TRANSACTIONS OFTHE
ROYAL
SOCIETY OF
TROPICAL MEDICINE AND HYGIENE (1992)86, 303-306
The slim disease in African
patients
303
with AIDS*
Chokri Mhiri’, Laurent Bklec 1,2, Bernard Di Costanzo3, Alain Georges2 and Romain Gherardil lDepartment of Neuropathology, H6pital Henri Mondor, 94010 Criteil Cedex, France; ‘Pasteur Institute of Bangui, BP. 923, Bangui, Central Aji-ican Republic; 3Department of Internal Medicine, Centre National Hospitalier Universitaire de Bangui, BP. 911, Bangui, Central African Republic Abstract
Ten unselected African patients infected with human immunodeficiency virus (HIV) and with slim disease were evaluated using physical examination, anthropometric measurements, Karnovsky performance score, and muscle biopsy. All had marked weight loss (36.8* 10.8%) with extreme fatigue, marked diffuse wasting with significantly decreasedcircumferences of arms, thighs and calves (PcO.O02), and a low Karnovsky performance score (range 30-70). Mild to moderate motor deficit (in 9/10 patients) contrasted with the major amyotrophy. Chronic diarrhoea (in 7110)andior prolonged fever (in 7/10) were always associatedwith the amyotrophy. Atrophy of muscle fibres was the main finding of muscle biopsy. Only 5 patients met the CDC criteria for the ‘HIV wasting syndrome’. We conclude that slim disease,which is highly suggestive of the acquired immune deficiency syndrome (AIDS) in Africa, is a condition associatedwith chronic diarrhoea and/or prolonged fever, that encompassesthe ‘HIV wasting syndrome’ sensu stricto and probably other debilitating diseasesassociatedwith AIDS, such as tuberculosis. Introduction
Patients and Methods
Sixty to 80% of African patients with the acquired immune deficiency syndrome (AIDS) present with associated marked weight loss, diffuse muscle weakness, chronic diarrhoea and prolonged fever (LESBORDESet al., 1985;
Ten heterosexual African patients hospitalized consecutively in the Centre National Hospitalier Universitaire of Bangui, Central African Republic, from January to June 1990 were studied. All showed the typical association of marked weight loss with muscle weakness, prolonged fever and/or chronic diarrhoea, and HIV-l infection attested by enzyme-linked immunosorbent assay with confirmatory Western blot. None of them had received previously zidovudine. The study paid special attention to previous body weight and occurrence of opportunistic infections. Neurological examination included muscle testing, evaluation of sensory pathways, tendon reflexes and plantar responses,and search for signs of encephalopathy. Degree of disability was evaluated by the Karnovsky performance score. General physical examination was complemented by anthropometric measurements at admission, which included weight and the mid-arm, mid-thigh and mid-calf circumferences. Two agematched groups of healthy African individuals (10 men and 10 women) were used as reference for anthropometric parameters.
CLUMECK, 1988; COLEBUNDERSet al., 1987; DEWITT et al., 1988; COULAUD, 1988; GOODGAME, 1990). SERWADA et al. (1985) eoined the term ‘slim disease’for this condition by reference to the usual name applied to AIDS pa-
tients by the local population in Uganda. Slim diseasehas been recorded in tropical areas outside Africa such as Haiti (PAPE et at., 1985), Trinidad (BARTHOLOMEW et aZ., 1987), Mexico (VALDESPINO et al., 1990) and Latin America (MOREIRA et aZ., 1990). The condition has been also referred to as ‘SIDA humide’ (wet AIDS) in Zaire becauseof the profuse diarrhoea (0~10 et aZ., 1985). Although slim diseaseconstitutes the clinical model in the WHOiBangui provisional clinic case definition for AIDS in Africa (WHO, 1985, 1986), and is therefore widely used for epidemiological survey in this area! precise clinical and pathological data on the syndrome m the literature are lacking. In an attempt to clarify the concept of slim disease,we Table
1. Clinical Age
Case (years) 00.
