Are tuberculosis wards a risk factor for HIV in Africa?

A twenty-year-old female prostitute had an indeterminant HIV western blot in Djibouti during June 1988. She was hospitalised at the tuberculosis hospital in October and was re-tested for HIV in November. Her western blot result was still indeterminant, despite a progressive profile, and she therefore escaped to the hospital's HIV surveillance system. There were strong indications that while in-hospital, the patient resumed the activities of her previous profession. We conclude that active tuberculosis may develop in African HIV patients prior to the development of a confirmatory HIV western blot profile. Thorough precautionary measures are indicated for preventing HIV from spreading to health care personnel and amongst hospitalised patients in Africa.

HIV infection surveillance in Mogadishu, Somalia

A group of 89 prostitutes and 45 patients attending sexually transmitted disease clinics in Mogadishu, Somalia were examined for evidence of HIV infection. Both groups reported more than 1 sexual partner routinely and had sexual contacts with prostitutes. There was a significant amount of sexually transmitted diseases (STDs) in these two groups, with 11.2% and 6.7% respectively being culture positive for N. gonorrhoea. Among the prostitutes, 28.1% were positive for antibodies to T. pallidum while only 4.4% of the STD patients were positive. One isolate of N. gonorrhoea was resistant to penicillin. All study participants were negative for antibodies to HIV suggesting an extremely low prevalence of HIV in high risk behaviour groups in the capital city of Somalia.

Replication of minute virus of mice DNA in adenovirus-infected or adenovirus-transformed cells

The effect of adenovirus infection or transformation on the DNA replication of Minute Virus of Mice (MVM) was studied in human fibroblast cell lines. In WI38, HeLa, and 293 cells MVM infection allowed production of viral NS-1 and capsid proteins with or without adenovirus 2 (Ad2) co-infection. However, MVM DNA replication varied markedly. In HeLa cells MVM DNA was replicated weakly in host nucleoli, and replication was increased markedly by Ad2 co-infection as well as recompartmentalized to Ad2 replication factories. In Ad-transformed 293 cells MVM DNA was replicated very efficiently when infected alone or with Ad2 co-infection although recompartmentalization from nucleoli to replication factories was also seen. In WI38 cells MVM DNA was not replicated under any conditions. The variation in DNA replication in WI38, HeLa, and 293 cells despite viral protein production in all cases suggests that MVM DNA replication is uncoupled from viral gene expression and that host factors required for MVM DNA replication are induced or recompartmentalized by adenovirus infection or transformation.

Epidemiology of bacterial pathogens associated with infectious diarrhea in Djibouti

During a survey examining the causes of diarrhea in the East African country of Djibouti, 140 bacterial pathogens were recovered from 209 diarrheal and 100 control stools. The following pathogens were isolated at comparable frequencies from both diarrheal and control stools: enteroadherent Escherichia coli (EAEC) (10.6 versus 13%), enterotoxigenic E. coli (ETEC) (11 versus 10%), enteropathogenic E. coli (EPEC) (7.7 versus 12%), Salmonella spp. (2.9 versus 3%), and Campylobacter jejuni-C. coli (3.3 versus 5%). Surprisingly, the EAEC strains isolated did not correspond to well-recognized EPEC serogroups. No Yersinia spp., enteroinvasive E. coli, or enterohemorrhagic E. coli were isolated during the course of this study. Only the following two genera were recovered from diarrheal stools exclusively: Shigella spp. (7.7%) and Aeromonas hydrophila group organisms (3.3%). Shigella flexneri was the most common Shigella species isolated. Patients with Shigella species were of a higher average age than were controls (27 versus 13 years), while subjects with Campylobacter or Salmonella species belonged to younger age groups (2.6 and 1.6 years, respectively). Salmonella cases were more often in females. Shigella diarrhea was associated with fecal blood or mucus and leukocytes. ETEC was not associated with nausea or vomiting. Anorexia, weight loss, and fever were associated with the isolation of Salmonella and Aeromonas species. EAEC, ETEC, EPEC, and Shigella species were resistant to most drugs used for treating diarrhea in Africa, while the antibiotic most active against all bacteria tested was norfloxacin. We conclude that in Djibouti in 1989, Shigella and Aeromonas species must be considered as potential pathogens whenever they are isolated from diarrheal stools and that norfloxacin should be considered the drug of choice in adults for treating severe shigellosis and for diarrhea prophylaxis in travelers.

[Aeromonas hydrophila in the drinking water in Djibouti: commensal germ or diarrhea-causing agent?]

