AIMS: To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. METHODS: A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest x ray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites. RESULTS: 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. CONCLUSIONS: In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDS patients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.
AIMS: To investigate ocular disease in patients with tuberculosis (TB) and HIV in Africa presenting with fever, and to determine if indirect ophthalmoscopy is useful in the diagnosis of mycobacteraemia. METHODS: A prospective study of all adult patients admitted with fever to a large central hospital in Malawi, Africa. All recruited patients had an ophthalmic examination, HIV tests, chest x ray, sputum examinations, bacterial and mycobacterial blood cultures, and malaria slide to observe the presence of parasites. RESULTS: 307 patients were recruited; 109 (36%) had TB, including 53 (17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV. Choroidal granulomas were found in four patients, all of whom had AIDS; three (2.8% of those with TB) had disseminated TB with mycobacteraemia, and one had persistent fever but no other evidence of TB. Among the patients with AIDS, 32 (17%) had microangiopathy manifest by cotton wool spots; one (0.5%) had signs of active cytomegalovirus (CMV) retinitis. The presence of microangiopathy was not related to TB. CONCLUSIONS: In Malawian patients with TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and were concurrent with mycobacteraemia and AIDS. Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia. Cytomegalovirus (CMV) retinitis is rarely seen in African AIDSpatients. This may be the result of mortality early in the disease course, or differences in race, HIV subtype, or comorbidity.
Authors: J Del Amo; A Petruckevitch; A N Phillips; A M Johnson; J M Stephenson; N Desmond; T Hanscheid; N Low; A Newell; A Obasi; K Paine; A Pym; C M Theodore; K M De Cock Journal: AIDS Date: 1996-11 Impact factor: 4.177
Authors: I Cochereau; N Mlika-Cabanne; P Godinaud; T Niyongabo; B Poste; A Ngayiragije; M C Dazza; P Aubry; B Larouzé Journal: Br J Ophthalmol Date: 1999-03 Impact factor: 4.638
Authors: S Lewallen; S P Harding; J Ajewole; W E Schulenburg; M E Molyneux; K Marsh; S Usen; N J White; T E Taylor Journal: Trans R Soc Trop Med Hyg Date: 1999 Nov-Dec Impact factor: 2.184
Authors: L K Archibald; L C McDonald; O Nwanyanwu; P Kazembe; H Dobbie; J Tokars; L B Reller; W R Jarvis Journal: J Infect Dis Date: 2000-04-13 Impact factor: 5.226
Authors: K P Balo; A Fany; Y Amoussou; H Mihluedo; P A Koffi Djagnikpo; K B Gue; K P Bassabi Journal: J Fr Ophtalmol Date: 1998 Jun-Jul Impact factor: 0.818