Peripheral neuropathies revealing HIV infection at the Hospital Center of Bobo-Dioulasso (Burkina Faso)

Several peripheral neuropathies are associated with human immuno-deficiency virus (HIV) infection. In Africa, certain diseases are of particular importance. In the present work, we report peripheral neurological involvement as revealing signs of HIV infection within the internal medicine unit of a large city over a 2-year period. All adult subjects with a positive HIV serology revealed by a peripheral neuropathy observed in the National Hospital Centre of Bobo-Dioulasso over a two-year period (1 January 1999 and 31 December 2000) were included in the study. 46 cases of peripheral neuropathies revealing HIV infection were screened. Peripheral facial paralysis concerned 25 patients, 15 women and 10 men, in the early stages of HIV infection. The average age was 34 years. For 80% of the patients, he CD4 count was over 200. 5/10 cases of polyneuropathy occurred at the early stage of the HIV infection. Herpes zoster occurred in the early stages in 5/7 cases. 3/4 cases of polyradiculopathy occurred at a later stage with CD4 count under 200. Our study indicates clearly that isolated peripheral facial paralysis, sensitive polyneuropathy, herpes zoster and polyradiculopathy in young adults should lead to HIV testing.     

Bilateral peripheral facial palsy in a patient with Human Immunodeficiency Virus (HIV) infection

Neurological complications are important causes of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. They can occur at any stage of the disease and can affect any level of the central or peripheral nervous systems. In the literature, several cases of HIV-associated facial paralysis have been reported; however, bilateral facial palsy is rarely reported. In this paper, we present the first case in Korea, of a bilateral facial palsy occurring as the first clinical manifestation of HIV infection.     

Neurologic and psychiatric manifestations of AIDS in Central African Republic

To describe and evaluate the frequency of neurological and psychiatric manifestations in African patients with AIDS, 93 in patients at the National Hospital Center, Bangui, were chosen according to the WHO clinical definition of AIDS and were confirmed to be HIV-1 positive (92/93) or HIV-2 positive (1/93) by Western blot. Patients were given both neurologic and psychiatric examinations. Cortico-spinal fluid (CSF) analysis was performed in case of neuro-psychiatric signs. 11 patients presented neurologic symptoms: 5 had focal processes associated in 2 cases with deep coma, 4 had cryptococcal meningitidis, 1 demonstrated peripheral facial paralysis, and there was one case of abnormal movement, choréo-athétotic type. 4 patients presented frank psychiatric symptoms (3 dementia syndromes, one of whom was HIV-2 positive, and 1 case of hallucinatory psychosis). CSF analysis was only helpful in the etiologic diagnosis of cryptococcal infection. The mortality rate in these 15 patients was 60% during the 2-month study. In this series, neurologic and/or psychiatric symptoms were detected in 16 (15/93)% of African patients with AIDS.     

手术治疗周围性面瘫的疗效观察

目的：探讨周围性面瘫手术治疗后的恢复效果。方法：根据其面神经损伤定位检查结果，分别采取经外耳道、乳突、颅中窝等不同入路行面神经减压术治疗。结果：术后随访1-5a，33例中面神经功能恢复达H-B Ⅰ级和Ⅱ级者共24例，其中手术时间30d者11例中，术后面神经功能达H-B Ⅰ级10例。结论：经保守治疗无效的周围性面瘫患者应尽早施行面神经减压治疗术，早期手术者其术后恢复效果明显好于晚期手术者。     

6例Melkersson-Rosenthal综合征的临床、病理及电生理特点

目的：分析梅-罗（Melkersson-Rosenthal）综合征（MRS）的临床、病理及电生理特点，以提高对本病的认识和诊断水平。方法：对6例MRS患者的临床表现、病理改变及神经电生理检查结果进行回顾性研究。结果：按MRS的诊断标准，6例中4例为完全型。全部患者均有唇、面部水肿；5例出现周围性面瘫；4例有皱襞舌表现。其中2例家族史阳性。2例患者的病理活检结果支持MRS诊断。神经电生理检查提示：面神经运动传导复合肌动作电位潜伏期延长、波幅降低或引不出波形；面神经支配的肌肉针电极肌电图无运动单位电位，或募集相呈单纯相、峰值减低。结论：MRS的主要临床特征为唇、面部水肿，周围性面瘫及皱襞舌。病程长、反复发作者多预后不佳。神经电生理检查对判断该病的预后有重要意义。     

Human papillomavirus infection and cervical abnormalities in Nairobi, Kenya, an area with a high prevalence of human immunodeficiency virus infection

