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Disorders of the Colon and Rectum

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Part of the Clinical Gastroenterology book series (CG)

Abstract

The specific aim of this chapter is to explore the various viral, bacterial, parasitic, and fungal organisms that can lead to colorectal disease processes in people living with HIV/AIDS (PLWH). Many of these diseases are fairly uncommon in the immunocompetent population but start to show their force in those who cannot mount a robust immune response. We will explore the mechanisms of these infections with specific focus on clinical methods of diagnosis, endoscopic findings, and the specific treatment regimens available to curtail the state of illness. One of the predominant presenting symptoms with all of these organisms is diarrhea, and thus, prior to elaborating on these organisms, we must first understand the approach necessary to take when assessing a patient with this complaint.

Keywords

HIV Colorectal disease Opportunistic infection Antiretroviral therapy 

References

  1. 1.
    Knox TA, Spiegelman D, Skinner SC, Gorbach S. Diarrhea and abnormalities of gastrointestinal function in a cohort of men and women with HIV infection. Am J Gastroenterol. 2000;95(12):3482–9.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int. 2011;2011:247923.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602–22.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Rotterdam H, Tsang P. Gastrointestinal disease in the immunocompromised patient. Hum Pathol. 1994;25(11):1123–40.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Dionisio D. Textbook-atlas of intestinal infections in AIDS. Milan, New York: Springer; 2003. xvi, 506 p.CrossRefGoogle Scholar
  6. 6.
    Paparone PP, Paparone PA. Cytomegalovirus colitis in a human immunodeficiency virus-positive patient with a normal CD4 count. Am J Med Sci. 2012;344(6):508–10.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Leach CT, Cherry JD, English PA, Hennessey K, Giorgi JV, Visscher BR, et al. The relationship between T-cell levels and CMV infection in asymptomatic HIV-1 antibody-positive homosexual men. J Acquir Immune Defic Syndr. 1993;6(4):407–13.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Chachoua A, Dieterich D, Krasinski K, Greene J, Laubenstein L, Wernz J, et al. 9-(1,3-Dihydroxy-2-propoxymethyl)guanine (ganciclovir) in the treatment of cytomegalovirus gastrointestinal disease with the acquired immunodeficiency syndrome. Ann Intern Med. 1987;107(2):133–7.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Whitley RJ, Jacobson MA, Friedberg DN, Holland GN, Jabs DA, Dieterich DT, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA. Arch Intern Med. 1998;158(9):957–69.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Agholi M, Safaei A, Ramzi M, Hatam GR, Sarvari J. A survey of the frequency of cytomegalovirus-associated diarrhea in immunocompromised patients using a non-invasive method. Iran J Microbiol. 2018;10(2):143–50.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Kram HB, Shoemaker WC. Intestinal perforation due to cytomegalovirus infection in patients with AIDS. Dis Colon Rectum. 1990;33(12):1037–40.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Dieterich DT, Chachoua A, Lafleur F, Worrell C. Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS. Rev Infect Dis. 1988;10(Suppl 3):S532–7.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Nyitray AG, Carvalho da Silva RJ, Baggio ML, Lu B, Smith D, Abrahamsen M, et al. Age-specific prevalence of and risk factors for anal human papillomavirus (HPV) among men who have sex with women and men who have sex with men: the HPV in men (HIM) study. J Infect Dis. 2011;203(1):49–57.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Hernandez BY, Wilkens LR, Zhu X, Thompson P, McDuffie K, Shvetsov YB, et al. Transmission of human papillomavirus in heterosexual couples. Emerg Infect Dis. 2008;14(6):888–94.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Tartaglia E, Falasca K, Vecchiet J, Sabusco GP, Picciano G, Di Marco R, et al. Prevalence of HPV infection among HIV-positive and HIV-negative women in Central/Eastern Italy: strategies of prevention. Oncol Lett. 2017;14(6):7629–35.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Kelly HA, Sawadogo B, Chikandiwa A, Segondy M, Gilham C, Lompo O, et al. Epidemiology of high-risk human papillomavirus and cervical lesions in African women living with HIV/AIDS: effect of anti-retroviral therapy. AIDS. 2017;31(2):273–85.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Assi R, Reddy V, Einarsdottir H, Longo WE. Anorectal human papillomavirus: current concepts. Yale J Biol Med. 2014;87(4):537–47.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Heard I. Human papillomavirus, cancer and vaccination. Curr Opin HIV AIDS. 2011;6(4):297–302.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Roberts JR, Siekas LL, Kaz AM. Anal intraepithelial neoplasia: a review of diagnosis and management. World J Gastrointest Oncol. 2017;9(2):50–61.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Megill C, Wilkin T. Topical therapies for the treatment of anal high-grade squamous intraepithelial lesions. Semin Colon Rectal Surg. 2017;28(2):86–90.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Wang CJ, Sparano J, Palefsky JM. Human immunodeficiency virus/AIDS, human papillomavirus, and anal cancer. Surg Oncol Clin N Am. 2017;26(1):17–31.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet. 1996;348(9034):1049–54.Google Scholar
