Page 302 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 5 Original Research

Serious clinical manifestations were seen more frequently manifestations, including purulent conjunctivitis, pancreatitis
in HIV-positive than HIV-negative patients (OR 5, 95% and encephalitis (Table 4).
confidence interval [CI] 0.48–51.8, p = 0.34). One of the six
patients testing HIV-negative developed pneumonia, while HIV-positive patients had a significantly longer hospital stay
six of the 18 HIV-positive patients had a clinical course (p = 0.03). There were three deaths in the HIV-positive group,
complicated by pneumonia (OR 2.5, 95% CI 0.23–26.5, but none in the HIV-negative group. The OR of death was
p = 0.63). Five of these HIV-positive patients required 2.9 times higher in the HIV-positive group (OR 2.9, 95%
admission to the intensive care unit or high care unit, three CI 0.13–65.3, p = 0.55).
developing respiratory failure necessitating mechanical
ventilation. These three patients also developed acute Discussion
kidney injury. HIV-positive patients had several other In this study, there were no differences in demographic,
clinical and laboratory parameters when comparing the
TABLE 1: Presenting symptoms in 24 adult patients with measles: Comparison of
HIV-positive and HIV-negative cases.
Presenting symptom HIV-positive patients HIV-negative patients p TABLE 4: Complications in 24 adult patients with measles: Comparison of
n N† % n N† % HIV-positive and HIV-negative cases.
Complication HIV-positive HIV-negative p-value
Fever 17 18 94.4 6 6 100 1.0 patients (N = 18) patients (N = 6)
Rash 18 18 100 6 6 100 1.0 n % n %
Red eyes or conjunctivitis 18 18 100 6 6 100 1.0 Any complication 9 50.0 1 16.7 0.34
Coryza 9 18 50 3 6 50 1.0 Pneumonia 6 33.3 1 16.7 0.63
Cough 11 18 61.1 6 6 100 0.13 ICU/ high care admission 5 27.8 0 0 0.28
Shortness of breath 2 18 11.1 0 6 0 1.0 Respiratory failure 3 16.7 0 0 0.55
Vomiting 3 16 18.8 3 4 75 0.06 Mechanical ventilation 3 16.7 0 0 0.55
Diarrhoea 2 17 11.8 0 4 0 1.0 Acute kidney injury 3 16.7 0 0 0.55
Abdominal pain 1 17 5.9 0 4 0 1.0 Purulent conjunctivitis 1 5.6 0 0 1
Headache 1 18 5.6 2 6 33.3 0.22
Pancreatitis 1 5.6 0 0 1
†, n denotes the number of patients in whom the symptom was present; N is the number of Encephalitis 1 5.6 0 0 1
patients in whom the presence or absence of the symptom was recorded.
TABLE 2A: Examination findings in 24 adult patients with measles: Comparison of HIV-positive and HIV-negative cases.
Vital signs Sub-indicator HIV-positive patients (N = 18) HIV-negative patients (N = 6) p-value
Median Range x ̅ s.d. Median Range x ̅ s.d.
Temperature (°C) - 39 37.5–40 - - 39 37–39 - - 0.1
Blood pressure (mmHg) Systolic 103.5 90–149 - - 123.5 103–129 - - 0.13
Diastolic 69.5 40–99 - - 75 67–79 - - 0.42
Heart rate (beats/min) - - - 124 23 - - 105 23 0.1

TABLE 2B: Examination findings in 24 adult patients with measles: Comparison of HIV-positive and HIV-negative cases.
Clinical features Sub-indicator HIV-positive patients (N = 18) HIV-negative patients (N = 6) p-value
n % n %
Rash - 18 100 6 100 1.00
Conjunctivitis - 18 100 6 100 1.00
Koplik spots - 5 27.8 1 16.7 1.00
Oral thrush - 6 33.3 0 0 0.28
Lymphadenopathy - 6 33.3 2 33.3 1.00
Confusion - 3 16.7 0 0 0.55
Chest examination Crackles 5 27.8 1 16.7 1.00
Bronchial breathing 1 5.6 0 0 1.00

TABLE 3: Laboratory findings in 24 adult patients with measles: Comparison of HIV-positive and HIV-negative cases.
Findings HIV-positive patients (n = 18) HIV-negative patients (n = 6) p-value
Median Range x ̅ s.d. Median Range x ̅ s.d.
White cell count (cells x10⁹/l)† 6.6 4–14.8 - - 6.9 5.8–16 - - 0.40
Haemoglobin (g/dl) 13.1 9.3–16.3 - - 16.5 9.6–17.4 - - 0.11
Platelets (cells x10⁹/l) - - 187.7 53.9 - - 183.0 49.9 0.87
Sodium (mmol/l) 135.5 122–140 - - 132.5 126–141 - - 0.24
Potassium (mmol/l) - - 4.0 0.6 - - 4.0 0.6 0.97
Bicarbonate (mmol/l) - - 21.7 3.4 - - 23.8 3.5 0.23
Urea (mmol/l) - - 9.6 6.1 - - 7.2 2.3 0.18
Creatinine (µmol/l) - - 117.9 55.2 - - 100.5 45.7 0.46
Albumin (g/l) - - 36.1 6.2† - - 34.3 6.7‡ 0.65
CRP (mg/l) - - 120.8 74.9† - - 110.6 58.5¶ 0.76
†, number of cases with available data = 17.
‡, number of cases with available data = 4.
¶, number of cases with available data = 5.

http://www.sajhivmed.org.za 295 Open Access