Seroprevalence and molecular diversity of Human Herpesvirus 8 among people living with HIV in Brazzaville, Congo

Human herpesvirus 8 (HHV8) is endemic in Africa, although studies of this infection are rare in Congo. We evaluated seroprevalence and HHV-8 diversity among people living with HIV. We included 353 patients receiving highly active antiretroviral therapy. Antibodies against HHV-8 latency-associated nuclear antigen were detected by indirect immunofluorescence. In HHV-8 positive patients, we performed HHV-8 quantification in blood and saliva by real-time PCR and typing by Sanger sequencing of K1 open reading frame. HHV-8 seroprevalence was 19%, being male (odd ratio [OR] = 1.741, [95% Confidence interval {CI}, 0.97-3.07]; p = 0.0581) and having multiple sex partners before HIV diagnosis (OR = 1.682, [CI 95%, 0.97-2.92]; p = 0.0629) tended to be associated with HHV-8 seropositivity. Of the 64 HHV-8 seropositive patients, HHV-8 DNA was detected in 10 (16%) in saliva, 6 (9%) in whole-blood and in 2 (3%) in both whole-blood and saliva. Three out of 6 HHV-8 strains were subtypes A5, 2 subtype B1 and 1 subtype C. HHV-8 seroprevalence was relatively low with more frequent carriage in men, associated with asymptomatic oral excretion and a predominance of subtype A5. These data tend to support the hypothesis of horizontal transmission in people living with HIV in Brazzaville.

[Clear cell kidney carcinoma revealed by cutaneous and sinus metastases: about a case and literature review]

Situé au troisième rang des cancers urologiques, le cancer du rein métastase habituellement au niveau du poumon, des os et du foie. Nous rapportons ici le cas clinique de métastases cutanée et sinusienne ayant révélées un cancer du rein chez un sujet de sexe masculin âgé de 70 ans.

[African histoplamosis. A report of three pediatric cases]

Histoplasmosis duboisii (Histoplasma capsulatum var duboisii) is uncommon disease especially in children. It is observed in Africa where the incidence is unknown. The authors report a series of three pediatric cases. The report concerned 2 girls and one boy who were 3, 9 and 4 year-old, respectively. Symptoms evolved for more than two months in each case. At admission, we found fever and poor general condition. Observed lesions were lymphnodes localisation disseminated (cases 1 and 2), subcutaneous (cold abscess) and cutaneous simulating molluscum contagiosum (case 2), osteoarticular (cases 2 and 3), abdominal including peritoneal and hepatosplenic (case 1). In all cases, a mild leukocytosis was found and an accelerated erythrocyte sedimentation rate (ESR) greater than 70mm. The HIV serology was negative. The treatment consisted of itraconazole in 2 cases and ketoconazole in one case. The evolution was insidious, leading to the discharge against medical advice. The death occurred at home in all cases.

CONCLUSION

Histoplasmosis duboisii can realize two main clinical presentations (localized or disseminated), affecting the skin, lymph nodes, bones, sometimes the intra-abdominal organs. HIV serology is not always positive in disseminated forms. The evolution is unpredictable and capricious under antifungal treatment. The disease should be well explained to prevent a possible discharge against medical advice, often pejorative.

[A case of isolated tuberculosis of the appendix at the University Hospital Center in Brazzaville, Congo]

Since the outbreak of human immunodeficiency virus (HIV) infection, extrapulmonary tuberculosis has become increasingly frequent in developing countries. The purpose of this report is to describe a case of isolated tuberculosis of the appendix diagnosed following generalized peritonitis in a 53-year-old man. The appendix is the least frequent gastrointestinal location of isolated tuberculosis. Diagnosis was achieved by histopathological examination of the appendix immersed in formalin 10% after appendectomy. Paraffin-embedded histological sections stained with hematoxylin-eosin (HE) displayed caseofollicular lesions characteristic of infection by Koch bacillus. Outcome was favourable with a 9-month regimen of antituberculosis treatment according to the protocol of the World Health Organization (WHO).

[Cutaneous B-cell lymphoma in a 50 year old woman at Brazsaville University Teaching Hospital]

The authors report one case of no epidermotropic cutaneous B-cell lymphoma on 50-year-old female patient, with acute evolution, presenting cutaneous, spleen, peritonea and ophthalmologic multiple nodular lesions, diagnosed while a knee staphylococcus aureus septic arthritis.