& sex’
1 2 3 4 5
30 40 30 38 25
findings
HIV stag@
M F F M
IV A
IV Cl
F
6
in ten African
WHO defmirion Of AIDS
patients
Weight loss (%I
IV A
Yes No Yes Yes Yes
35 30 18 38 40
26 F
IV Cl
Yes
29
7
28 F
IV B
Yes
51
8
56 F
IV B
Yes
47
9
28 F
IV B
Yes
38
IV A IV A
with slim disease
Chronic diarrhoea (stools/d)
5
Chronic weakness’
Chronic fever
5 4
ROYAL
SOCIETY OF
TROPICAL MEDICINE AND HYGIENE (1992)86, 303-306
The slim disease in African
patients
303
with AIDS*
Chokri Mhiri’, Laurent Bklec 1,2, Bernard Di Costanzo3, Alain Georges2 and Romain Gherardil lDepartment of Neuropathology, H6pital Henri Mondor, 94010 Criteil Cedex, France; ‘Pasteur Institute of Bangui, BP. 923, Bangui, Central Aji-ican Republic; 3Department of Internal Medicine, Centre National Hospitalier Universitaire de Bangui, BP. 911, Bangui, Central African Republic Abstract
Ten unselected African patients infected with human immunodeficiency virus (HIV) and with slim disease were evaluated using physical examination, anthropometric measurements, Karnovsky performance score, and muscle biopsy. All had marked weight loss (36.8* 10.8%) with extreme fatigue, marked diffuse wasting with significantly decreasedcircumferences of arms, thighs and calves (PcO.O02), and a low Karnovsky performance score (range 30-70). Mild to moderate motor deficit (in 9/10 patients) contrasted with the major amyotrophy. Chronic diarrhoea (in 7110)andior prolonged fever (in 7/10) were always associatedwith the amyotrophy. Atrophy of muscle fibres was the main finding of muscle biopsy. Only 5 patients met the CDC criteria for the ‘HIV wasting syndrome’. We conclude that slim disease,which is highly suggestive of the acquired immune deficiency syndrome (AIDS) in Africa, is a condition associatedwith chronic diarrhoea and/or prolonged fever, that encompassesthe ‘HIV wasting syndrome’ sensu stricto and probably other debilitating diseasesassociatedwith AIDS, such as tuberculosis. Introduction
Patients and Methods
Sixty to 80% of African patients with the acquired immune deficiency syndrome (AIDS) present with associated marked weight loss, diffuse muscle weakness, chronic diarrhoea and prolonged fever (LESBORDESet al., 1985;
Ten heterosexual African patients hospitalized consecutively in the Centre National Hospitalier Universitaire of Bangui, Central African Republic, from January to June 1990 were studied. All showed the typical association of marked weight loss with muscle weakness, prolonged fever and/or chronic diarrhoea, and HIV-l infection attested by enzyme-linked immunosorbent assay with confirmatory Western blot. None of them had received previously zidovudine. The study paid special attention to previous body weight and occurrence of opportunistic infections. Neurological examination included muscle testing, evaluation of sensory pathways, tendon reflexes and plantar responses,and search for signs of encephalopathy. Degree of disability was evaluated by the Karnovsky performance score. General physical examination was complemented by anthropometric measurements at admission, which included weight and the mid-arm, mid-thigh and mid-calf circumferences. Two agematched groups of healthy African individuals (10 men and 10 women) were used as reference for anthropometric parameters.
CLUMECK, 1988; COLEBUNDERSet al., 1987; DEWITT et al., 1988; COULAUD, 1988; GOODGAME, 1990). SERWADA et al. (1985) eoined the term ‘slim disease’for this condition by reference to the usual name applied to AIDS pa-
tients by the local population in Uganda. Slim diseasehas been recorded in tropical areas outside Africa such as Haiti (PAPE et at., 1985), Trinidad (BARTHOLOMEW et aZ., 1987), Mexico (VALDESPINO et al., 1990) and Latin America (MOREIRA et aZ., 1990). The condition has been also referred to as ‘SIDA humide’ (wet AIDS) in Zaire becauseof the profuse diarrhoea (0~10 et aZ., 1985). Although slim diseaseconstitutes the clinical model in the WHOiBangui provisional clinic case definition for AIDS in Africa (WHO, 1985, 1986), and is therefore widely used for epidemiological survey in this area! precise clinical and pathological data on the syndrome m the literature are lacking. In an attempt to clarify the concept of slim disease,we Table
1. Clinical Age
Case (years) 00.
& sex’
1 2 3 4 5
30 40 30 38 25
findings
HIV stag@
M F F M
IV A
IV Cl
F
6
in ten African
WHO defmirion Of AIDS
patients
Weight loss (%I
IV A
Yes No Yes Yes Yes
35 30 18 38 40
26 F
IV Cl
Yes
29
7
28 F
IV B
Yes
51
8
56 F
IV B
Yes
47
9
28 F
IV B
Yes
38
IV A IV A
with slim disease
Chronic diarrhoea (stools/d)
5
Chronic weakness’
Chronic fever
5 4
