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|Title: ||The prevalence of HIV in patients with anorectal sepsis and its clinical pattern in Mulago Hospital.|
|Authors: ||Aluvaala, Eliud Seme|
|Issue Date: ||2005 |
|Abstract: ||Objective: To determine prevalence of HIV in patients with anorectal sepsis and describe the clinical pattern of the anorectal sepsis in patients seen in the colo-rectal clinic and emergency surgery departments of Mulago hospital and thus identify it as major sign of underlying HIV infection.
Summary Background Data: The advent of HIV has seen the prevalence of anorectal sepsis increase worldwide. Africa currently has the highest prevalence of HIV. Although homosexuality has been noted to be a major factor in anorectal sepsis and HIV in the West this is not the case here in Uganda. There is general agreement that anorectal sepsis is an indicator of underlying immunosuppression due to HIV.There is however paucity of data on this here in Uganda.
Study design: A cross-sectional descriptive study.
Setting: Mulago hospitals colo-rectal clinic and emergency surgery department.
Patients: 96 patients with anorectal sepsis and were 15 years and above were recruited over a study period of four months.
Overall: 71(74%) were male and 25 (26%) were female, age range was 16- 73 with mean of 39.3958, most affected were in the 35-44 age group i.e. 32 (33.3%). Most, 65 (67.7%) were married and peasants 37 (38.5%). All denied any other form of sexual habits other than heterosexual. The largest category 41 (42.7%) had had symptoms for more than 2 years. Fistula in ano 54 (56.25%) was the most common lesion found.
Correlation to HIV status: Of the 9,653 (55.2%) were HIV -ve and 43 (44.8%) were HIV +ve. Most, 23 (53.5%) were in WHO (World Health Organisation) stage III of HIV.
Sensation of anal discomfort was the most common complaint while PR (per rectal) bleeding was the least common in both HIV+ve and HIV-ve groups. PR bleeding with (p value 0.023) was significant for HIV positive status. The most common finding was pus discharge in both groups. The least common was swelling or mass for the HIV +ve and bleeding for the HIV -ve groups. Perianal skin changes (p value 0.001) and bleeding (p value 0.030) were found to be significant for HIV positive status. At proctoscopy combined suppuration and ulceration was found in 18 patients, of these 15 were HIV positive (p value 0.0003); this was significant to HIV positive status. Proctitis (p value 0.0009) and combined/multiple anorectal lesions (p value 0.0042) carried a positive correlation to HIV positive status.
• Anorectal sepsis is a significant sign of HIV.
• Patients who present with bleeding and on examination are found to have perianal skin changes and bleeding in addition to other symptoms and signs of anorectal sepsis are more likely to be HIV positive than HIV negative.
• Patients with proctitis and a combination of anorectal lesions are more likely to be HIV positive than negative.|
|Description: ||A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine in Surgery Degree of Makerere University.|
|Appears in Collections:||Theses & Dissertations (Health-Sciences)|
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