P.M.V. Martin

Peripheral facial paralysis and HIV infection: report of four African cases and review of the literature.

SummaryFour cases of infranuclear facial palsy associated with infection by the human immunodeficiency virus in young heterosexual African patients are reported. Two cases were healthy HIV carriers, one patient manifested AIDS-related complex, and one case fulfilled the CDC criteria for AIDS. Two patients had a typical Bells palsy, one presented with manifest cephalic Herpes zoster infection and one, who suffered from facial diplegia, could be considered to have a cephalic form of Guillain-Barré syndrome. A review of the literature confirmed that peripheral facial palsy can occur at any stage of HIV infection and in various clinical contexts. In stages I and II of the HIV infection, patients may develop either Bells palsy or Guillain-Barré syndrome. In stages III and IV, when the cellular immunity has begun to decline, Herpes zoster-related facial paralysis, seventh cranial nerve involvement secondary to meningeal lymphomatosis, and peripheral facial paralysis as one aspect of widespread chronic peripheral neuropathy may also occur.

HIV-specific IgA antibodies in tears of children with aids or at risk of AIDS

To improve on the diagnosis of human immunodeficiency virus (HIV) infection, 14 children with clinical evidence of AIDS, 86 children less than 15 months old and born to seropositive mothers, and 29 controls were tested for the presence of IgA antibody in tears directed against HIV antigens on Western blots. IgA antibodies in tears against env- and pol-encoded proteins were present in 13 of 14 children with AIDS and in 13 of 86 children born to seropositive mothers. No HIV-specific IgA was observed in tears of the 29 controls. Among the 86 children less than 15 months old, 11 had clinical evidence of AIDS and 7 of them (64%) had HIV-specific IgA in tears. Results show that the demonstration of lacrimal HIV-specific IgA may help to distinguish between truly infected children and those whose HIV antibodies are passively transferred from the mother. Therefore, this simple method is a good tool for laboratory diagnosis of paediatric AIDS.

Antibodies to HIV2 in genital secretions

In order to study the local immune response to HIV2, three exclusively heterosexual, infected West African patients were selected: one male with full blown AIDS, one female with ARC and one healthy HIV2-carrier female. Sera and genital secretions were obtained and tested for anti-HIV2 IgG and IgA antibodies by Western blotting. In semen and in vaginal secretions, IgG antibodies directed against all viral antigens were detected. In comparison with the IgG response, local IgA antibody response was less intense and heterogenous. Two out of 3 patients had local antibodies of the IgA class directed against the envelope glycoprotein GP105. Such antibodies of both the IgG and IgA classes in genital secretions could play a protective role in heterosexual transmission of HIV2.

High levels of anti-Campylobacter-flagellin IgA antibodies in breast milk

Several studies have shown the beneficial role of immunity against enteric Campylobacter sp. Circulating antibodies against flagellin and possibly maternal antibodies seem to protect against intestinal colonization by Campylobacter. Milk from women in Central Africa (n = 120) and in France (n = 31) were investigated for the presence of anti-flagellin antibodies. Results showed that most French and all African milk possessed anti-flagellin IgA but not IgG. The titres of anti-flagellin IgA were elevated in colostrum and decreased in later milk. Specific activities were constant during lactation, suggesting constant antigenic stimulation. The fact that IgA but not IgG are elicited against flagellin could be due to an infection limited to the mucosal surface.

Association between HIV1 infection and sexually transmitted disease among men in Central Africa.

In Africa, heterosexual contact is the major route of transmission of the human immunodeficiency virus (HIV). Previous studies have strongly suggested that other sexually transmitted diseases (STD) may facilitate HIV transmission. However, the association of HIV infection with other STD may simply be a marker of sexual promiscuity. Thus, we compared the association of different STD, HIV status, and sexual behaviour of 160 STD patients and 95 STD-free control individuals. Results showed that STD patients differed from controls in most of the sociological and behavioural parameters, as well as in HIV serological status. Within the STD group, people with genital ulcer disease (GUD) (n = 62) were more likely to be HIV-seropositive (21%) than people with urethritis (n = 98, 11.2%). Meanwhile, there was almost no difference in the sociological and behavioural parameters between the GUD and the urethritis group. Thus, our results reinforce the specific role of mucosal breakage (i.e. genital ulcers) in the transmission of HIV.

Immune response to Treponema pertenue and Treponema pallidum nichols in patients with yaws

Human sera from African patients with acute yaws were analysed by Western blot (WB) against antigens of Treponema pallidum Nichols and two Treponema pertenue isolates. The Western blot patterns were remarkably similar from one patient to another, and strains of both subspecies exhibited exactly the same banding pattern. Sera from yaws patients failed to detect at least one antigen in T. pertenue which was absent from T. pallidum.