To investigate the bacteriological quality of drinking water used by inhabitants of the Republic of Djibouti who were not supplied with piped running water, we analysed 16 fresh-water samples from various sources. Only 3 samples were sterile; they were taken from village pumps and from a water-truck. Eleven samples yielded colonies of Aeromonas hydrophila too numerous to be counted; they were taken from water tanks, metal barrels, or wells dug in either dry river beds or along the seashore. We speculate that this high isolation frequency of Aeromonas hydrophila in fresh water samples may be related to conditions that are exceptionally favourable for the growth of the bacterium (e.g. high temperature and elevated concentrations of certain salts and minerals in the fresh water of Djibouti). We wonder nevertheless whether the infected water supplies were a source of diarrhoea for humans. Indeed, antibiotic resistance patterns were dissimilar when the 11 environmental strains were compared to 7 strains of Aeromonas hydrophila isolated from diarrhoeal patients in Djibouti during the same period. More studies are needed to determine if Aeromonas hydrophila is always a commensal inhabitant of fresh water in Djibouti, or if it can be a cause of infectious diarrhoea. Accordingly, Public Health authorities in Djibouti will be able to decide if water from wells and tanks is safe for drinking, or if it needs disinfection before consumption.

Adenovirus and minute virus of mice DNAs are localized at the nuclear periphery

The localization of adenovirus 2 (Ad2) and Minute Virus of Mice (MVM) DNAs was studied in situ in infected HeLa cell nuclei using fluorescent DNA probes and confocal microscopy. Ad2 DNA was found in multiple foci which were localized along the periphery of the infected cell nuclei. MVM DNA was found in HeLa cell nucleoli which are associated with the nuclear envelope, and when co-infected with Ad2 MVM DNA was compartmentalized to multiple foci which again were localized at the nuclear periphery. The data are discussed in terms of a model for the role of intranuclear compartmentalization in eukaryotic DNA structure and function.

HHV-6 in Djibouti--an epidemiological survey in young adults

Human herpesvirus type six (HHV-6), previously called human B-cell lymphotropic virus (HBLV), was first isolated in 1986 from patients with various lymphoproliferative disorders, some related to the acquired immunodeficiency syndrome. In order to investigate the epidemiology of HHV-6 in the Horn of Africa, we studied 281 young adults living in the city of Djibouti during June 1988. Of these, 181 belonged to various groups at risk for human immunodeficiency virus (HIV), while 100 represented the normal young adult population. Sera were screened and titrated for antibodies against HHV-6 by an indirect fluorescent antibody assay. The percentage seropositivity for HHV-6 was 71 in the normal population, 75 in the population at risk for HIV, and 93 in the population of subjects with a confirmed positive HIV Western blot. Mean titres of positive sera were similar in all population groups. No correlation existed between HHV-6 seropositivity and age, sex, tribe, habitat, and risk factors for HIV. A positive correlation was noted between HHV-6 and patients complaining of fatigue.

Serological evidence for human immunodeficiency virus type 2 in east Africa

Infection by human immunodeficiency virus type 2 (HIV-2) has not previously been described in North or East Africa. We examined over 1200 sera of high-risk individuals from three North/East African countries for antibodies to HIV-2. Results indicated that 17 were repeatedly reactive by ELISA; 4 were confirmed by Western blot. Of the 4 confirmed, 2 produced strong reactions to the envelope antigens of HIV-2 but not of HIV-1. One of these subjects was a foreigner from Senegal who was tested while in Egypt and one was a Djiboutian prostitute who was infected presumably prior to October 1987. We conclude that HIV-2 has been introduced into this region and that specific testing of selected individuals for HIV-2 is warranted.

Repressive coping style and anxiety in stressful dental surgery

Elevated state-anxiety prior to oral surgery is common and is associated with increased post-operative pain. This paper presents a psychological model of predicting elevated anxiety prior to dental surgery. Elevated anxiety and intraoperative stress can be predicted by measuring trait-anxiety. However, prediction may be improved by using a situationally specific measure of trait-anxiety, and by taking the patient's coping style into account. Thirty-nine patients undergoing wisdom-tooth extraction took part in the study. The Corah Dental Anxiety Scale was a better predictor of pre-operative anxiety than the STAI trait-anxiety scale. Coping style was measured by means of the Marlowe-Crowne Social Desirability Scale in conjunction with scores on trait-anxiety to define three coping style groups: sensitizers (high-anxious), truly low-anxious, and repressors who verbally deny anxiety. Two oral surgeons rated patient intra-operative state on 100 mm visual analogue scales. These ratings indicate that 'repressors' exhibit significantly more stress responses than the truly low-anxious group, in spite of similar (low) trait-anxiety scores. It is concluded that a situationally specific measure of trait-anxiety is the most appropriate predictor of differential state-anxiety elevations prior to oral surgery. Repressive coping style may be a confounding factor, in terms of predicting elevated anxiety, since some people verbally deny being anxious but express it behaviourally.

