Etiological agents of diarrhea in patients infected by the human immunodeficiency virus-1: a review

Abstract

Despite the importance of understanding the epidemiology of agents responsible for infectious diarrhea in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) population, the number of articles about this subject is relatively few. The current article summarizes published data on bacterial, fungal, viral and parasitic enteropathogens in the HIV/AIDS seropositive subjects in different countries, regions and localities. In general, there is a great difference in the frequencies of etiological agents due to factors which include immune status, geographical location, climate and socioeconomic conditions. It is important to stress that a great prevalence of infection by emergent agents has been reported in the more advanced stages of AIDS. Therefore, to establish specific treatment depends directly on knowledge of these agents and risk factors associated to their distribution. Moreover, the colonization by potential pathogenic agents verified in these individuals is high thus implicating that they act as carriers. Finally, public health measures of control and prevention must take into consideration the regional previously identified enteropathogens, especially in areas where HIV prevalence is high.

Etiologic Characteristics of Enterocolitis in Hospitalized HIV-Infected Patients for 3-Year Period (2013-2015)

“…All these patients had chronic diarrhea and severe immune suppression (their count of CD4 cells were < 50/mm 3 ). In the literature, both fungal species are less common and less pathogenic than Candida albicans, but they are problem in patients with severe neutropenia and can lead to septicemia and fatal outcome [4,13]. Another problem is their resistance to Fluconazole.…”

“…The incidence and severity of diarrhea increase with progression of the immune defi ciency [10,11,12]. In the literature, 30-60% of patients with diarrhea among HIVinfected individuals remain without specifi ed etiological agent [4,13]. Upon location of the pathogen in the small intestine, there are often profuse watery stools immediately after having a meal.…”

“…In "invasive" diarrhea there are more often pathological impurities in stools as mucus and blood, patients have pain in the lower abdominal and/or permanent and unproductive defecation urgency (tenesmus) [4,10]. The most common HIV-associated pathogens, causing acute diarrhea, regardless of CD4 cells count are: viruses (Adeno-, Astro-, Picorna-, Calici-), Clostridium diffi cile, Salmonella spp., Shigella spp., Campylobacter jejuni, Escherichia coli O157: H 7 [4,7,9,10,13]. Respectively, the most common infectious agents of the chronic diarrhea, regardless of the number of CD4 cells, are: Clostridium diffi cile, Giardia lamblia, Entamoeba histolytica.…”

“…Respectively, the most common infectious agents of the chronic diarrhea, regardless of the number of CD4 cells, are: Clostridium diffi cile, Giardia lamblia, Entamoeba histolytica. In patients with a CD4 cells <100/mm3, the most common infectious agents of chronic diarrhea are: Microsporidia, Cryptosporidium spp., Mycobacterium avium complex, Isospora beli, Cyclospora cayetanensis, Cytomegalovirus (CMV) (especially in cases with CD4 cells < 50/mm3) [1,5,6,13].…”

“…The causes of chronic diarrhea in HIV-infected patients can also be non-infectious, the most common of which are the following: irritable bowel syndrome, infl ammatory bowel disease (IBD -chronic ulcerative colitis and Crohn's disease), lymphomas, lactose insuffi ciency, celiac disease, bacterial overgrowth syndrome, pancreatic insuffi ciency, diverticulitis, fecal incontinence and symptoms due to side effects of some anti-retroviral drugs [10,11,12,13].…”