  23. 23.
    Osborne MC, Maykel J, Johnson EK, Steele SR. Anal squamous cell carcinoma: an evolution in disease and management. World J Gastroenterol. 2014;20(36):13052–9.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372(8):711–23.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Stier EA, Chigurupati NL, Fung L. Prophylactic HPV vaccination and anal cancer. Hum Vaccin Immunother. 2016;12(6):1348–51.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Collini PJ, Kuijper E, Dockrell DH. Clostridium difficile infection in patients with HIV/AIDS. Curr HIV/AIDS Rep. 2013;10(3):273–82.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Sanchez TH, Brooks JT, Sullivan PS, Juhasz M, Mintz E, Dworkin MS, et al. Bacterial diarrhea in persons with HIV infection, United States, 1992–2002. Clin Infect Dis. 2005;41(11):1621–7.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Le Guern R, Wallet F. Laboratory diagnosis of Clostridium difficile infection. Ann Biol Clin (Paris). 2013;71(4):395–400.Google Scholar
  29. 29.
    Brecher SM, Novak-Weekley SM, Nagy E. Laboratory diagnosis of Clostridium difficile infections: there is light at the end of the colon. Clin Infect Dis. 2013;57(8):1175–81.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Farooq PD, Urrunaga NH, Tang DM, von Rosenvinge EC. Pseudomembranous colitis. Dis Mon. 2015;61(5):181–206.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):987–94.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Wilcox MH, Gerding DN, Poxton IR, Kelly C, Nathan R, Birch T, et al. Bezlotoxumab for prevention of recurrent Clostridium difficile infection. N Engl J Med. 2017;376(4):305–17.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Vindigni SM, Surawicz CM. Managing Clostridium difficile: an old bug with new tricks. Am J Gastroenterol. 2018;113(7):932–5.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Shogbesan O, Poudel DR, Victor S, Jehangir A, Fadahunsi O, Shogbesan G, et al. A systematic review of the efficacy and safety of fecal microbiota transplant for Clostridium difficile infection in immunocompromised patients. Can J Gastroenterol Hepatol. 2018;2018:1394379.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Ronn MM, Ward H. The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis. 2011;11:70.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci. 2012;57(2):269–73.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Voltaggio L, Montgomery EA, Ali MA, Singhi AD, Arnold CA. Sex, lies, and gastrointestinal tract biopsies: a review of selected sexually transmitted proctocolitides. Adv Anat Pathol. 2014;21(2):83–93.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Ronn M, Hughes G, Simms I, Ison C, Alexander S, White PJ, et al. Challenges presented by re-emerging sexually transmitted infections in HIV positive men who have sex with men: an observational study of lymphogranuloma venereum in the UK. J AIDS Clin Res. 2014;5(8):1000329.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Ward H, Ronn M. Lymphogranuloma venereum in men who have sex in men: are we missing a reservoir of infection? Sex Transm Dis. 2013;40(8):609–10.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Bartlett JG, Auwaerter PG, Pham PA, Johns Hopkins Medicine, Johns Hopkins POC-IT Center. The Johns Hopkins ABX guide: diagnosis and treatment of infectious diseases. 2nd ed. Sudbury: Jones and Bartlett Publishers; 2010. xii, 856 p.Google Scholar
  41. 41.
    Lebedeff DA, Hochman EB. Rectal gonorrhea in men: diagnosis and treatment. Ann Intern Med. 1980;92(4):463–6.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Suay-Garcia B, Perez-Gracia MT. Drug-resistant Neisseria gonorrhoeae: latest developments. Eur J Clin Microbiol Infect Dis. 2017;36(7):1065–71.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Hale TL, Keusch GT. Shigella. In: Baron S, editor. Medical microbiology. Galveston: University of Texas Medical Branch at Galveston; 1996.Google Scholar
  44. 44.
