Biomedical subjects
Publications and source records attributed to P Kestelyn.
Radiation-induced optic neuropathy is a well-known complication of cranial radiotherapy. We describe four cases. In two cases, the diagnosis was made on MRI. After administration of Gadolinium-DTPA, there was an enhanced captation at the level of the optic nerve. In addition we reviewed 47 cases reported in the literature. Visual prognosis is less than 1/10 in 78% of affected eyes. In case of associated brain necrosis, the mortality rate is 62%.
Sixteen human immunodeficiency virus type 1 (HIV-1)-seropositive children aged 5 to 12 years (nine girls and seven boys), born to HIV-1-infected mothers, were diagnosed between 1984 and 1987 in Kigali, Rwanda. They were compared with a group of age- and sex-matched HIV-1-seronegative children consecutively selected from the outpatient department. Two subjects were asymptomatic. Chronic cough was the most frequent symptom (seven of 16 patients). The most common signs were short stature (12 of 16 patients), low weight for age (seven of 16 patients), chronic parotitis (eight of 16 patients), persistent generalized lymphadenopathy (seven of 16 patients), and pulmonary tuberculosis (four of 16 patients). Lymphoid interstitial pneumonitis was diagnosed on radiologic grounds in five of 16 patients. Evidence of perivasculitis in the fundus was noted in three of 16 patients. Two children died during the study period (mean duration of follow-up, 40 months; range, 27 to 62 months); none of the other children had life-threatening infection or loss of developmental milestones. Immunologic assessment in the 16 children revealed high levels of IgG, decreased CD4+/CD8+ ratio, and skin test anergy. Endocrinologic investigations revealed normal thyroid function and normal basal human growth hormone levels but low basal insulinlike growth factor I levels (0.21 +/- 0.07 vs 0.44 +/- 0.20 U/mL for controls). In Kigali, perinatally HIV-1-infected children surviving beyond 5 years of age often present with moderate signs and symptoms, principally pulmonary involvement, chronic parotitis, and persistent generalized lymphadenopathy. Short stature is the major clinical manifestation in these patients and may be due, in part, to low growth hormone secretion rather than to malnutrition.
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Between 25% and 50% of children in African countries are exposed to Neisseria gonorrhoeae at birth and are at risk of developing gonococcal ophthalmia neonatorum. The problem is aggravated by the emergence of penicillinase-producing strains of N. gonorrhoeae (PPNG). Twenty-one children (9 boys, 12 girls, mean age 13 days) presenting with gonococcal conjunctivitis were identified during a 47-month period. Nineteen children received a single im injection of 100 mg/kg cefotaxime (maximum dose 1 g) without topical antibiotic therapy. One neonate with concurrent otitis media was treated with cefotaxime for five days and a 17-month old girl received two im injections because of the severity of her symptoms. Eight patients (38%) had received previous antibiotic therapy (penicillin im and/or tetracycline eye ointment). Twelve isolates of N. gonorrhoeae were found to be PPNG strains. At three to seven day follow-up examination all 21 patients were clinically cured without residual eye damage. Cefotaxime offers an effective first line treatment for gonococcal ophthalmia neonatorum in areas where there is a high prevalence of PPNG strains. The advantages of a single-dose treatment over multidose regimens in terms of compliance and cost are discussed.
We evaluated the efficacy of oral norfloxacin in 15 patients with culture-proven gonococcal eye disease caused by Neisseria gonorrhoeae. The first seven patients received 1,200 mg of oral norfloxacin for three consecutive days. The other eight patients were each treated with a single oral dose of 1,200 mg of norfloxacin. All control cultures were negative, and there was no progression of the corneal lesions after treatment was initiated. No adverse effects were observed. The results of this study suggested that a single dose of oral norfloxacin may be a valuable alternative to the currently recommended treatment regimens for gonococcal eye disease because it combines high efficacy and low toxicity with low cost and excellent patient compliance.
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Nine neonates with culture proved gonococcal ophthalmia neonatorum were treated with a single intramuscular injection of 100 mg/kg of cefotaxime without topical antibiotic therapy. Five of the nine strains were penicillinase-producing Neisseria gonorrhoeae. All nine cases were clinically and microbiologically cured, and no side effects were observed.
During a 3-month period, 131 cases of herpes zoster were diagnosed in Kigali, Rwanda. There were 46 female and 85 male patients. Mean age was 29 years (range 1-66). An unusually high proportion of patients presented with cranial and sacral nerve localisation of their cutaneous lesions. 55/131 patients (42%) had involvement of more than one dermatome. None of the patients had an underlying condition known to favour herpes zoster. 120/131 (92%) had antibodies to HIV detected by an immunoenzymatic assay (EIA) and indirect immunofluorescence. 92/125 adult patients (74%) had no sign or symptom related to HIV infection other than herpes zoster. This study suggests that herpes zoster in Central Africa is an early and readily detectable manifestation of HIV-induced immunosuppression.
This report proves the relationship between herpes zoster ophthalmicus and seropositivity for HTLV-III in young and often apparently healthy African patients. The ophthalmologist should screen patients with herpes zoster ophthalmicus for antibodies against HTLV-III in areas where this virus is endemic or if the patient belongs to a known risk group. If the test is positive, the patient should be instructed about the infectious nature of his condition to prevent spread of this sexually transmitted disease. As the rate of corneal involvement and postherpetic neuralgia are very high in these patients, it would be worthwhile to ascertain whether routine use of acyclovir treatment in HTLV-III seropositive patients with herpes zoster has a beneficial effect on these complications.
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The human T-cell leukemia/lymphotropic virus type III (HTLV-III) has been isolated from aqueous humor in two patients with perivasculitis of the peripheral retinal vessels, an AIDS-related ocular manifestation. Both patients had antibodies to HTLV-III and although they presented with herpes zoster ophthalmicus, they did not present other symptoms known to be associated with HTLV-III infection. The isolation of HTLV-III from aqueous humor in these two patients with retinal perivasculitis suggests that the virus itself may play a role in the etiology of this ocular sign. The presence of infectious HTLV-III in the anterior chamber further emphasises the necessity to discard corneas from HTLV-III infected donors.
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A prospective study of ophthalmologic findings in 20 African patients with the acquired immunodeficiency syndrome (Group 1) and nine patients with acquired immune deficiency syndrome related complex (Group 2) disclosed that 11 patients in Group 1 and two patients in Group 2 had ocular involvement. Cotton-wool spots, Roth spots, and hemorrhages were frequent features in Group 1. In this series, unlike most others, perivasculitis occurred in five patients whereas cytomegalovirus retinitis and ocular involvement of Kaposi's sarcoma were not observed. These African patients also differed from those previously described in the high proportion of women (11 of 29) and the lack of the usual risk factors (homosexuality, intravenous drug abuse, and hemophilia).
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