Biotype and lior serogroup distribution of enteric Campylobacter isolated from children in Bangui (Central African Republic), and comparison with penner serotypes

The new extended biotyping scheme of Lior as well as the slide agglutination technique were applied to 209 strains of enteric Campylobacter isolated from children in Bangui (Central African Republic). Three biotypes of C. jejuni and 2 biotypes of C. coli were identified among the strains; 31.1% were C. jejuni I, 11% C. jejuni II, 2.4% C. jejuni III, 44% C. coli I and 11.5% C. coli II. We were able to serotype 71.3% of the strains with 20 immune sera prepared against strains of Campylobacter isolated previously; 63% of the strains were distributed among the ten most common serogroups. No significant difference was observed in the distribution of biotypes or serogroups between strains from healthy and diarrhoeic children. Comparison of Lior serogroups with Penner serotypes showed that different Penner serotypes may correspond to a Lior serogroup and vice versa.

ISOLATION OF HIV-2 IN CENTRAL AFRICA FROM AIDS PATIENT AND HER SYMPTOM-FREE PARTNER

HIV-2 does seem to be present in central Africa but until now we have been unable to isolate the virus. We report here the isolation of HIV-2 from a 25-year old black woman and her 43-year old white husband. The wife who was pregnant was an inpatient with full-blown AIDS; her husband was healthy. Both were seronegative for HIV-1 by ELISA but in an HIV-2 ELISA (Diagnostic Pasteur) both sera were positive. In western blots against HIV-1 antigens the sera reacted with the internal p18-p25 protein only; however they reacted strongly with the internal p16-p26 proteins and envelope gp 160-gp140 glycoproteins of HIV-2. Virus was isolated from periperal blood lymphocytes from the woman and her husband and reverse transcriptase activity was 250000 cpm/ml after 10 days. When cell-free virus was separated on polyacrylamide gel and transferred onto nitrocellulose the viral antigens reacted in p26 p35 p55 p68 and gp 140 with the patients serum with p26 p55 and gp 140 with an HIV-2 positive reference serum and with p26 and p55 only with an HIV-1 positive control serum. HIV-1 infection is endemic in central Africa (eg. in Zaire and the Central African Republic) but HIV-2 infection had not previously been described in this area. HIB-2 seems to originate from West Africa. (The woman with AIDS had had a 1 year sexual relationship with a man from Benin 8 years earlier but we do not know whether he is positive for HIV-2.) Further studies are neeeded to pinpoint the origin of these 2 cases the 1st in the Central African Republic. If the woman was infected by the West African man this case would confirm the long latency of HIV-2 infection before AIDS develops and would confirm the need for her husband to be followed-up. (Full text)

Detection of anti-HIV IgA in tears of children born to seropositive mothers is highly specific

In order to improve the diagnosis of HIV infection in children born to seropositive mothers, 86 children were previously tested by Western blotting for anti-HIV IgA in tears and IgG in serum, at a median age of 9.2 months. To determine the exact value of the assay, 68/86 children of the same cohort were retested 9 months later. Nine children (13.4%) were seropositive and all had anti-HIV IgA in tears. Eight of them had possessed lachrymal antibodies 9 months earlier. The ninth child was seronegative when 9 months old and then seroconverted. Four children (6%), known to be seronegative, had an indeterminate Western blot pattern and no HIV IgA in tears. Fifty four (80.6%) were seronegative at 18 months; none of them had ever had anti-HIV IgA in tears. This highlights the fact that only the children without lachrymal HIV IgA at the age of 9 months became seronegative at the age of 18 months. Our results clearly show that the detection of anti-HIV IgA in tears is a highly specific and reliable diagnostic test in children aged less than 15 months, born to seropositive mothers.

TRUE HIV-1 INFECTION IN A PYGMY

I SIR,--S~UX the first clinical and serological surveys done on pygmies in 1984‘ no insrance of either HIV-I antibodies confirmed by immunolwestem blotting or of AIDS has been reported for t h i s ethnic p u p ? From 1984 to date we have tested 752 sera from p y w e s m the Central f i m Republic for HIV-1 antibodies. The Aka and Rabpygmy populations investigated live in rhe 1 two main forest areas of the country, Lobaye and Sangha. Sera were screened by ELISA (‘ELAVIA’, Diagnostic Pasteur) and 32 were positive; none was continned by i”no/westem blot (‘LA\’Blot’, Diamostic Pasteur). In March, 1987, from rhe Sangha pygmy group, 1 serum was found to contain antibodies direaed against all HIV-1 proteins (gp160, gp41, p a , p55, p40, p25, and p15). The patient, a 33-year-old h d h y woman, said that she had had sexVal intemurse with a4O-year-old male Banru from the same area. His se& was found to contain antibodies to HN1envelope proteins when he presented with clinical symptoms of AIDSrelated complex. This observation leads us to condude that pygmies are susceptible to HIV-I despite their apparenrly isolared ecosystem. ’