Di Costanzo B, Belec L, Testa J, Georges A J, Martin P M
Centre National Hospitalier Universitaire de Bangui, République centrafricaine.
Bull Soc Pathol Exot. 1990;83(4):425-36.
In order to evaluate the predictivity of neurological signs and symptoms in african patients, in Bangui's National Hospital Center (Central African Republic), 79 inpatients (aged 15-65 years) presenting with neurological manifestations (vascular attack, proved metabolic coma, or neuro-paludism excluded), and 64 age and sex matched controls in the same ward, without neurological or AIDS-related symptoms, were tested for the presence of HIV1-antibodies. 51/79 (65%) patients with neurological manifestations were HIV1-seropositive, and 10 (16%) of 64 controls (P less than 0.001). The positive predictive value (PPV) for HIV1 was 100% for patients with cutaneous zona (9 cases), Bell's palsy (4 cases) or cryptococcal meningitis (8 cases). The PPV for HIV1 was less important for the other neurological disorders: 43% for purulent meningitis (21 cases), 62% for major involvements of the central nervous system, without diagnosed etiology (32 cases; in which 13 were meningo-encephalitis, 16 focal deficits and 3 possible meningeal tuberculosis). In central Africa, the predictivity of neurological manifestations is high for HIV1 infection that emphasises the need for including neurological signs in clinical case definitions of AIDS in Africa.
为了评估非洲患者神经体征和症状的预测价值，在班吉的国家医院中心（中非共和国），对79名有神经表现的住院患者（年龄15 - 65岁，排除血管性发作、已证实的代谢性昏迷或神经型疟疾）以及同一病房64名年龄和性别匹配、无神经或艾滋病相关症状的对照者进行了HIV1抗体检测。79名有神经表现的患者中51例（65%）HIV1血清学呈阳性，64名对照者中有10例（16%）呈阳性（P小于0.001）。对于患有皮肤带状疱疹（9例）、贝尔麻痹（4例）或隐球菌性脑膜炎（8例）的患者，HIV1的阳性预测值（PPV）为100%。对于其他神经疾病，HIV1的PPV则较低：化脓性脑膜炎（21例）为43%，中枢神经系统主要受累但病因未明确（32例；其中13例为脑膜脑炎，16例为局灶性缺损，3例可能为结核性脑膜炎）为62%。在中非，神经表现对HIV1感染的预测价值较高，这强调了在非洲艾滋病临床病例定义中纳入神经体征的必要性。
