Cyclospora infection is common in Haitian patients with HIV infection, responds to trimethoprim-sulfamethoxazole therapy, and has a high recurrence rate that can be largely prevented with long-term trimethoprim-sulfamethoxazole prophylaxis.

Isospora belli has recently been recognized as an opportunistic protozoan pathogen in patients with the acquired immunodeficiency syndrome (AIDS). Although I. belli rarely causes diarrhea in patients with AIDS in the United States, we have documented isosporiasis in 15 percent (20 of 131) of such patients in Haiti. The infection was associated with chronic watery diarrhea and weight loss that was clinically indistinguishable from disease caused by the related coccidia cryptosporidium. No demographic or laboratory data distinguished the patients with AIDS and isosporiasis from those with either cryptosporidiosis or other opportunistic infections. Neither I. belli nor cryptosporidium was detected in stool samples from 170 healthy siblings, friends, and spouses of the patients with AIDS. In all patients with isosporiasis, diarrhea stopped within two days of the beginning of treatment with oral trimethoprim-sulfamethoxazole. Recurrent symptomatic isosporiasis developed in 47 percent of the patients, but it also responded promptly to therapy with trimethoprim-sulfamethoxazole. We conclude that isosporiasis is common in Haitian patients with AIDS, and that it responds to therapy with trimethoprim-sulfamethoxazole but is associated with a high rate of recurrence.

To identify the characteristics of the acquired immunodeficiency syndrome (AIDS) as it occurs in Haiti, we studied 61 previously healthy Haitians who had diagnoses of either Kaposi's sarcoma (15), opportunistic infections (45), or both (1) established in Haiti between June 1979 and October 1982. The first cases of Kaposi's sarcoma and opportunistic infections in Haiti were recognized in 1978-1979, a period that coincides with the earliest reports of AIDS in the United States. We do not believe that AIDS existed in Haiti before this period. The types of opportunistic infections and the clinical course in Haitians with Kaposi's sarcoma and opportunistic infections were similar in most aspects to those in patients with AIDS in the United States. The median age of Haitians with Kaposi's sarcoma and opportunistic infections was 32 years, and 85 per cent were men. The interval between diagnosis and death was six months in 80 per cent of the patients. Diarrhea was the most common reason for seeking medical attention in patients with opportunistic infections. Lymphopenia and skin-test anergy were observed in 86 and 100 per cent of patients, respectively. Potential risk factors (bisexual activity or blood transfusions) were identified in 17 per cent of male and 22 per cent of female patients. Demographic information suggests that patients belonged to all socioeconomic strata of Haitian society.

The occurrence of the anthropophilic dermatophyte Trichophyton tonsurans as a frequent causative agent of tinea capitis in several developed countries has been associated with a global rise in its isolation during recent years. While T. tonsurans was never found in Haiti before 1988, a sharp increase in the number of isolates of this species from scalp lesions began to be observed in 2005 in Port-au-Prince, Haiti. A prospective study was conducted in Port-au-Prince from May to November 2006 of 64 children presenting with tinea capitis at the dermatological outpatient clinic of the university hospital. Forty-five (70%) were male and 19 female (30%), with an average age at presentation of 6.1 years (age range 1-16 years). Direct microscopic examination of scalp hair using 10% potassium hydroxide was positive in 93.8% and culture confirmation was established in 55 cases (85.9%). Five species of dermatophytes were identified, with the anthropophilic dermatophyte T. tonsurans, accounting for the majority or 35 (63.6%) of all cases of tinea capitis. Other dermatophyte species identified included T. mentagrophytes (14.5%), Microsporum audouinii (12.7%), T. rubrum (7.3%) and in one case, the geophilic M. gypseum (1.8%). In two cases caused by T. tonsurans skin involvement on other areas of the body was recorded. The most frequent pathogen in tinea capitis is now T. tonsurans in Port-au-Prince. We speculate that the recent emergence of T. tonsurans in Haiti is linked to the dramatically increasing mobility of Haitian Diaspora.

Two hundred twenty-nine patients in Haiti with the acquired immunodeficiency syndrome were studied between 1979 and 1984. The clinical spectrum of the syndrome in Haitians was similar in most aspects to that in patients with the disease in the United States. However, in contrast to findings in the United States, accepted risk factors (bisexuality, blood transfusions, intravenous drug abuse) were identified in only 43% of Haitian patients. Patients in Haiti with and without these risk factors were similar to each other but differed from age- and sex-matched siblings and friends in the number of heterosexual contacts and receipt of intramuscular injections. These latter activities were commoner in patients than in their siblings and friends, and represent potential modes of transmission of infection with the human T-lymphotropic virus type III.