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In a study of factory workers in Tanzania, 10.5% of the women and 15.3% of the men were HIV-positive. Sixty-five percent of the male deaths and 60% of the female deaths were caused by HIV infection.

Background: Infertility is common in Africa, but virtually no data exist on HIV prevalence among infertile women. Mainly anthropological studies in Africa have shown that infertile women have higher risks of marital instability and possibly also have more sexual partners than fertile women.Method: This study was conducted in a hospital in northwest Tanzania during 1994 and 1995. Women presenting themselves with infertility problems to the outpatient clinic were interviewed, examined and blood was drawn. Women who came to deliver in the hospital, excluding primiparae, were taken as a control group. The analysis was limited to women > or = 24 years. In total 154 infertile and 259 fertile women were included in the study.Results: HIV prevalence was markedly higher among infertile women than among fertile women: 18.2% and 6.6% respectively (adjusted odds ratio [OR] for age, residence and occupation 2.7; 95%-confidence interval [CI]: 1.4-5.3). Data on past sexual behaviour showed that infertile women had more marital breakdowns, more lifetime sexual partners and a higher level of exposure to sexually transmitted diseases (STD).Conclusion: Women with fertility problems appear to have higher HIV prevalence, which justifies more attention for such women in the context of AIDS programmes. In addition, caution is needed when using sentinel surveillance data from antenatal clinics to monitor HIV prevalence. [ABSTRACT FROM AUTHOR]

A case of contact dermatitis to garlic is described. Patch tests with a piece of garlic bulb and extracts of garlic were positive. A tulip extract gave a positive reaction in this patient, but extracts of onion did not do so. The active substance proved to be readily soluble in water, alcohol and acetone. The allergenic material was found to be of low molecular weight, heat labile and present in the outer parts of the bulb. [ABSTRACT FROM AUTHOR]

This article discusses omenn syndrome in a male patient aged one and half year.In the first months of life this baby showed a skin eruption of the scalp suggestive of a seborrhoeic dermatitis. From the age of i year a widespread pruritic skin disorder developed with fever, lymphadenopathy, anaemia and cosinophilia. Topical steroids were not effective. From the age of 14 months chronic diarrhoea was present. Biopsy from a nodule showed acanthosis, an oedematous papillary layer and in the lower part of the dermis a dense infiltrate consisting of histiocytes, lymphocytes, eosinophils and mast cells.

This article discusses woolly hair naevus with triangular hairs. Since birth she had noticed a 'strange patch' on the scalp but she had no other physical complaints. Above the left ear was a sharply demarcated patch, approximately 5 cm in diameter, of scalp hair that was different in shape and consistency from the surrounding normal straight, fair hair. The hair in the affected area was darker in colour and the hair itself was thinner, softer and curly. There was decrease of the hair diameter. In several places thestructureofthecuticulewasdisturbed. There was twisting of the shafts, with torsion of the hair around the long axis at irregular distances. No abnormalities in blood cell count, ESR, liver function, renal function and urinalysis were noted.

This article discusses leprosy, borderline-lepromatous, and cytomegalovirus infection in an Indonesian patient. The Indonesian patient has been living in the Netherlands almost continually for 30 years. He left Indonesia in 1951. At that time he seems to have had a white spot on his right cheek. In 1979 he visited Indonesia for several weeks. In August 1980 a coronary-by pass operation was performed in Geneva. In September 1980 the patient noticed red, elevated spots on his face which spread to the trunk. The nerves were not thickened. There were no functional disturbances. There was no loss of sensitivity, except on the lateral side of the lower left leg.

This article discusses the rebirth of dermatopathology. Early dermatology was modelled upon these disciplines which were the offspring of dermatologists. So far, between 1848 and 1982, more than twenty handbooks on dermatopathology have been written, all of them except one by dermatologists. These facts are not reflected in the present situation, as both disciplines tend to fade away from the dermatologists' daily life. Most dermatologists nowadays send biopsies for examination to general pathologists, and are satisfied to receive a written report like the one they receive from the clinical pathologist about the leukocyte count.

Though the World Health Organization (WHO) has acted to reduce the price of anti-HIV assays for developing countries, the cost of the large-scale testing to be done may still be prohibitive to the health budget of these countries. GACPAT, a modified commercial particle assay, is ten times cheaper than the WHO price of ELISAs. In this study GACPAT was introduced in three district hospital laboratories (DHL) in Tanzania, and the results compared with those on the same sera in a reference laboratory (RL). Sensitivity and specificity were 92.6% and 98.7%, respectively at DHL. It is concluded that GACPAT is a valid, feasible and cheap alternative for ELISA anti-HIV-testing also at district hospital laboratory level.

