Search PubMed⌕ Search

Biomedical subjects

H Taelman

Publications and source records attributed to H Taelman.

At least 37 records · Page 2Linked to original sources
PubMed1994

Twelve patients with severe malaria treated with partial exchange transfusion. Comparison between mathematically predicted and observed effect on parasitaemia.

Imported malaria is increasing in Western countries, which results in considerable morbidity and mortality, the latter mainly due to delayed diagnosis and treatment. Partial exchange transfusion has been proposed as a therapy for very severe falciparum malaria, but the utility of this procedure has not been proven. We report on 12 patients with severe Plasmodium falciparum malaria, treated with exchange transfusion in 5 Belgian hospitals between 1987 and 1991. The mean parasitaemia before exchange was 17.2% (range 6-35%). An average of 3.1 l was exchanged within 3 to 7 hours. Ten of the 12 patients survived. One patient recovered initially, but died as a consequence of a cascade of complications of dialysis. Three patients developed the adult respiratory distress syndrome (ARDS), two had less serious pulmonary involvement, and five had temporary renal failure; none of the survivors had sequelae. A formula is proposed to calculate the expected reduction in parasitized erythrocytes by exchange transfusion in function of the initial parasitaemia, the initial haemoglobin level and the volume of blood exchanged. Comparison between the mathematically predicted and the observed decline in parasitaemia shows on average a 25% excess of observed over predicted efficacy per unit of blood exchanged. After introducing this correction the formula enables the clinician to estimate roughly the volume of blood that has to be exchanged in order to bring the initial parasitaemia down to a desired level.

Adult↗
PubMed1994

[Tests for an early detection of pulmonary cryptococcosis by sputum culture].

Cryptococcosis is a serious opportunistic infection occurring in acquired immunodeficiency syndrome (AIDS) patients. As the number of infected patients with the human immunodeficiency virus (HIV) in Central Africa and especially in Rwanda increases, the prevalence of cryptococcosis can also be expected to rise. An earlier diagnosis and treatment will improve the prognosis of cryptococcosis. As it is widely accepted that the lungs are the portal of entry for the yeast, 270 sputum samples coming from 230 patients attending the Centre Hospitalier de Kigali (CHK)--Rwanda for lung diseases, were investigated. Cr. neoformans var neoformans was cultured from 8 samples coming from 5 out of 230 patients. A retrospective review showed that 4 out of 5 patients were infected with HIV, a predisposing factor for cryptococcosis.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Ecology of Cryptococcus neoformans in central Africa].

Cryptococcosis associated with AIDS is mainly due to Cryptococcus neoformans var. neoformans which is found in saprophytic form in pigeon droppings. This variety has been isolated in Central Africa, particularly in Zaire, Burundi and Rwanda, from dust collected from the houses of patients with cryptococcosis. Several patients confirmed frequent contact with pigeons. Recent studies in Australia demonstrated a link between the yeast and Eucalyptus of the camaldulensis and teriticornis species. These two species were imported to Central Africa from Australia. Examination of 657 Eucalyptus specimens collected in Rwanda did not detect the yeast in any type of tree. This finding casts doubt on the role of Eucalyptus in the ecology of cryptococcosis in Central Africa.

AIDS-Related Opportunistic Infections↗
PubMed1994

Persistent arthralgia and its association with HIV infection in Rwanda.

A prospective study of persistent arthralgia was carried out on 331 consecutive female patients admitted to the Department of Internal Medicine of the Centre Hospitalier de Kigali in Kigali, Rwanda. The aim of this study was to determine its association with HIV-1 infection and to describe its clinical characteristics. Ten additional HIV-1-seropositive patients with this condition attending the outpatient clinic were also included in the clinical study. Persistent arthralgia was significantly more common in HIV-1-seropositive hospitalized patients (14 of 209, 6.7%) than in HIV-1-seronegative hospitalized patients (one of 122, 0.8%; p = 0.02) and had a specificity and a positive predictive value for HIV-1 infection of 99.1% and 93.3%, respectively. HIV-1-related persistent arthralgia, studied in 24 patients in early as well as late stages of HIV-1 infection, commonly affected several and mainly large joints, was mostly distributed symmetrically, and was usually relieved with nonsteroidal antiinflammatory drugs. Recurrencies were noted in eight patients. In areas highly endemic for HIV-1, persistent arthralgia should be considered a probable manifestation of HIV-1 infection, and although it is uncommon, it can be regarded as a predictor of HIV-1 infection.