Human papillomavirus (HPV) infection and cervical abnormalities, and their association with human immunodeficiency virus (HIV) infection were studied in 488 women who visited a health center in Nairobi. PCR-based HPV and cervical cytology tests were carried out on all participants, and peripheral CD4+ T cells and plasma HIV RNA were quantitated in HIV positive women. HIV were positive in 32% (155/488) of the women; 77% of these were untreated, and the others had been treated with anti-retroviral drugs within 6 months. Cervical HPV infection was detected in 17% of HIV negative and 49% of HIV positive women. Low-grade squamous intraepithelial lesions were observed in 6.9% of HIV negative and 21% of HIV positive women, while high-grade squamous intraepithelial lesions and cancer were seen in 0.6% and 5.8%, respectively. Multivariate analysis revealed that HIV and HPV infections were associated with each other. Cervical lesions were significantly associated with high-risk HPVs and with HIV infection, depending on HPV infection. HPV infection increased in accordance with lower CD4+ T cell counts and higher HIV RNA levels, and high-grade lesions were strongly associated with high-risk HPV infection and low CD4+ T cell counts. Immunosuppression as a result of HIV infection appears to be important for malignant progression in the cervix. Nationwide prevention of HIV infection and cervical cancer screening are necessary for the health of women in this area. High-risk HPV infection and low CD4+ T cell counts are the risk factors for cervical cancer.     

CD4+ CD25+调节性T细胞在HIV/AIDS患者中的作用及其与HIV病毒载量的相关性研究

目的 研究HIV感染者／AIDS患者外周血CD4^＋ CD25^＋ 调节性T细胞（CD4^＋ CD25^＋ regulatory Tcell，Treg）频率、功能及其临床意义。方法 选择31例HIV感染者／AIDS患者和30例健康对照者，采用流式细胞仪检测各组外周血Treg的表型和频率。采取MACS磁珠分选CD4^＋CD25^＋T细胞，利用[^3H]胸腺嘧啶掺入法检测CD4^＋ CD25^＋T细胞在特异性HIV抗原刺激下对CD4^＋ CD25-T细胞的增殖影响。结果HIV／AIDS患者组与正常对照组相比较，外周血CD4^＋ CD25^＋ T细胞频率在统计学上差异无统计学意义。与正常对照组比较，HIV感染者外周血CD4^＋ CD25^＋ T细胞频率升高，差异有统计学意义（P〈0.01）；与正常对照组比较，AIDS患者者外周血CD4^＋ CD25^＋ T细胞频率降低，差异有统计学意义（P〈0．0001）。HIV RNA病毒载量与患者外周血CD4^＋ CD25^＋ T细胞数量呈正相关性（P〈0．01）。CD4^＋ CD25^＋ T细胞具有抑制HIV特异性的CD4^＋ CD25^- T细胞的增殖作用。结论HIV感染者／AIDS患者的细胞免疫功能紊乱，CD4^＋ CD25^＋ T细胞能抑制HIV感染者／AIDS患者的HIV特异性细胞免疫反应，促进HIV病毒复制，与形成持续HIV感染有关。     

HIV isolation from pulmonary cells derived from bronchoalveolar lavage.

In a study of 75 alveolar cell co-cultures from 55 HIV-seropositive subjects, p24 antigen production was identified by ELISA in 11 out of 26 (42%) of unseparated cell cultures, 15 out of 39 (38%) purified alveolar macrophage cultures and eight out of 10 purified alveolar lymphocyte samples. Positivity in unseparated cell cultures was associated with an alveolar lymphocytosis greater than 30%. Negative macrophage cultures were significantly more likely in the early stages of HIV infection with none positive when the subject had a peripheral CD4+ cell count greater than 300/microliters. Alveolar macrophage infection thus appears to increase with HIV disease progression.     

Human immunodeficiency virus (HIV) infection in haemophiliacs: long-term prognostic significance of the HIV serologic pattern.