Interactions of minute virus of mice and adenovirus with host nucleoli

Biochemical evidence is presented that both minute virus of mice (MVM) and adenovirus interact with the nucleolus during lytic growth and that MVM can also target specific changes involving nucleolar components in adenovirus-infected cells. These virus-nucleolus interactions were studied by analysis of intranuclear compartmentalization of both viral DNAs and host nucleolar proteins: (i) MVM in mouse cells (its normal host) replicates its DNA in the host nucleoli; (ii) specific nucleolar proteins as well as small nuclear ribonucleoprotein antigens are recompartmentalized to multiple intranuclear foci in adenovirus-infected HeLa cells; and (iii) when adenovirus helps MVM DNA replication in a nonpermissive human cell (HeLa), the MVM DNA is also recompartmentalized for synthesis. The data suggest mechanisms for disruption of nucleolar function common to oncogenic or oncolytic virus lytic growth and cell transformation.

The interrelationship of Plasmodium falciparum and P. vivax in the Punjab

Analysis of data obtained from Giemsa-stained blood films from patients with mixed Plasmodium vivax and P. falciparum parasitaemias seen in outpatient clinics held over 20 consecutive months in 4 villages in the Pakistani Punjab suggest that infections with P. falciparum and P. vivax were independent of each other. There was no evidence to support the hypothesis that P. falciparum suppressed P. vivax. A likely explanation for the seasonal variation in species parasitaemia rates in the Punjab is that P. vivax was predominant early in the transmission season due to late relapses, while P. falciparum was predominant later in the transmission season because of community-wide development of immunity to P. vivax.

Diagnostic usefulness of five screening assays for HIV in an east African city where prevalence of infection is low

Five commercial screening assays for HIV-1, evaluated for their usefulness in detecting infection in high-risk groups in the East African country of Djibouti, produced varying degrees of performance when compared to Western blot and immunofluorescence confirmatory assays. In this population with a low prevalence of HIV infection (16/599), two enzyme-linked immunosorbent assays (ELISA; Abbott and Elavia) and two rapid assays (cambridge latex agglutination and Du Pont's HIV-CHEK) exhibited less than optimal sensitivities. However, with the exception of Elavia, these assays displayed excellent specificities. The fifth test (Serodia gelatin agglutination) produced the highest sensitivity (0.938) and negative predictive value but the lowest specificity and positive predictive value of all five tests. False positive reactions, which occurred only with the Elavia and Serodia tests, could not be explained on the basis of early infection in patients or cross-reactions with the related retroviruses HIV-2 and HTLV-I. We conclude that none of the five tests alone is sufficient in this testing situation, but that a combination of tests could satisfy most requirements for identifying HIV-1 reactive and non-reactive sera.

[Malaria in the Djibouti Republic. Results of a serologic survey in Ambouli]

To investigate the importance of malaria as a public health problem in Djibouti, we studied 144 febrile subjects living south of Djibouti-city in the agricultural area of Ambouli. All blood slides examined were negative for parasites. Antibodies against the merozoite stage of Plasmodium falciparum were investigated by an indirect immunofluorescence assay using serial serum dilutions. Only 9 sera reacted negatively at the titer of 50 (the chosen cut-off for positivity). Fourteen sera tested positive at a titer above 1000. Percentages of seropositive subjects and geometric mean titers increased with age. We conclude that inhabitants of Ambouli were heavily exposed to Plasmodium falciparum in the recent past. However, our data do not allow to ascertain if the malaria infections were contracted inside or outside of the national territory, since Djiboutians are frequent and extensive travelers.

Trait anxiety and coping style as predictors of pre-operative anxiety

A situationally specific measure of trait anxiety based on the Endler model was a better predictor of pre-operative state anxiety than the STAI trait anxiety scale in 54 patients undergoing colonoscopy. Lower self-reported pre-operative anxiety was found for (a) repressors, who report low trait anxiety and high defensiveness on the Marlowe-Crown scale, than for (b) truly low anxious patients, who report low trait anxiety and low defensiveness.

Low prevalence of HIV infection in Djibouti--has the AIDS epidemic come to a stop at the Horn of Africa?