Adult↗
PubMed1993

Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome.

The present study was undertaken to determine the nature and the prevalence of ophthalmic manifestations of infections with Cryptococcus neoformans in human immunodeficiency virus seropositive patients and to analyze whether the presence or absence of ocular signs is associated with improved survival. Eighty human immunodeficiency virus seropositive patients with cryptococcal infection were enrolled. We observed papilledema in 26 of the 80 patients (32.5%). Visual loss and abducens nerve palsy occurred in seven patients (9%). Only two patients (2.5%) had optic atrophy. Visual loss caused by optic nerve involvement was less frequent among the 62 patients treated with oral conazoles exclusively than among the 18 patients who had received amphotericin B or a combination of amphotericin B and conazoles. Actual invasion of the intraocular structures with Cryptococcus neoformans was an uncommon complication in our series. In addition to the ocular manifestations attributable to cryptococcal disease, human immunodeficiency virus-related retinopathy was present in nearly half of the patients. Cytomegalovirus retinitis was diagnosed in four patients (5%). The 26 patients (32.5%) with papilledema had a median survival of 182 days vs 160 days for the patients without papilledema. The median survival for 18 patients (22.5%) with cotton-wool spots was 102 days vs 186 days for those without cotton-wool spots. The differences between these subgroups were not statistically significant.

AIDS-Related Opportunistic Infections↗
PubMed1993

Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae from Rwanda, 1984-1990.

A total of 383 clinical isolates of Streptococcus pneumoniae, obtained from an equal number of patients in Kigali, Rwanda, was tested for resistance to penicillin G with a 1 microgram oxacillin disc. Of these isolates, 99 (25.8%) showed reduced zones of inhibition. By means of an agar dilution method, 21% all isolates were confirmed as relatively resistant (MIC > or = 0.12- < or = 1.0 mg/l) strains of Streptococcus pneumoniae (RRSP). A high degree of resistance to penicillin G (MIC > or = 2 mg/l) was not observed. Resistance to chloramphenicol (MIC > or = 8 mg/l) was found in 31% RRSP and in 6% penicillin susceptible strains (PSSP). Doxycycline resistance was common in both RRSP and PSSP strains. All isolates remained fully susceptible to erythromycin. Children more often harboured a strain giving a reduced inhibition zone than did adults (74/230 versus 25/153; P = 0.0005). A total of 32 serotypes or serogroups were identified, seven of them relating to 64.8% all isolates typed. Of all the isolates 84% belonged to a serotype represented in the 23-valent vaccine or to a cross-reacting serotype. Serotype 25, not included in the vaccine, accounted for 10.7% typed isolates from adults but only for 2.0% typed isolates from children. Results of susceptibility testing and clinical experience suggest that penicillin G, ampicillin and chloramphenicol should not be used alone as empirical treatment for pneumococcal meningitis in patients in Rwanda.

Adult↗
PubMed1993

Pleural effusion, tuberculosis and HIV-1 infection in Kigali, Rwanda.