To identify markers of prognostic value in the course of HIV disease, immunologic parameters and profiles of HIV antibodies and antigen were studied in 60 haemophiliacs. The 43 HIV-seropositive subjects were followed prospectively over a 4 year period with a retrospective analysis as well of their frozen plasma for HIV markers. This group had a significant decrease in number of helper/inducer T lymphocytes as compared with 17 HIV seronegative subjects. The degree of changes correlated with the stage of disease, with the most severe depletion of CD4 cells in those who developed AIDS. Counts of B cells and platelets were also lower in HIV-infected haemophiliacs. Ten out of 12 AIDS patients had undetectable antibodies to HIV p24 antigen; low levels of p24 antibody were also seen in six out of 15 subjects with lymphadenopathy (CDC stage III), but in only two out of 16 asymptomatic subjects (CDC stage II). Sustained HIV p24 antigenaemia (greater than 30 pg/ml) was seen in 10 AIDS patients, in five subjects with lymphadenopathy and in two asymptomatic haemophiliacs. Initial HIV serologic profiles, obtained when all patients were asymptomatic, were highly predictive for progression of the HIV infection: the initial pattern of low anti-p24 antibody and positive p24 antigenaemia conferred the worst prognosis, with all patients in this group developing ARC or AIDS within 36 months, whereas an initial high level of anti-p24 without p24 antigenaemia was associated with relatively the best prognosis. Of such subjects, 58% have remained clinically asymptomatic after 48 months of the study (P less than 0.00001). The serologic profile of HIV antibody pattern and HIV antigen in haemophilic patients thus already provides important prognostic information at an early stage of HIV infection.     

Hepatitis viruses and HIV infection in the Naples area

In 189 anti-HIV positive subjects (130 males and 59 females; median age 32 years, range 17-57) we evaluated the prevalence of patients with hepatitis infections, the role of parenteral and sexual risk factors on the acquisition of these infections and the reciprocal influence between HIV and HCV infections. HCV infection was detected in 53.9% of cases and HBV infection in 8.4%. In only 32% of our patients no marker of hepatitis virus infection was detected. The presence of a hepatitis virus infection was associated to drug addiction; indeed in 91 drug abusers HIV/HCV co-infection was present in 80% of cases and HIV infection alone in 7.7%, p<0.0001. On the other hand, the association between unsafe sexual activity, whether homosexual or heterosexual, and sexual activity with a steady anti-HIV positive partner with HCV infection was less evident, although the high prevalence of anti-HCV in these cases (10.4%, 15.4% and 26.4% respectively) clearly suggests that HIV infection may improve the sexual transmission of HCV. No substantial differences in the level of immunodeficiency, nor in the HIV viral load nor in the frequency of AIDS cases were observed between patients with HIV infection alone and those with HIV/HCV co-infection. In fact, the percentage of patients with AIDS was similar in these two groups. However, we observed a statistically significant association between an advanced HIV clinical stage and the presence of HIV/HCV co-infection (p<0.005), since subjects with co-infection more frequently than with HIV infection alone were in the CDC-B clinical stage. The presence of a more severe liver disease was linked to a multiple hepatitis virus infection, regardless of the degree of immunodeficiency.     

Importance of anticomplement immunofluorescence antibody titration for diagnosing varicella-zoster virus infection in Bell''s palsy.

Anticomplement Immunofluorescence was used for antibody titration against varicella-zoster virus (VZV) in 43 patients with peripheral facial palsy. Nine of 31 patients (29%) with Bell's palsy and eight of 12 patients (75%) with Ramsey-Hunt syndrome had anticomplement immunofluorescence antibody titres of greater than or equal to 1/10. On the other hand, none of 14 patients with herpes simplex virus (HSV) infection and 51 healthy adults showed anticomplement immunofluorescence antibody titres of greater than or equal to 1/10. The anticomplement immunofluorescence antibody titre in two patients with Ramsey-Hunt syndrome increased later and decreased sooner than the indirect immunofluorescence antibody titre, becoming undetectable at 66 and 104 days, respectively, after onset of the disease. There was no cross reaction between anti-VZV and anti-HSV antibodies in the patients who showed a positive antibody rise for VZV. As the acute stage of VZV infection is obscure in the patients with peripheral facial palsy without herpes the screening of anticomplement immunofluorescence antibody to VZV at titres greater than or equal to 1/10 may be useful for the diagnosis of VZV infection in patients with peripheral facial palsy.     

手术治疗周围性面瘫40例疗效分析

目的探讨周围性面瘫患者发病原因、发病机制、有效的治疗方法及预后分析。方法对颞骨骨折及贝尔面瘫患者采用面神经减压术;面神经离断伤患者采用面神经吻合术;不能行面神经吻合患者则采用面神经移植转接手术治疗;术后配合神经营养药物及针灸治疗。结果对40例患者进行随访,发病1个月内与1—3个月以内手术治疗患者面神经功能恢复的疗效差异无统计学意义（P〉0．05）,而两者与3个月以上患者的疗效差异则有统计学意义（P〈0．05）。28例颞骨骨折和4例贝尔面瘫患者行面神经减压术,面神经功能恢复Ⅰ级21例,Ⅱ～Ⅲ级7例,Ⅳ-Ⅴ级4例;2例患者行面神经端．端吻合,面神经功能恢复Ⅲ级;另外4例是听神经瘤、面神经鞘瘤切除术后行面神经一副神经、舌下神经转接吻合,面神经功能Ⅲ～Ⅳ级;2例腮腺肿瘤切除术后采用耳大神经、腓肠神经进行移植吻合,面神经功能Ⅳ级。结论周围性面瘫患者3个月以内手术治疗较3个月以上者效果好;颞骨骨折导致周围性面瘫患者行面神经减压术效果最好,面神经移植转接术效果最差。对周围性面瘫患者适时进行手术治疗是有必要而且是安全有效的。     

