Otieno M W, Remick S C, Whalen C
Department of Haematology and Blood Transfusion, University of Nairobi, College of Health Sciences, P.O. Box 19676, Nairobi, Kenya.
Int J Cancer. 2001 Jun 1;92(5):687-91. doi: 10.1002/1097-0215(20010601)92:5<687::aid-ijc1246>3.0.co;2-z.
Prior to the acquired immunodeficiency syndrome (AIDS) epidemic, one or two cases of adult Burkitt's lymphoma (BL) were seen annually at the Kenyatta National Hospital, the national referral medical center in Nairobi, Kenya. To investigate the influence of human immunodeficiency virus (HIV) infection in adult BL in Kenya, we conducted a national prevalence survey of all patients 16 years of age and older with BL. A systematic review of medical records of all patients diagnosed with BL between 1992 and 1996 was performed. The diagnosis of BL was based and confirmed on review of pathological material from time of original diagnosis. HIV serology was confirmed by enzyme-linked immunosorbent assay (ELISA). Twenty-nine adult patients with BL were identified during the 5-year study period. Of these patients, 17 (59%) were males, 12 (41%) were females, and the median age was 26 years. Nineteen patients (66%) with BL were HIV-seropositive. The proportion of men was similar in HIV-seropositive and -seronegative patients (58% vs 60%). HIV-seropositive BL patients were significantly older than seronegatives (median 35 vs 19.5 years, p < 0.001). HIV-seropositive patients uniformly presented with constitutional or B symptoms and advanced BL accompanied by diffuse lymph node involvement, whereas the clinical presentation of HIV-seronegative patients during this time period was reminiscent of the "typical" endemic pattern of disease with complete sparing of peripheral lymph nodes. The overall survival of HIV-seropositive cases was significantly worse than that of the HIV-seronegative cases; median survival in the HIV-seropositive patients was 15 weeks. There is an approximate 3-fold increase in the incidence of adult BL during the time period of this study, which is attributable to the AIDS epidemic. In this setting, patients often present with disseminated disease, diffuse peripheral lymphadenopathy and fever, the latter two of which heretofore have been commonly associated with non-lymphoproliferative disorders such as Mycobacterium tuberculosis and sexually transmitted diseases in Kenya. These observations warrant inclusion of AIDS-related BL in the differential diagnosis of the adult patient with unexplained fever and lymphadenopathy in Kenya. The corollary is that HIV infection is virtually excluded in an adult patient without peripheral lymphadenopathy and biopsy-proven BL.
在获得性免疫缺陷综合征（艾滋病）流行之前，肯尼亚内罗毕的国家转诊医疗中心肯雅塔国家医院每年会接诊一到两例成人伯基特淋巴瘤（BL）病例。为了调查人类免疫缺陷病毒（HIV）感染对肯尼亚成人BL的影响，我们对所有16岁及以上的BL患者进行了全国患病率调查。对1992年至1996年间所有被诊断为BL的患者的病历进行了系统回顾。BL的诊断基于并通过对原始诊断时的病理材料复查得以确认。HIV血清学检测通过酶联免疫吸附测定（ELISA）得以确认。在为期5年的研究期间，共识别出29例成人BL患者。其中，17例（59%）为男性，12例（41%）为女性，中位年龄为26岁。19例（66%）BL患者HIV血清学检测呈阳性。HIV血清学阳性和阴性患者中的男性比例相似（58%对60%）。HIV血清学阳性的BL患者明显比血清学阴性患者年龄大（中位年龄分别为35岁和19.5岁，p<0.001）。HIV血清学阳性患者均表现为全身性或B症状以及伴有弥漫性淋巴结受累的晚期BL，而在此期间HIV血清学阴性患者的临床表现让人联想到“典型”的地方性疾病模式，外周淋巴结完全未受累。HIV血清学阳性病例的总体生存率明显低于HIV血清学阴性病例；HIV血清学阳性患者的中位生存期为15周。在本研究期间，成人BL的发病率大约增加了3倍，这归因于艾滋病的流行。在这种情况下，患者常表现为播散性疾病、弥漫性外周淋巴结病和发热，后两者此前在肯尼亚通常与非淋巴增殖性疾病如结核病和性传播疾病相关。这些观察结果表明，在肯尼亚，对于原因不明发热和淋巴结病的成年患者进行鉴别诊断时应考虑艾滋病相关的BL。相应地，在没有外周淋巴结病且活检证实为BL的成年患者中，几乎可以排除HIV感染。
