A Study of Gastrointestinal Manifestations in HIV/AIDS Patients (original) (raw)
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Clinical Infectious Diseases, 1996
The spectrum of bowel infections in patients with AIDS in India is not well characterized. To examine this spectrum of infections, an autopsy study of 49 subjects was carried out. Multiple sections were obtained from the gastrointestinal tract. A pathogenic organism was detected in 2S (71%) of 3S patients with diarrhea vs. 4 (29%) of 14 patients without diarrhea (P < .01). The most frequent pathogen was cytomegalovirus (in 13; 27%), followed by parasites (9; 18%), fungi (8; 16%) and Mycobacterium tuberculosis (7; 14%).This is the first autopsy study of patients with AIDS in the Indian subcontinent and shows important differences in the profile of their opportunistic infections compared with those of such patients in the West. These findings will help define the optimal diagnostic and therapeutic approaches to patients with AIDS, which, in view of the considerable budgetary restrictions in developing countries, should be targeted toward the pathogens most frequently identified in such areas.
Gastrointestinal symptoms in ambulatory HIV-infected patients
Digestive Diseases and Sciences, 1993
Gastrointestinal symptoms are commonly seen in patients with established AIDS. We examined the charts of 258 HIV-infected patients attending our HIV outpatient clinic to determine: (1) the frequency of gastrointestinal symptoms in unselected HIV-infected patients and (2) if there are any predictors of the development of symptoms in initially asymptomatic patients. We found the overall frequency of gastrointestinal symptoms at initial presentation in our ambulatory, predominantly homosexual population of HIV-infected patients was 35% (95% CI 30-40%) with 19% having anorexia, 15% weight loss, 14% diarrhea, and 5% dysphagia. There was no association between the presence of symptoms and stool parasites, which were found in 51% of patients. In 165 patients who were initially asymptomatic, 72% subsequently developed symptoms over 36 months of actuarial follow-up. Patients with initial T4 counts &amp;amp;amp;amp;amp;lt; 500 were more likely to develop symptoms. Patients with a greater degree of immunosuppression as indicated by a lower T4 count, are more likely to develop gastrointestinal symptoms.
Enteric Infections and Diarrhea in Human Immunodeficiency Virus–Infected Persons
Archives of Internal Medicine, 1999
Background: Persons infected with human immunodeficiency virus (HIV) are at increased risk for diarrhea and enteric infections. We studied (1) the epidemiology of enteric pathogens associated with diarrhea, (2) the diagnostic yield of stool examination and endoscopic evaluation, (3) risks to develop diarrhea, and (4) the impact of diarrhea on patients' survival. Methods: A total of 1933 participants in the Swiss HIV Cohort Study were prospectively followed up for a median of 25.5 months. A total of 560 diarrheal episodes were evaluated by standardized stool examination. Endoscopic evaluation was performed in 25% of patients with chronic diarrhea. Results: The incidence of diarrhea was 14.2 per 100 person-years (95% confidence interval, 13.0-15.4). Among patients with CD4 cell counts below 0.05 ϫ 10 9 /L, the probability to develop diarrhea within 1, 2, and 3 years was 48.5%, 74.3%, and 95.6%, respectively. The risk to develop diarrhea was increased among patients with severe immunodeficiency, homosexual men, and patients taking antiretroviral therapy. Pneumocystis carinii chemoprophylaxis did not reduce the risk of diarrhea. Diarrhea was an independent negative predictor of survival. Enteric pathogens were detected in 16.5% of 212 acute diarrheal episodes and in 46% of 348 chronic diarrheal episodes. The sensitivity of histological and stool examination was similar except for the diagnosis of intestinal cytomegalovirus infection and leishmaniasis, which required invasive evaluation. Conclusions: Intestinal infections were diagnosed in less than 50% of chronic diarrheal episodes. The prevalence of enteric pathogens tended to decrease during the observation period, possibly because of improved antiretroviral therapy. Endoscopic evaluation did not improve the diagnostic yield compared with stool examination except for the diagnosis of cytomegalovirus enteritis and leishmaniasis.
Intestinal parasitic infections in HIV/AIDS patients presenting with diarrhoea in Jakarta, Indonesia
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2009
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Jundishapur Journal of Microbiology, 2012
Although the prevalence of gastrointestinal parasites in HIV (+) patients is not high, parasitic disease should be considered in such patients who live in tropical and endemic areas due to failure of their immune system. Background: Accute Immune Deficiency Syndrom (AIDS) is a serious and lethal disease in many parts of the world, rendering a patient sensitive to all opportunistic pathogens that can cause death as the disease progresses. Many patients suffer from intestinal opportunistic infections by parasites. Objectives: The aim of present study was to examine parasitic intestinal infections in AIDS patients in Razi Hospital, Ahvaz. Patients and Methods: We collected 100 stool samples from 60 HIV (+) patients who were referred to Razi Hospital, Ahvaz. The samples were examined by direct and MIF (merthiolateiodine-formaldehyde) method. All samples were stained with Ziehl-Neelsen (acid fast staining) and trichrome. General data, such as clinical signs, duration of disease, route of infection, and habitat of patient, were obtained by questionnaire. Results: Thirty percent of HIV (+) patients were infected with intestinal protozoan parasites. There was no significant difference in the prevalence of parasite infections between sex or age. The prevalence of parasitic infections was as follows: Blastocystis hominis, 16. 7%; Cryptosporidium parvum, 8. 3%; Endolimax nana, 5%; Entamoeba coli, 5%; Giardia intestinalis, 3. 3%; E. histolytica cyst, 1. 7%, and Dientamoeba fragilis, 1. 7%. Conclusions: This study shows that the prevalence of parasitic infections is not high in HIV (+) patient in Ahvaz compared with other studies, but it is recommended that fecal examination be performed every 3 months to detect serious parasitic infections and that parasitic infections should be treated after laboratory diagnosis and in the presence of the gastrointestinal symptoms.