Prevalence of fungal meningitis among HIV positive & negative subjects in Indore (MP state)

The aim of the study was to find out the prevalence of fungal meningitis among AIDS cases and to assess the prognosis of fungal meningitis among HIV positive & negative subjects. The study comprised of 15 & 10 cases of fungal meningitis among HIV positive & negative subjects respectively during the study period 1992-2001. India ink preparation and Gram's staining procedures were carried out on the centrifuged CSF deposits. The CSF deposits were also used for bacterial and fungal culture. In the present study the prevalence of fungal meningitis was noted among 15 (3.1%) of 483 AIDS cases. Twelve of them had cryptococcal meningitis while 3 were infected with Candida albicans. Four AIDS cases presented fungal meningitis as a primary opportunistic infection and HIV status was confirmed in 4 of them after the diagnosis of fungal meningitis. 13 of the 15 cases were in the age group 26-40 yrs while one was 55 yrs old and the other 16 month old child; these two cases had blood transfusion transmitted and vertically transmitted mode of HIV transmission respectively. Further, only two of 15 cases were females and both acquired HIV infection through blood transfusion. Overall prognosis of fungal meningitis was poor among HIV positives and 7 of the 15 cases died in hospital within 2-3 weeks after diagnosis of cryptococcal meningitis. Among HIV negative subjects, ten cases of fungal meningitis (3 with Candida albicans and 7 with Cryptococcous neoformans) were noted at our end and nine of them had immunocompromised status (3 cases of renal transplant on immunosuppressives, 3 cases neonates/infant and 2 diabetic subjects. The fungal meningitis is one of the important causes of morbidity & mortality among immunocompromised among HIV positive subjects.     

Direct detection of proviral gag segment of human immunodeficiency virus in peripheral blood lymphocytes by colorimetric PCR assay as a clinical laboratory tool applied to different at-risk populations.

We used a colorimetric polymerase chain reaction (PCR)-based assay in kit form to detect directly human immunodeficiency virus type 1 (HIV-1) proviral gag sequences in peripheral blood cells from 68 healthy blood donors, 51 subjects at risk for HIV infection, 122 patients with HIV-1 infection, 11 patients with indeterminate Western blot (immunoblot) results, 4 blood donors HIV-1 positive by enzyme immunoassay, and 13 children born to HIV-1-seropositive mothers. The results obtained in the blood donors and HIV-1-infected patients demonstrated the high degree of diagnostic specificity and sensitivity of the PCR method. HIV-1 infection was excluded in 10 of the 11 patients with indeterminate Western blot results and in all four enzyme immunoassay-positive blood donors. A diagnosis of HIV infection was ruled out by negative PCR results in 5 of 13 children from seropositive mothers, which excluded vertical transmission of the infection in these cases; these children were younger than 3 months and had positive serological results. Two at-risk patients with negative serological results had positive PCR results. All results were confirmed by conventional PCR. In conclusion, colorimetric PCR, which is commercially available in kit form, is an easy and reliable technique that can be used to detect proviral HIV-1 genomes in blood cells, and despite the limitations owing to HIV genome variability, it is useful in the clinical setting for the diagnosis of HIV infection in selected categories of patients.     

面神经减压术中鼓索解剖观察及临床意义

目的　观察面神经鼓索发出的位置和类型,为面神经减压手术和其它中耳乳突手术提供解剖学资料。 方法　2005年4月~2009年10月在我科接受单侧面神经减压术的216名成年汉族周围性面瘫患者,在手术显微镜下,观察分析鼓索发出的位置和类型。 结果　鼓索以单根的形式由面神经干发出占69.0%（149例）。以双根的形式发出,占19.4%（42例）。以3根的形式发出,占3.2%（7例）,鼓索的多个根最终都在面隐窝下方汇合成1根,进入鼓室。由于手术入路的关系,18例未见鼓索的发出点,占8.3%。单根鼓索按发出的部位：由茎乳孔区的锥形筋膜分出占55.0%（82例）,由乳突段面神经干分出占43.0%（64例）,由面神经锥段分出者占2%（3例）。 结论　鼓索由面神经乳突段发出的只占29%。22.6%的鼓索存在多根现象,本调查还发现2%的鼓索由面神经锥段发出的异常现象,都应该引起医生的重视,避免在手术中误伤,出现医疗事故。     