[Cysts and congenital fistulas of the face and the neck. About 78 cases]

The cysts and congenital fistulas of the face and neck induce frequent malformations in Oto-Rhino-Laryngology. A retrospective study on these malformations has been carried out from January 1986 to December 2001 in the Oto-Rhino-Laryngology unit of the Brazzaville Teaching Hospital. This study considered the epidemio-clinical aspects, the modes of therapeutic treatment and the evolution of these congenital pathologies. The cysts and congenital fistulas represented 2% of the consultations in the service. Patients were aged of 10 months to 50 years (average age: 21 +/- 5 years) among them 49 men (63%) and 29 women (37%). The pathology appeared in childhood in 41% of the cases and during adult age in 59% of the cases. The main circumstances of discovery were: cystic swelling (72%), infectious complication (18%) and productive fistula (10%). The clinical forms have been dominated by the cysts of the thyreoglossal tractus (72%), followed by the pre-auricular fistulas (10%), the amygdaloid (9%), dermoid (6%) and nasopalatine (3%) cysts. The treatment was in any case surgical. A good embryo-pathogenic knowleldge should contribute to a complete surgical exeresis, a necessary condition to avoid recurrence.

[Thyroid disorders in the Brazzaville Teaching Hospital]

The authors report their experience with thyroid disorders. Between January 1994 and December 2003, a total of 567 patients (sex ratio: 1/20, men to women) with thyroid disease were examined in the endocrine and metabolic department of the Brazzaville Teaching Hospital. Their mean age was 43 years. 333 (58.7%) had a simple goiter, 118 (20.8%) hyperthyroidism, most often related to Graves' disease (60.8%). Other disorders included multinodular goiters (19.2%), toxic adenoma (7.1%) and thyroiditis (13.8%). Hypothyroidism was identified in 7.4% of cases, mainly following thyroid surgery. Thyroid cancer was rare (4 cases).

[Inverted naso-sinusal papilloma: analytic study on 13 cases]

OBJECTIVES

Inverted nasosinusal papilloma is a rare tumorous process involving mucosa of nasal fossa and paranasal sinus unilaterally. The authors studied inverted naso-sinusal papilloma observed and treated in ENT and Head and Neck department at Brazzaville University Hospital.

MATERIAL AND METHODS

Retrospective study concerning 13 patients treated between 1988 and 2001.

RESULTS

The average age is 34 years (range: 16 to 60 years); old nasal obstruction is the main symptom (12 cases); the diagnosis is histologic; association with Killian polyp (1 case), human papilloma virus infection (1 case) and rhinosporidiosis (1 case); large surgical removal (Caldwell-Luc, para-latero-nasal) and polypectomy associated to diathermy of tumorous insertion place permitted to have satisfactory results; the recurrencies were observed in four cases from 7 months to 10 years (average: 4 years); malignant transformation is noted in 2 cases with one case of inverted papilloma combined to Human Papilloma Virus infection.

CONCLUSION

All naso-sinusal polypoid should have a histological study. Patients must be followed-up regularly; this is very difficult in Africa.

[Malignant solid tumours in Brazzaville children: epidemiological and anatomo-pathological aspects]

In this retrospective study over six years the authors report 65 malignant solid tumours of the children under the age of 15 years old. The average age was 7.9 years with a peak of frequency between 5 and 9 years. There was a male prevalence with a sex-ratio of 1.3. The most frequent histological types were: lymphoma of Burkitt (52%), retinoblastoma (20%), nephroblastoma (9%) and malignant tumours of the soft tissues (6%). The malignant solid tumours of the child are relatively rare and histologically very diversified.

[The first Congolese case of cervical clear cell adenocarcinoma]

The authors report the first Congolese case of uterine cervix clear cell adenocarcinoma in a menopausal multipara, whose mother had not been treated by diethystilboestrol (DES). The histological diagnosis was made on embedded-paraffin samples, stained by HE and PAS. Discharged from hospital on parents' request in order to be on infusion and brew-based traditional treatment, the patient died at home two months after diagnosis.

[Histoepidemiologic profile of 375 primary bowel cancers at the University Hospital Center in Brazzaville, Congo]

This retrospective study was undertaken to determine the histoepidemiologic profile of primary digestive tract cancer based on analysis of 375 of the 2558 cases diagnosed in the Cytopathology Department of the the University Hospital Center in Brazzaville, Congo from January 1992 to December 2001. Incidence was 14.6%. The sex ratio was 1:5. Age ranged from 39 to 49 years. The liver (40.2%) was the most frequent location followed by the colon/rectum (30.2%), stomach (26.2%), and esophagus 2.1%. Predisposing factors included low-fiber diet, heavy consumption of smoked foods, and history of hepatitis B and C virus infection. The most frequent histological entity accounting for 57% of cases was adenocarcinoma that was observed in the esophagus, stomach, colon, rectum, and pancreas. Systematic screening and treatment of precancerous lesions in high-risk patients is necessary to reduce the incidence of digestive tract cancer.