Enteric pathogens in HIV/AIDS from a tertiary care hospital
Indian journal of community …, 2009
Background:Patterns of enteric infections in HIV in developing countries may differ in several important ways from developed countries, the knowledge of which can often guide therapy when resource limitations hamper the exact diagnosis of the etiological agent in HIV-associated diarrhea.Objectives:The primary objective of this study was to define and compare the microbial etiologies of diarrhea in HIV-1 infected and non infected patients and in HIV infected non diarrheal patients.Materials and Methods:This study was conducted between April 2007 and July 2007 at the Department of Microbiology, Maulana Azad Medical College, New Delhi. Stool samples from 50 HIV seropositive cases with diarrhea (study group), 50 HIV seropositive cases without diarrhea (control group I), and 50 HIV seronegative cases with diarrhea (control group II) were examined. After the diagnosis of HIV infection was made, routine parasitological and bacteriological detection was done. An ELISA was used for the detection of Clostridium difficile toxin and Cryptosporidium antigen in stool samples.Results:The overall prevalence of enteric parasitosis in the study group was 20% and the bacteria identified were Escherischia coli in 24% of the case, Clostridium difficile in 10% of the cases, Salmonella species and Vibrio cholerae in 4% of the cases, and Shigella species in 2% of the cases. Candida species was identified in 36% of the cases.Conclusions:Identification of the etiological agent of diarrhea in a patient with AIDS is very important as it can help in the institution of appropriate therapy and the reduction of morbidity and mortality in these patients.
HIV enteropathy : a challenge in diagnosis and management
Journal of the National Medical Association, 1994
The gastrointestinal tract is the largest lymphoid reservoir of the body and is subject to damage that compromises the cellular and humoral defense mechanism. With the increasing numbers of patients infected with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), health-care practitioners need to be familiar with infections that affect the gastrointestinal tract. These infections cause severe morbidity and sometimes even death in immunocompromised patients. This article reviews the diagnosis and management of gastrointestinal infections in the immunocompromised patient. (J Nat! Med Assoc. 1994;86:347-351.) Key words * human immunodeficiency virus (HIV) acquired immunodeficiency syndrome (AIDS) * gastrointestinal infections In 1990, there were 1 million people in the United States infected with the human immunodeficiency virus (HIV) virus and approximately 155 000 cases of acquired immunodeficiency syndrome (AIDS), of which 95 000 people died.' By the end of 1993, the US Public Health Service estimated that there were between 390 000 and 480 000 AIDS cases in the United States. Of these, 50% to 90% will present with gastrointestinal tract symptoms such as odynophagia, dysphagia, and diarrhea.2'3 In North American and European populations, 30% to 50% of these patients will present with diarrhea. In developing countries, almost 90% of these patients will present with
The American Journal of Tropical Medicine and Hygiene, 2007
The objectives of this study were to evaluate characteristics associated with diarrhea, the effect of trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis on diarrhea, the response to treatment with ciprofloxacin and tinidazole (Cipro-TZ™), and presence of enteric pathogens. Adults infected with human immunodeficiency virus with and without diarrhea served as cases and controls, respectively. Participants provided a medical history and underwent a physical examination. Blood was collected for CD4 cell counts and stool for culture. Cases were treated with Cipro-TZ™. Factors associated with a risk of diarrhea included crowded living and no toilet (all P < 0.05). Protective variables (P < 0.05) included a CD4 count greater than 200 cells/mm 3 and TMP/SMX prophylaxis. Cases were more likely to have a pathogen identified (P ס 0.05). Eighty-six percent of the cases responded to treatment. Important risk factors for diarrhea were identified. Protection by TMP/SMX reinforces the importance of prophylaxis. These data suggest that treatment with an antibiotic and anti-parasitic medication may be effective.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Gastrointestinal infections are very common in HIV patients, and diarrhea is a common clinical condition seen in them. With this observation, a study was conducted to find the parasites that cause opportunistic infections (OIs) and its association with immune status in the HIV-infected patients. Materials and Method: This study was conducted in the Department of Microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India, for 3 months, that is, from January to March 2013. Stool samples were collected and observed under microscope to detect diarrhea-causing parasites. Direct saline mount, iodine mount, and modified acid fast, modified trichrome stain were carried out. CD4 counts were measured by using FACS counting system. Results: Among the 178 study participants who had diarrhea and who were on antiretroviral treatment, maximum parasites were observed in patients with CD4 counts <200 cells/µL (65%), followed by 200–499 cells/µL (35%). Conclusion: OIs were identified in 54.5% of the HIV patients and the infections were more in patients with CD4 count <200 cells/µL. This would help the clinician to plan a proper treatment schedule.