HIV抗体不确定样品的鉴别策略研究

目的探索HIV抗体不确定样品的确证策略。方法对93例HIV抗体不确定样品的抗体检测数据进行分析,并进行病毒载量检测和HIV抗体随访检测。结果复检时两种试剂检测结果不一致的有51例,病毒载量检测结果均为阴性。两种复检试剂检测结果均为阳性的42例样品中,有27例病毒载量检测结果为阳性,其中ELISA S/CO〉6的9例样品病毒载量检测结果均为阳性,ELISA S/CO≤6的33例样品中有18例病毒载量检测结果为阳性。对17例不确定样品进行了HIV抗体随访检测,11例病毒载量为阳性的样品均确证为HIV抗体阳性,6例病毒载量为阴性的样品均排除HIV感染。结论对于HIV抗体不确定样品应当慎重对待,HIV抗体复检结果和病毒载量检测结果有助于鉴别HIV感染状态。     

Beta2 microglobulin as a surrogate marker for HIV infection: good correlation with CD4 counts

To determine if beta-2 microglobulin (beta2M) levels were elevated in our HIV infected patient population and if it could be used as a surrogate marker for disease progression. Thirty-eight HIV infected individuals and 26 age and sex-matched controls were studied. Measurement of CD4 cell count was carried out on a flowcytometer using anti-human CD4 monoclonal antibody and beta2M was measured by an enzyme immunoassay. Mean levels of HIV infected individuals were 1.29 +/- 0.52 mg/L and were significantly higher than 0.74 +/- 0.07 mg/L, the value of controls (p value <0.01). There was a negative correlation between CD4 counts and beta2M levels (r-value-0.79, p value <0.001). Beta2M levels in HIV infected individuals who have no opportunistic infection are elevated and these levels correlate with the CD4 counts. Beta2M can be used for the clinical follow-up of patients with HIV infection.     

腹针治疗周围性面瘫选穴规律研究

目的 研究腹针治疗周围性面瘫的选穴规律。方法 通过计算机及手工检索,选取近15年有关腹针治疗周围性面瘫的相关文献,以临床研究、疗效观察、现代对比实验研究为依据,进行分析归纳,探讨腹针的选穴规律。结果 腹针治疗周围性面瘫主要取任脉、肾经、胃经及脾经上的穴位及腹部新穴,使用频率依次为55.70%、15.44%、14.09%、2.68%、12.08%;腹针治疗周围性面瘫选用的标志性穴位组合规律:主要有引气归元、腹四关、天地针、调脾气,其使用频率依次为48.48%、27.27%、12.12%、12.12%。结论 合理运用腹针,遵循其选穴规律,可有效治疗周围性面瘫。     

柳州市2008年新报告HIV/AIDS流行病学分析

目的 了解柳州市2008年新发现HIV阳性者流行病学特征,为今后制定艾防政策提供依据。方法 对全国艾滋病综合防治管理系统中2008年柳州市报告的553例HIV阳性者,其＂艾滋病个案流行病学调查表＂进行整理分析。结果 2008年新报告553例HIV阳性者,其中64.6%是感染者,柳州市本地人占28.8%,大部分是其他县区人（61.7%）;年龄最小4岁,最大77岁,50岁以上达22.2%;553例中有5个儿童,2人在幼托,3人散居;31.5%为家政、家务及待业者,8%是离退休人员;58.6%已婚有配偶;经异性传播56.4%,经注射毒品血液传播17.4%。结论 柳州市艾滋病疫情形势严峻,三种传播途径并存,异性传播已经超过吸毒传播而成为主要传播途径;已婚有配偶者居多,出现多例老年病例,疫情有向一般人群扩散的趋势。     

沿下颌缘支逆向解剖面神经在腮腺肿瘤手术中的临床意义

目的分析沿下颌缘支逆向解剖面神经方法切除腮腺肿瘤的手术效果。方法回顾性分折2002~2010年我科施行腮腺肿瘤切除术43例。腮腺浅叶切除31例,腮腺全切除12例。全部病例均采用下颌缘支逆行法解剖面神经。结果全组术后随访10～60个月,无肿瘤复发病例。2例术后腮腺瘘,14～23 d痊愈。无永久性面瘫、术后出血、感染等并发症。结论沿下颌缘支逆向解剖面神经的腮腺肿瘤手术方法解剖标志清楚,容易寻找,可有效降低面瘫的发生,有一定的临床应用价值。