    Mohan K, Hibbert M, Rooney G, Canvin M, Childs T, Jenkins C, et al. What is the overlap between HIV and shigellosis epidemics in England: further evidence of MSM transmission? Sex Transm Infect. 2018;94(1):67–71.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Khuroo MS, Mahajan R, Zargar SA, Panhotra BR, Bhat RL, Javid G, et al. The colon in shigellosis: serial colonoscopic appearances in Shigella dysenteriae I. Endoscopy. 1990;22(1):35–8.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Kotloff KL, Riddle MS, Platts-Mills JA, Pavlinac P, Zaidi AKM. Shigellosis. Lancet. 2018;391(10122):801–12.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Chaisson RE, Schecter GF, Theuer CP, Rutherford GW, Echenberg DF, Hopewell PC. Tuberculosis in patients with the acquired immunodeficiency syndrome. Clinical features, response to therapy, and survival. Am Rev Respir Dis. 1987;136(3):570–4.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Horvath KD, Whelan RL. Intestinal tuberculosis: return of an old disease. Am J Gastroenterol. 1998;93(5):692–6.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Pintor E, Piret MV, Velasco M, Barreiro P, Ruiz M, Blanco J. Colonic tuberculosis as a cause of rectal bleeding in 2 patients with HIV infection. Enferm Infecc Microbiol Clin. 1996;14(9):538–40.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Chatzicostas C, Koutroubakis IE, Tzardi M, Roussomoustakaki M, Prassopoulos P, Kouroumalis EA. Colonic tuberculosis mimicking Crohn’s disease: case report. BMC Gastroenterol. 2002;2:10.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Kolawole TM, Lewis EA. A radiologic study of tuberculosis of the abdomen (gastrointestinal tract). Am J Roentgenol Radium Ther Nucl Med. 1975;123(2):348–58.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Aris F, Naim C, Bessissow T, Amre R, Artho GP. AIRP best cases in radiologic-pathologic correlation: Mycobacterium avium-intracellulare complex enteritis. Radiographics. 2011;31(3):825–30.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Bhargava DK, Kushwaha AK, Dasarathy S, Shriniwas CP. Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointest Endosc. 1992;38(5):571–4.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Sekine K, Nagata N, Shindo T, Morino E, Shimbo T, Akiyama J, et al. Combined identifying granuloma and biopsy culture is useful for diagnosing intestinal tuberculosis. Int J Colorectal Dis. 2015;30(7):939–45.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Sun HY, Chen MY, Wu MS, Hsieh SM, Fang CT, Hung CC, et al. Endoscopic appearance of GI mycobacteriosis caused by the Mycobacterium avium complex in a patient with AIDS: case report and review. Gastrointest Endosc. 2005;61(6):775–9.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Connolly GM, Shanson D, Hawkins DA, Webster JN, Gazzard BG. Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients. Gut. 1989;30(2):195–200.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Schneebaum CW, Novick DM, Chabon AB, Strutynsky N, Yancovitz SR, Freund S. Terminal ileitis associated with Mycobacterium avium-intracellulare infection in a homosexual man with acquired immune deficiency syndrome. Gastroenterology. 1987;92(5 Pt 1):1127–32.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Farhi DC, Mason UG 3rd, Horsburgh CR Jr. Pathologic findings in disseminated Mycobacterium avium-intracellulare infection. A report of 11 cases. Am J Clin Pathol. 1986;85(1):67–72.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Viriyavejakul P, Nintasen R, Punsawad C, Chaisri U, Punpoowong B, Riganti M. High prevalence of Microsporidium infection in HIV-infected patients. Southeast Asian J Trop Med Public Health. 2009;40(2):223–8.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Mumcuoglu I, Cetin F, Dogruman Al F, Oguz I, Aksu N. Prevalence of microsporidia in healthy individuals and immunocompetent patients with acute and chronic diarrhea. Infect Dis (Lond). 2016;48(2):133–7.CrossRefGoogle Scholar
  61. 61.
    Anane S, Attouchi H. Microsporidiosis: epidemiology, clinical data and therapy. Gastroenterol Clin Biol. 2010;34(8–9):450–64.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Hutin YJ, Sombardier MN, Liguory O, Sarfati C, Derouin F, Modai J, et al. Risk factors for intestinal microsporidiosis in patients with human immunodeficiency virus infection: a case-control study. J Infect Dis. 1998;178(3):904–7.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Bernard E, Carles M, Pradier C, Boissy C, Roger PM, Hebuterne X, et al. Persistent diarrhea in HIV infected patients: role of Enterocytozoon bieneusi. Presse Med. 1995;24(14):671–4.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Wiwanitkit V. Intestinal parasite infestation in HIV infected patients. Curr HIV Res. 2006;4(1):87–96.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Wang RJ, Li JQ, Chen YC, Zhang LX, Xiao LH. Widespread occurrence of Cryptosporidium infections in patients with HIV/AIDS: Epidemiology, clinical feature, diagnosis, and therapy. Acta Trop. 2018;187:257–63.