Advertisement

Digestive Diseases and Sciences

, Volume 33, Issue 9, pp 1141–1146 | Cite as

Infectious diarrhea in patients with AIDS

  • Michael A. Antony
  • Lawrence J. Brandt
  • Robert S. Klein
  • Leslie H. Bernstein
Original Articles

Abstract

A multitude of opportunistic infections has been documented in virtually every organ system of patients with the acquired immunodeficiency syndrome (AIDS). Prominent among these are infections of the gastrointestinal tract. However, studies of large numbers of patients documenting the frequency of such involvement are lacking. We reviewed the records of 100 patients with AIDS and assessed the frequency and organisms causing infectious diarrhea. We found diarrhea to be more common in homosexuals (80%) than heterosexuals with a risk factor of parenteral drug use (58%). In one third of all cases, no infectious etiology was found. Myobacterium avium intracellulare (MAI) was the most commonly identified cause of infectious diarrhea in our series, followed by cytomegalovirus, cryptosporidium, Salmonellaspp., and herpes virus. In addition, bacteremia was documented in 43% of patients with infectious diarrhea and was most commonly due to MAI. Finally, we demonstrated that multiple concurrent infections are not uncommon (22%) in AIDS patients and that the diarrheal syndrome may not respond unless all pathogens are eradicated.

Key words

infectious diarrhea acquired immunodeficiency syndrome opportunistic infections homosexuality intravenous drug abuse 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Quinn T: Clinical approach to intestinal infections in homosexual men. Med Clin North Am 70:611–634, 1986PubMedGoogle Scholar
  2. 2.
    DeHovitz J, Pape J, Boncy M, Johnson W: Clinical manifestations and therapy ofIsospora belli infection in patients with the acquired immunodeficiency syndrome. N Engl J Med 315:87–90, 1986PubMedGoogle Scholar
  3. 3.
    Jacobs J, Gold J, Murray H, Roberts R, Armstrong D:Salmonella infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med 102:186–188, 1985PubMedGoogle Scholar
  4. 4.
    Hawkins CC, Gold JWM, Whimbey E, Kiehn TE, Brannon P, Cammarata R, Brown AE, Armstrong D:Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med 105:184–188, 1986PubMedGoogle Scholar
  5. 5.
    Bodey G, Fainstein V, Guerrant R: Infections of the gastrointestinal tract in the immunocompromised patient. Annu Rev Med 37:271–281, 1986PubMedGoogle Scholar
  6. 6.
    Kotler D, Gaetz H, Lange M, Klein E, Holt P: Enteropathy associated with the acquired immunodeficiency syndrome. Ann Intern Med 101:421–428, 1984PubMedGoogle Scholar
  7. 7.
    Laurence J: Gastrointestinal infections in AIDS patients. Infect Med 3:318–328, 1986Google Scholar
  8. 8.
    Dritz SK, Goldsmith RS: Sexually transmissible protozoal, bacterial and viral enteric infections. Compr Ther 6:34–40, 1980Google Scholar
  9. 9.
    Dritz SK, Ainsworth TE, Garrard WF, Back A, Palmer RD, Boucher LA, River E: Patterns of sexually transmitted enteric disease in a city. Lancet 2:3–4, 1977PubMedGoogle Scholar
  10. 10.
    Hurwitz AL, Owen RL: Veneral transmission of intestinal parasites. West J Med 128:89–91, 1978PubMedGoogle Scholar
  11. 11.
    Schmerin MJ, Jones TC, Klein H: Giardiasis: Association with homosexuality. Ann Intern Med 88:801–803, 1978PubMedGoogle Scholar
  12. 12.
    Schmerin MJ, Gelston A, Jones TC: Amebiasis: An increasing problem among homosexuals in New York City. JAMA 238:1386–1387, 1977PubMedGoogle Scholar
  13. 13.
    Sohn N, Robilotti JG: The gay bowel syndrome: A review of colonic and rectal conditions in 200 male homosexuals. Am J Gastroenterol 67:478–484, 1977PubMedGoogle Scholar
  14. 14.
    Baker RW, Peppercorn MA: Gastrointestinal ailments of homosexual men. Medicine 61:390–405, 1982PubMedGoogle Scholar
  15. 15.
    McMillan A: Threadworms in homosexual males. Br Med J 1:367, 1978Google Scholar
  16. 16.
    Phillips SC, Mildvan D, William DC, Gelb AM, White MD: Sexual transmission of enteric protozoa and helminths in a veneral disease clinic population. N Engl J Med 305:603–606, 1981PubMedGoogle Scholar
  17. 17.
    Carney WP, Rubin RH, Hoffman RA, Hansen WP, Healey K, Hirsh MS: Analysis of T lymphocyte subsets in cytomegalovirus mononucleosis. J Immunol 126:2114–2116, 1981PubMedGoogle Scholar
  18. 18.
    Reinherz EL, O'Brien C, Rosenthal P, Schlossman SF: The cellular basis for viral-induced immunodeficiency: Analysis by monoclonal antibodies. J Immunol 125:1269–1274, 1980PubMedGoogle Scholar
  19. 19.
    Sonnabend J, Witkin SS, Purtilo DT: Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals: A hypothesis of etiologic factors in pathogenesis. JAMA 250:2370–2374, 1983Google Scholar
  20. 20.
    Brown SM, Stimmel B, Taub RN, Kochwa S, Rosenfeld RE: Immunological dysfunction in heroin addicts. Arch Intern Med 134:1001–1006, 1974PubMedGoogle Scholar
  21. 21.
    McDonough RJ, Madden JJ, Falek A: Alteration of T and null lymphocytic frequencies in the peripheral blood of human opiate addicts:In vivo evidence for opiate receptor site on T lymphocytes. J Immunol 125:2539–2543, 1980PubMedGoogle Scholar
  22. 22.
    Lane HC, Fauci AS: Immunologic aspects of the acquired immunodeficiency syndrome.In Advances in Host Defense Mechanisms, Vol 5. Gallin JI, Fauci AS, (eds.) New York, Raven Press, 1985, pp. 131–148Google Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Michael A. Antony
    • 1
  • Lawrence J. Brandt
    • 1
  • Robert S. Klein
    • 1
  • Leslie H. Bernstein
    • 1
  1. 1.Division of Gastroenterology Division of Infectious Diseases Department of MedicineMontefiore Medical Center of the Albert Einstein College of MedicineUSA

Personalised recommendations