per cent of these are relatively simple and can be dealt with without need for referral.
- Psychological worries are common and it is important to have close liaison between the counsellor and the worker.
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