OBJECTIVE AND METHODS: An increasing number of diagnoses of pleural effusions (PE) have been made over the last 8 years in the Department of Internal Medicine of the Centre Hospitalier de Kigali, Rwanda. In order to determine the aetiology of PE and to examine its possible association with HIV-1 infection, we performed an aetiological work-up, including thoracocentesis and pleural punch biopsy, of all new patients with PE of undetermined aetiology referred to the Division of Pulmonary Diseases of the Department of Internal Medicine of the Centre Hospitalier de Kigali between 14 September 1988 and 16 October 1989. HIV-1 serological testing was performed for most of the patients. RESULTS: A total of 127 patients (81 men, 46 women; mean age, 34 years; range, 16-71 years) with PE of undetermined aetiology were enrolled. Pleural tuberculosis was diagnosed in 110 (86%) and confirmed histologically and/or bacteriologically in 90 (82%). Of 98 pleural tuberculosis patients tested for HIV-1-antibody, 82 (83%) were HIV-1-seropositive. Metastatic cancer was responsible for PE in six (5%) patients, Kaposi's sarcoma in three, lymphoma in one (all four HIV-1-seropositive), anaplastic carcinoma in one, and adenocarcinoma in one (both HIV-1-seronegative). Non-tuberculous pneumonia was documented in five (4%) patients and was associated with HIV-1 infection in four. Other causes of PE were congestive heart failure (three patients), decompensated cirrhosis (one), constrictive percarditis (one), or undetermined (one); only one of these patients was HIV-1-seropositive. CONCLUSIONS: We conclude that tuberculosis is the predominant cause of PE in our patients and is strongly associated with HIV-1 infection. Although less frequent, non-tuberculous pneumonia, Kaposi's sarcoma and lymphoma are other causes of HIV-1-associated PE. In an African area highly endemic for HIV-1 and Mycobacterium tuberculosis co-infection, PE should be considered a good marker of tuberculosis as well as HIV-1 infection.

AIDS-Related Opportunistic Infections↗
PubMed1993

Acute arthritis and human immunodeficiency virus infection in Rwanda.

OBJECTIVE: To determine the etiology of acute arthritis observed in adults and to define its relationship with human immunodeficiency virus 1 (HIV-1) infection in Kigali, capital city of Rwanda. METHODS: From September 1, 1989 until March 31, 1990 we conducted a study of all new patients admitted with acute arthritis to the outpatient and inpatient services of the Department of Internal Medicine at the Centre Hospitalier de Kigali, in Kigali, Rwanda, a city highly endemic for HIV infection. RESULTS: Thirty-six patients (27 men 9 women; mean age: 31 years, range 18-65) were included in the study. Twenty-six (72%) were HIV seropositive. Two main diagnostic categories emerged, both strongly associated with HIV infection: (1) aseptic arthritis: 16 (44.5%) patients including 12 (33.5%) patients with spondyloarthropathy of whom 10 (83%) were HIV seropositive, and 4 (11%) patients with HIV related arthritis, (2) septic arthritis: 11 (30%) patients of whom 9 (82%) were HIV seropositive, including 4 with gonococcal, 2 with staphylococcal, 1 with Salmonella B and 2 with tuberculous arthritis. CONCLUSION: In an area highly endemic for HIV, acute arthritis should be considered a possible manifestation of HIV infection and should prompt HIV testing.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Cryptococcal meningitis associated with acquired immunodeficiency syndrome (AIDS) in African patients: treatment with fluconazole.

Cryptococcal meningitis associated with acquired immunodeficiency syndrome (AIDS) is particularly common in tropical Africa. This could be explained by the dramatic increase in the number of human immunodeficiency virus (HIV) infections and the high prevalence of Cryptococcus neoformans var. neoformans in the domestic and general environment of HIV-positive and AIDS patients Meningoencephalitis is the usual and dominant clinical feature of cryptococcal infection in AIDS patients and 'slim disease', tuberculosis and candidiasis are the most common opportunistic infections associated with cryptococcal meningitis. In a group of 64 African patients with AIDS and cryptococcosis treatment with a daily dose of 400 mg fluconazole (FCA) during the acute phase showed a clinical cure in 63% of the evaluable patients. Mycological response to treatment with negative culture was found in 76% of our patients (at day 60-90). The overall tolerance of FCA was excellent. This treatment was also used successfully for relapse of cryptococcal meningitis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pulmonary tuberculosis in Kigali, Rwanda. Impact of human immunodeficiency virus infection on clinical and radiographic presentation.

