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diarrhea in patients with AIDS
The majority of AIDS patients with diarrhea have one or more identifiable pathogens.
Etiology:
1) viral
a) cytomegalovirus (CMV colitis)
b) adenovirus
c) Herpes simplex
2) bacteria
a) Mycobacterium avium-intracellulare
b) Salmonella
c) Shigella flexneri
d) Campylobacter jejuni
e) Clostridium difficile
f) Chlamydia
g) Neisseria gonorrhoeae
h) Treponema pallidum & other spirochetes
3) fungi
- Histoplasma capsulatum
4) protozoa
a) cryptosporidium
b) Isospora belli
c) Microsporidia
d) Entamoeba histolytica
e) Giardia lamblia
f) Blastocystis hominis
5) human immunodeficiency virus (HIV-1) itself can cause diarrhea
Laboratory:
initial studies
1) examination of stool for leukocytes
2) stool cultures (at least 3 specimens)
a) Salmonella species
b) Shigella flexneri
c) Campylobacter jejuni
3) stool examination for ova & parasites
- saline, iodine, trichrome & acid-fast preparations
4) stool assay for Clostridium difficile
additional testing as indicated Special labooratory:
as needed
1) uppper GI endoscopy
a) gastric aspirate & biopsy
b) duodenal aspirate for parasites & culture
c) duodenal biopsy with culture for Mycobacterium & cytomegalovirus
2) colonoscopy
a) visualization
b) biopsy
1] culture for cytomegalovirus, adenovirus, mycobacteria, Herpes simplex
2] stains
a] hematoxylin-eosin for protozoa & viral inclusions
b] methenamine silver or Giemsa for fungi
c] Fite stain for mycobacterium
3) electron microscopy
a) duodenal biopsy for Microsporidia
b) colon biopsy for adenovirus
Management:
1) specific treatment for specific etiology
2) empiric treatment with loperamide unless contraindicated
3) general measures
a) elimination of lactose-containing foods
b) soluble fiber, i.e. rice or psyllium
Related
Acquired Immuno-Deficiency Syndrome (HIV infection stage 3, AIDS)
Specific
cytomegalovirus colitis; CMV colitis
General
HIV1/AIDS-associated gastrointestinal disorder (includes HIV1-associated diarrhea)
infectious diarrhea; infectious colitis
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 303-304
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 237