SUMMARY BackgroundLymphogranuloma venereum (LGV) is a recognized cause of proctitis. Symptoms, endoscopy and histology findings are similar in IBD and LGV proctitis.
From the earliest reports of what has since become the pandemic of human immunodefi ciency virus (HIV) infection, a close association between HIV infection and a previously un common mycobacterial disease-that due to infection with Mycobacterium avium complex (MAC)-was evident. 1 Then and since, clinically significant disease due to MAC is restricted to HIV-positive people in industrialized countries. Later it was realized that M. tuberculosis is associated with HIV infection to the extent that, in sub-Saharan Africa, tuberculosis is clinically the most important opportunistic disease in HIV-positive people.2 A significant proportion of the population there is latently infected with M. tuberculosis, and it is thought that HIV infection, by its progressive destruction of cell mediated immunity, permits the reactivation of tuberculous lesions. What about M. /eprae and HTV? Tn Africa, which today has the greatest number of HTV-infected people of all the continents, leprosy is still relatively common. Further, India has the greatest number of known cases of leprosy in the world, and appears to be on the rising curve of an HTV epidemic potentially as significant as that in Africa.3 So, an interaction between the two infections could be important. In fact, despite expectations,4-7 little interaction has been observed. The potential interactions and complications are many. HTV infection could: I increase the probability of infection with M. /eprae; 2 increase the probability of clinical leprosy developing in a dually infected person; 3 alter the clinical pattern of leprosy; 4 alter the response to anti leprosy chemotherapy.
The specialty of tropical medicine originated from the needs of the colonial era and is removed from many of the health care requirements of tropical countries today. Tropical medicine concentrates on parasitic diseases of warm climates, although other infections and diseases related to poverty rather than climate dominate medicine in developing countries challenged by population pressure, civil strife, and migration. In the new century, tropical medicine would best be absorbed into the specialty of infectious diseases, which should incorporate parasitic diseases, travel medicine, and sexually transmitted diseases. Pressing questions for health care and research in developing countries concern the provision of appropriate services for problems such as HIV/AIDS, tuberculosis, sexually transmitted diseases, and injuries. The question of how to provide appropriate clinical care in resource poor settings for the major causes of morbidity and premature mortality has been neglected by donors, academic institutions, and traditional tropical medicine.
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