We evaluated the enrollment of secondary school students as voluntary unremunerated blood donors in a city where the HIV-1 prevalence among the adult population is 11.8%. Between 1st July, 1992 and 1st December, 1993, consecutive blood donors were screened for anti-HIV-1, TPHA, HBsAg and anti-HBc. Test results were related to age, sex, voluntary or relative donor status. 525 (22.4%) of 2345 were voluntary donors aged 24 years or less and 529 (29.6%) of 1820 of the relative donors were of the same age group. Voluntary donors had statistically significant lower prevalence rates of anti-HIV-1, TPHA, and anti-HBc, 1.5%, 2.1% and 50.2% respectively, compared to relative donors of the same age group, 4.7%, 9.0% and 70.3% respectively. We conclude that secondary school students constituted a safer donor population. The student population offered the additional advantage of being easily accessible for donation and lesser blood units needed to be discarded. For a blood transfusion centre in an urban settlement, recruitment of secondary school students as voluntary unremunerated blood donors should be considered as a cost-effective strategy.

A cohort study has been started of urban factory workers and their spouses in Tanzania, in order to 1) identify risk factors for HIV-1 seroconversion, and 2) document changes over time in risk behaviour, in particular condom use and partner change, and determine whether these are associated with a reduced incidence of HIV-1 and other sexually transmitted diseases. We report findings at intake from October 1991 to March 1992. Study participants were interviewed, examined, and screened for HIV-1 and syphilis. HIV-1 prevalence was 91/926 (10%) in males and 36/217 (17%) in females. Statistically significant risk factors for HIV-1 infection in males were age group, region of birth, not being married for more than 5 years, being uncircumcised, having had a genital ulcer in the past four months, and having received injections from medical staff in the past four months. HIV-1 incidence in this group is expected to be between 1% and 2% per year. It is concluded that a longitudinal study is needed to assess the importance of partner change. This cohort appears to be suitable for such a study as HIV-1 incidence is expected to be fairly high, HIV-1 prevalence and risk factors are comparable to those of the general population and cooperation of the factory workers is good.

A case-control study was carried out in Tanzania to determine the relative risk of those with HIV-1 infection for getting leprosy. Cases were 93 consecutively diagnosed patients with leprosy aged 15-54 years from the Mwanza Region. Controls were a representative population sample of 4161 people drawn from a stratified cluster sample from urban areas, roadside settlements, and rural villages. HIV-1 infection was determined by enzyme-linked immunosorbent assay (ELISA); Western blot was used when the ELISA result was indeterminate. The HIV-1 prevalence in leprosy cases was 10% in rural (7 of 72) and in roadside and urban areas (2 of 21); in controls these prevalences were 3.4% and 9.9%, respectively. The relative risk of HIV-1 infection for the development of leprosy was estimated to be 2.2 [95% confidence interval (CI) = 1.0-4.7; p = 0.07]. HIV-1 infection was significantly associated with multibacillary (MB) leprosy (odds ratio 4.6; CI = 1.3-13.2) but not with paucibacillary leprosy (odds ratio 1.4; 95% CI = 0.4-3.8). The population etiological fraction for the development of MB leprosy attributable to HIV-1 infection in this population is estimated to be 13% (95% CI = 4%-23%). We conclude that HIV-1 is a risk factor for the development of MB leprosy. The impact of the HIV-1 epidemic on the incidence of leprosy so far has been limited since HIV-1 occurs mainly in urban areas and leprosy in rural areas.

We report on a patient with the diagnosis granuloma eosinophilicum faciale (GEF). Clinical and histological findings are described with special emphasis on immunhistological characteristics in lesional skin. A review on the literature is given.

A historic introduction reviews the start of DDS (diaminodiphenylsulphone) therapy in leprosy, stressing the fact that, far after the start of combined therapy in tuberculosis, leprosy continued to be treated with monotherapy of DDS. Reports about resistance of M. leprae to DDS initiated a review of policy. A complete breakthrough toward combined therapy started after 1962, when Shepard introduced mousefootpad inoculation of M. leprae to be used for therapeutic trials. Full attention is given to Freerksen's trial in Malta where combined treatment with rifampicin, INH, prothionamide, and DDS were given for 2 years only to all patients, while at resurvey after 4 years no relapse was found. The applicability of short-term combined therapy for endemic areas is discussed.