The aim of the present study was to compare the clinical and radiographic presentation as well as the therapeutic outcome of pulmonary tuberculosis (PT) in adult patients with and without human immunodeficiency virus type 1 (HIV-1) infection in Kigali, Rwanda. Over a 17-month period 59 consecutive patients with bacteriologically and/or histopathologically documented PT were enrolled. Of these, 48 (81%) patients were HIV seropositive. Among these, 35 fit the WHO clinical criteria for AIDS (WHOCCA) at the time of admission. Significant differences were found between the HIV-seropositive and HIV-seronegative groups of patients: fever (85 versus 36%; p less than 0.001), tuberculin skin test anergy (69 versus 0%; p less than 0.01), mediastinal and/or hilar adenopathies (31 versus 0%; p = 0.05), and pleural effusion (43 versus 9%; p less than 0.05) were more frequently encountered in the HIV-seropositive group, and upper lobe infiltrates (55 versus 16%; p less than 0.02) and cavitation (91 versus 39%; p less than 0.003) were more often seen in the HIV-seronegative group. However, HIV-seropositive patients not meeting WHOCCA were less frequently anergic (0 versus 100%; p less than 0.001) and feverish (53 versus 97%; p less than 0.01) and more often had cavitation (69 versus 28%; p less than 0.02) and less often mediastinal and/or hilar adenopathies (7 versus 40%; p less than 0.04) compared with HIV-seropositive patients meeting WHOCCA. Under antituberculosis treatment, clearance of fever was slower in HIV-seropositive compared with HIV-seronegative patients, and among the HIV-seropositive group it was slower in those fitting WHOCCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1992

Two-year incidence of tuberculosis in cohorts of HIV-infected and uninfected urban Rwandan women.

To determine the prevalence of Mycobacterium tuberculosis infection and the incidence of tuberculosis in HIV-infected and uninfected urban Rwandan women, 460 HIV-positive and 998 HIV-negative childbearing women were recruited from pediatric and prenatal care clinics and were enrolled in a prospective study in 1988 and followed for 2 yr. Tuberculin testing was administered 12 to 18 months after enrollment. Fifty-three percent of HIV-negative women had positive tuberculin tests (induration > or = 10 mm), with higher rates among older women and among women who had received BCG vaccine. Only 21% of HIV-positive women had positive tuberculin tests, with no relationship to BCG vaccine. Follow-up was available for 93% of subjects. Tuberculosis was diagnosed in 20 HIV-positive women and in two HIV-negative women. Features associated with an increased risk of tuberculosis among HIV-positive women included: age > or = 30, body mass index in the lowest quartile, low income, erythrocyte sedimentation rate > 75, positive tuberculin test, and chronic cough, chronic fever, and weight loss. Among Rwandan women who are infected with HIV, approximately half of those who are infected with M. tuberculosis do not have positive tuberculin tests. The rate ratio for development of tuberculosis among HIV-positive women was 22 (95% CI, 5 to 92). New algorithms are needed to improve the early detection of tuberculosis among HIV-positive patients in Africa.

AIDS Serodiagnosis↗
PubMed1992

Evaluation of the cryptococcal antigen test as a diagnostic tool of AIDS-associated cryptococcosis in Rwanda.

To evaluate the latex test, two different retrospective studies were undertaken. A positive culture for Cr. neoformans was used as the golden standard of active cryptococcal infection. 439 sera selected at random sent to the NSP laboratory for screening of HIV antibody were tested as well as--71 CSF from patients with meningeal symptoms sent to the laboratory of the Centre Hospitalier de Kigali. In total, two discrepancies were found: two CSF samples from ancient cases of cryptococcosis under treatment were positive with the latex test and negative by culture. If it stands to reason that the antigen test cannot differentiate between active and inactive cryptococcal diseases, the persistence of small amounts of soluble antigens in a CSF implies that the patient must remain under surveillance, a relapse being very frequent in AIDS patients. As a conclusion, the latex test is a fast, easy to perform and quite reliable test for the diagnosis of cryptococcosis.

AIDS-Related Opportunistic Infections↗