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Shirley DA, Moonah SN, Kotloff KL. Burden of disease from cryptosporidiosis. Curr Opin Infect Dis. 2012;25(5):555–63.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Goudal A, Laude A, Valot S, Desoubeaux G, Argy N, Nourrisson C, et al. Rapid diagnostic tests relying on antigen detection from stool as an efficient point of care testing strategy for giardiasis and cryptosporidiosis? Evaluation of a new immunochromatographic duplex assay. Diagn Microbiol Infect Dis. 2019;93(1):33–6.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Waywa D, Kongkriengdaj S, Chaidatch S, Tiengrim S, Kowadisaiburana B, Chaikachonpat S, et al. Protozoan enteric infection in AIDS related diarrhea in Thailand. Southeast Asian J Trop Med Public Health. 2001;32(Suppl 2):151–5.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Pape JW, Verdier RI, Boncy M, Boncy J, Johnson WD Jr. Cyclospora infection in adults infected with HIV. Clinical manifestations, treatment, and prophylaxis. Ann Intern Med. 1994;121(9):654–7.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Farthing MJ. Treatment options for the eradication of intestinal protozoa. Nat Clin Pract Gastroenterol Hepatol. 2006;3(8):436–45.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Farthing MJ. Treatment options in irritable bowel syndrome. Best Pract Res Clin Gastroenterol. 2004;18(4):773–86.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Allason-Jones E, Mindel A, Sargeaunt P, Katz D. Outcome of untreated infection with Entamoeba histolytica in homosexual men with and without HIV antibody. BMJ. 1988;297(6649):654–7.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Lowther SA, Dworkin MS, Hanson DL. Entamoeba histolytica/Entamoeba dispar infections in human immunodeficiency virus-infected patients in the United States. Clin Infect Dis. 2000;30(6):955–9.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Hung CC, Deng HY, Hsiao WH, Hsieh SM, Hsiao CF, Chen MY, et al. Invasive amebiasis as an emerging parasitic disease in patients with human immunodeficiency virus type 1 infection in Taiwan. Arch Intern Med. 2005;165(4):409–15.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Abdollahi A, Saffar H, Saffar H, Sheikhbahaei S, Rasoulinejad M. Is the evaluation of Entamoeba histolytica infection in HIV-positive patients of any clinical significance? Acta Med Iran. 2015;53(1):46–50.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Fotedar R, Stark D, Beebe N, Marriott D, Ellis J, Harkness J. Laboratory diagnostic techniques for Entamoeba species. Clin Microbiol Rev. 2007;20(3):511–32, table of contents.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Zengzhu G, Bracha R, Nuchamowitz Y, Cheng IW, Mirelman D. Analysis by enzyme-linked immunosorbent assay and PCR of human liver abscess aspirates from patients in China for Entamoeba histolytica. J Clin Microbiol. 1999;37(9):3034–6.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Verkerke HP, Hanbury B, Siddique A, Samie A, Haque R, Herbein J, et al. Multisite clinical evaluation of a rapid test for Entamoeba histolytica in stool. J Clin Microbiol. 2015;53(2):493–7.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Nagata N, Shimbo T, Akiyama J, Nakashima R, Niikura R, Nishimura S, et al. Predictive value of endoscopic findings in the diagnosis of active intestinal amebiasis. Endoscopy. 2012;44(4):425–8.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Mathew G, Bhimji SS. Amebiasis. Treasure Island: StatPearls; 2018.Google Scholar
  81. 81.
    Kahi CJ, Wheat LJ, Allen SD, Sarosi GA. Gastrointestinal histoplasmosis. Am J Gastroenterol. 2005;100(1):220–31.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    McKinsey DS, Spiegel RA, Hutwagner L, Stanford J, Driks MR, Brewer J, et al. Prospective study of histoplasmosis in patients infected with human immunodeficiency virus: incidence, risk factors, and pathophysiology. Clin Infect Dis. 1997;24(6):1195–203.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Assi M, McKinsey DS, Driks MR, O’Connor MC, Bonacini M, Graham B, et al. Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review. Diagn Microbiol Infect Dis. 2006;55(3):195–201.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Guimaraes AJ, Nosanchuk JD, Zancope-Oliveira RM. Diagnosis of Histoplasmosis. Braz J Microbiol. 2006;37(1):1–13.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Halline AG, Maldonado-Lutomirsky M, Ryoo JW, Pau A, Pursell K. Colonic histoplasmosis in AIDS: unusual endoscopic findings in two cases. Gastrointest Endosc. 1997;45(2):199–204.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807–25.PubMedCrossRefPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology and HepatologyRenaissance School of Medicine at Stony Brook UniversityStony BrookUSA

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