To determine if the HIV-epidemic had reached Djibouti by autumn 1987, we investigated 645 subjects belonging to various risk groups; 150 were patients with a disease compatible with acquired immune deficiency or with a mycobacterial infection, 115 were young males having a sexually transmitted disease, 295 were female prostitutes, and 69 were villagers from a rural area; the remaining 16 belonged to other groups. All subjects answered an epidemiological questionnaire and had their serum tested for evidence of HIV antibodies. Eight sera were HIV-antibody positive by both ELISA and Western blot. Of these, 2 were from young men while 6 were from young women who admitted to prostitution. This accounts for an HIV seropositivity rate of 2.0% +/- 1.6% in the prostitute population. Also, one antibody-positive subject was positive for circulating HIV antigen. Seven of the seropositive individuals had no general complaints or abnormal clinical signs. The eighth subject was a 28 year old man in hospital for pneumonia. We conclude that in Djibouti, in late 1987, the prevalence of both AIDS and HIV infection in high risk individuals was much lower than that reported from other East African countries.

[Knowledge of sexually transmitted diseases and attitudes towards them in populations at risk in Djibouti]

Sexually transmitted diseases (STDs) are an increasing public health problem in Djibouti. The authors have attempted to obtain basic information on the level of knowledge concerning STDs and on the sexual behaviour of highly sexually promiscuous individuals for use in the organization of future STD control programmes; the information was obtained from a population of 213 bar hostesses, 66 unlicensed prostitutes, and 115 male sufferers from STDs. The level of knowledge of these diseases was very high among the prostitutes and the bar hostesses, except that little was known about syphilis by the bar hostesses; the male sufferers were relatively ignorant concerning both syphilis and AIDS. Medical and paramedical personnel do not figure among the sources given for knowledge of STDs. On the other hand, friends play an important role in this knowledge, especially among unlicensed prostitutes. The second most frequently instanced source was radio and TV. The bar hostesses and the unlicensed prostitutes often exhibited distinct social characteristics. Neither education nor marriage appeared to prevent men from contracting STDs. The use of condoms is extremely rare among STD patients and not very common among unlicensed prostitutes. Half the bar hostesses report their frequent use.

Low prevalence of infection by HTLV-I in populations at risk for HIV in Djibouti

In order to determine whether HTLV-I (a recently discovered retrovirus causing T-cell leukaemias and lymphomas, as well as tropical spastic paraparesis) was present in Djibouti in 1988, we investigated 576 subjects belonging to various groups at risk of acquiring HIV, a related retrovirus transmitted analogously to HTLV-I. Sera were screened by a commercial agglutination assay and confirmation of repeatedly reactive sera was performed by specific Western blot analysis. Four sera were strongly positive for HTLV-I by Western blotting, while one serum displayed equivocal reactivity. All positive sera came from young women who engaged in prostitution. This accounted for an HTLV-I seropositivity rate of 0.7% (95% CI, 0.03-1.4%) in the total study population and 1.2% (95% CI, 0.02-2.4%) in the population engaged in prostitution. We concluded that in Djibouti in June 1988, HTLV-I was present but that the prevalence of infection in high risk individuals was very low.

Viral hepatitis markers in Djibouti: an epidemiological survey

A serosurvey involving 656 individuals revealed that hepatitis A infection was virtually universal in Djibouti in 1987, and more than half of the people investigated had serum markers of hepatitis B infection. The rate of chronic HBsAg carriers was 7.3% and was higher for males than for females. Both HBsAg and anti-HBs positivity rates were directly related to increasing age. No uniform mechanism could be found to account for transmission of the hepatitis B virus, and no correlation was noted between HBV-marker status and sexual promiscuity or the classic blood exposure risks. However, a significant association existed between the abuse of khat and the chronic HBsAg carrier state.

Malaria and splenomegaly in the Punjab

Splenomegaly and parasitaemia were correlated in 2891 children examined in outpatient clinics during 13 consecutive months in 4 Punjabi villages. The average monthly splenomegaly rate varied from 0.05-0.13 before the monsoon malaria transmission season to 0.18-0.27 during and after this season. Moderate splenic enlargement reached a peak during the malaria transmission season, while the highest proportion of very enlarged spleens occurred towards the end of, and after, the transmission season. Children with splenomegaly were 3 times more likely to have Plasmodium falciparum and 1.5 times more likely to have P. vivax parasitaemias than were children without palpable spleens. The larger the spleen the more likely a P. falciparum infection, whereas P. vivax was more commonly associated with minimal spleen enlargement. Although the probability of a child with splenomegaly having a malaria parasitaemia was highest (0.58-0.72) during and immediately following periods of malaria transmission, the odds ratio of malaria infections among those with splenomegaly to those without was at its lowest (1.41-2.11) during those months. Mean P. falciparum parasitaemias were significantly higher in infected children with moderately enlarged spleens than in infected children with nonpalpable spleens or in those with minimal or extensive splenomegaly. These results are compatible with splenomegaly being a result of both the malaria infection and the immune response. Early in infection many children had parasitaemia without splenomegaly; after the parasitaemia had cleared splenomegaly often persisted.