Cholecystectomy in Patients with AIDS: Clinicopathologic Correlations in 107 Cases

Abstract

The etiologic and clinical features of cholecystisis in infection due to human immunodeficiency virus (HIV) were studies retrospectively. The charts and histopathologic specimens of 136 HIV-infected patients who underwent cholecystectomy between February 1987 and May 1993 at a large tertiary care center were reviewed. Opportunistic pathogens infecting the 107 patients with AIDS included microsporidia (eight cases-- Enterocytozoon bieneusi in six and Septata intestinalis in two); cytomegalovirus alone (six cases); Cryptosporidium alone (eight cases); cytomegalovirus plus Cryptosporidum (15 cases); and Pneumocystis carinii and Isospora belli (one case each). In addition, histopathologic changes characteristic of Kaposi's sarcoma were seen in one case. Thirty-eight patients with AIDS had acalculous cholecystitis for which no etiologic agent was found. Twenty-eight AIDS patients had cholelithiasis, six with coexistent opportunistic gallbladder infection. In the 107 AIDS patients, no specific symptom was found to be predictive of opportunistic infection of the gallbladder, but such infection was significantly associated with an abnormal abdominal ultrasound (P = .017) and with nonvisualization of the gallbladder by radionucleotide biliary scan (P < .001).

Cryptosporidium parvum is cytopathic for cultured human biliary epithelia via an apoptotic mechanism

“…Patients often have right upper quadrant pain, nausea, vomiting, fever, and biochemical evidence of cholestasis. [22][23][24] Strictures, narrowing, and irregu- larities of the intrahepatic bile ducts, with dilatation of the common hepatic and common bile ducts and thickening of the ductal walls, can be seen by noninvasive (i.e., ultrasound and computed tomography) and invasive (i.e., retrograde cholangiography) imaging studies. The immune response to C. parvum is not completely understood, although a low CD4 count in AIDS patients is associated with chronic severe infection.…”

Case report: Nitazoxanide treatment failure in chronic isosporiasis.

“…[8][9][10] According to our observation, these patients might be predisposed to treatment failure with orally administered nitazoxanide.…”

First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS

“…Coccidian organisms usually comprise a single merozoite-like stage, and many thousands of these organisms may be present. Except for Sarcocystis, infection with other gut coccidian parasites in the gallbladder epithelium has been reported (Pitlik et al 1983, Benator et al 1994, French et al 1995, Zar et al 2001. Clinical signs in patients with parasites in these locations are not specific for coccidiosis, and parasites are diagnosed after tissue biopsy as part of a diagnostic workup (French et al 1995).…”

“…Except for Sarcocystis, infection with other gut coccidian parasites in the gallbladder epithelium has been reported (Pitlik et al 1983, Benator et al 1994, French et al 1995, Zar et al 2001. Clinical signs in patients with parasites in these locations are not specific for coccidiosis, and parasites are diagnosed after tissue biopsy as part of a diagnostic workup (French et al 1995). To our knowledge, biliary and gallbladder diseases caused by gut coccidian parasites such as Cryptosporidium, Cyclospora cayetanensis and I. belli have been demonstrated only in immunocompromised patients, but to date no cholangitis or cholecystitis due to sarcocystosis has been reported in immunocompetent or immunocompromised patients.…”