Correspondence
Anaesthesia, 2001, 56, pages 183±197
................................................................................................................................................................................................................................................
4 Howlett WP, Nkya WM, Mmuni KA,
Missalek WR. Neurological disorders
in AIDS and HIV disease in the
northern zone of Tanzania. AIDS 1989;
3: 289±9.
infection was a frequent, even the most
common, illness associated with GBS [1,
2, 5]. Retrospective data were collected
on GBS patients admitted to the Inten-
sive Care Units of the Harare Teaching
Hospitals over a 28-month period up to
March 1991: out of 14 patients, 10 were
tested for HIV and seven found to be
seropositive [6].
Anaesthesia 2000; 55: 1040) demonstrates
the continuing interest over many years
of the effects of aspiration of stomach
contents. The paper by Charles C. Hall
[1], as noted by Dr Ravalia, details some
experimental work carried out on rabbits
in 1940 indicating that aspiration of
acidic liquid material sets up a chemical
pneumonitis. However, chemical pneu-
monitis may not be the complete
explanation for the fatalities resulting
from aspiration of liquid material. Work
relating to sudden death in infants (cot-
deaths) carried out by Parish et al. on
sensitised guinea-pigs suggests that an
anaphylactic reaction might equally well
be involved in these reactions [2].
5 Berger JR, Difini JA, Swerdloff MA,
Ayyar R. HIV seropositivity in
Guillain±Barre syndrome. Annals of
Neurology 1987; 22: 393±4.
6 McKenzie AG. Outcome of patients
with human immunodeficiency virus
(HIV) infection admitted to intensive
care: a preliminary study. Central African
Journal of Medicine 1991; 37: 436±7.
7 Bergstrom S. The pathology of poverty.
In: Lankinen KS, Bergstrom S, Makela
PH, Peltomaa M, eds. Health and
Disease in Developing Countries. London:
Macmillan Press, 1994: 3±12.
In the last few years, in parts of
central, east and southern Africa up to
40% of pregnant women attending
antenatal clinics are HIV seropositive
[7]. I suggest that GBS occurring in
HIV seropositive pregnant women may
be underreported. The implications for
the unborn baby are obvious.
The association of GBS and HIV-1,
usually occurring at the time of
seroconversion or during the phase of
early infection (CDC Category A),
remains well recognised [8]. The same
treatments ± intensive care, plasmapher-
esis and infusions of human immune
globulin ± are effective [8]. In GBS, a
history of a preceding flu-like illness and,
especially, pleocytosis in the CSF, should
prompt a search for HIV-1 infection; if
initial serology is negative, follow-up
testing may be appropriate [2, 8].
Parish and his co-workers were testing
the results of earlier investigations that had
given rise to the belief that anaphylaxis did
not occur when the subject was anaes-
thetised. Sensitised, anaesthetised guinea-
pigswerechallengedeither byintravenous
injection of 0.5 ml of a 1 in 2 dilution of
antigen in saline, or by instilling 0.25 ml
of the undiluted antigen over the larynx
to be inhaled by the animal. The
anaesthetic agents used were pentobarbi-
tal, di-ethyl ether, halogen in oxygen and
air, nitrous oxide with trichlorethylene
with oxygen, and carbon dioxide and
oxygen. Death usually occurred between
3 and 5 min after challenge.
8 Cornblath DR, McArthur JC.
Peripheral neuropathies in human
immunodeficiency virus type 1
infection. In: Asbury AK, Thomas PK,
eds. Peripheral Nerve Disorders 2.
Oxford: Butterworth-Heinemann,
1995: 223±37.
A reply
We thank Dr McKenzie for pointing out
the association between Guillain±BarreÂ
syndrome and HIV infection. In neither
of our cases was serology testing for HIV
performed. In the first case, virology
confirmed recent infection with Epstein
Barr virus and in the second case HIV
testing was not felt to be indicated.
We agree that, in pregnancy, there
should be a low index of suspicion for
HIV testing for fetal reasons. It is now
well recognised that appropriate anti-
retroviral therapy in pregnancy, delivery
by Caesarean section and avoidance of
breast-feeding can significantly reduce
vertical transmission to the fetus.
I wonder whether Brooks, Christian
and May could reveal whether virology
testing was undertaken in their second
case. It would be interesting to receive
their comments on this.
Of interest to anaesthetists was the
finding that ether gave some protection
from death due to anaphylaxis and that
animals under pentobarbital narcosis
showed none of the usual signs of
obstructed breathing or respiratory
arrest prior to death. The experiments
demonstrated that the signs of anaphy-
laxis might become greatly modified
under anaesthesia so that the reaction
may not be recognised. Thus, it is
possible that in humans, blood trans-
fusions and the administration of drugs
to which the patient is already sensitised
may cause unrecognised anaphylaxis
during surgical operations; so may the
inhalation of vomit during operations if
the stomach contains substances to
which the patient is sensitised.
A. G. McKenzie
Edinburgh Royal Infirmary,
Edinburgh EH3 9YW, UK
References
1 Thornton CA, Latif AS, Emmanuel JC.
Guillain±Barre syndrome associated
with human immunodeficiency virus
infection in Zimbabwe. Neurology 1991;
41: 812±5.
H. Brooks
A. S. Christian
A. E. May
Leicester Royal Infirmary,
Leicester LE1 5WW, UK
E-mail: hbrooks@doctors.org.uk
2 Dalakas MC, Pezeshkpour GH.
Neuromuscular diseases associated with
human immunodeficiency virus
infection. Annals of Neurology 1988; 23
(Suppl.): S38±S48.
3 Conlon CP. HIV infection presenting
as Guillain±Barre syndrome in Lusaka, Mendelson's syndrome
Zambia. Transactions of the Royal Society
L. W. Hall
University of Cambridge School
of Veterinary Medicine,
Cambridge CB3 0ES, UK
of Tropical Medicine and Hygiene 1989;
83: 109.
The letter from Dr A. Ravalia quoting
Mendelson's paper in 1945 (Ravalia.
194
q 2001 Blackwell Science Ltd