Diarrhea in patients with AIDS

Abstract

Diarrhea in patients with AIDS is a worldwide problem that can have a devastating impact on quality of life for the patient. Chronic diarrhea, usually defined as at least 4 weeks' duration, is more common in patients with low CD4-positive T-lymphocyte counts, signaling advanced immunosuppression. Some organisms, such as Microsporidia, usually cause diarrhea only in the immunosuppressed; others, such as Cryptosporidium, Salmonella, Shigella, and Campylobacter, which are capable of causing diarrhea in the immunocompetent population, produce more severe or prolonged infections in people living with AIDS. Familiarity with the most common pathogens in the clinician's region will help with diagnosis and treatment. Because treatment options vary widely depending upon the infectious agent, thorough microbiologic evaluation is warranted. A stepped diagnostic approach of stool cultures and specialized microscopy and stains for protozoa, followed by sigmoidoscopy or colonoscopy and duodenoscopy with biopsies for histopathological examination is recommended in all patients with persistent, disabling diarrhea who have a CD4 count of less than 200/mm3, and should be considered for those with higher counts on an individual basis. Treatment, tailored to the specific pathogen, may need to be prolonged in the most severely immunocompromised patients to prevent relapse or recrudescence. For patients taking antiretroviral therapy (especially protease inhibitors) in whom no infectious agent can be found, diarrhea may be due to the medications. Nonspecific antidiarrheal agents should be tried until one that suits the patient is found. The most essential component of any therapeutic strategy for a patient with AIDS-associated diarrhea is restoration of the underlying immunologic defect using highly active antiretroviral therapy.

ChronicSalmonella entericaSerovar Typhimurium-Induced Colitis and Cholangitis in Streptomycin-PretreatedNramp1+/+Mice

“…In addition, severe mucosal and submucosal infiltrates (T and B cells, dendritic cells, macrophages, and PMNs) were observed. Human cases of chronic diarrheal Salmonella infection have also been observed occasionally, and the chronic murine colitis symptoms resemble aspects of the human disease (20,26,31). Thus, serovar Typhimurium infection of streptomycin-pretreated 129Sv/Ev mice may provide a useful model for study of bacterial and host factors contributing to chronic colitis at a molecular level.…”

Cryptosporidiosis - From Epidemiology to Treatment

“…It is an opportunistic infection. The risk of infection increases in more profoundly immunosuppressed persons, as measured by the CD4-T-lymphocyte counts (Houpt et al, 2005;Morpeth & Thielman, 2006). Various presentations of cryptosporidiosis in HIV-positive patients were described (Blanshard et al, 1992;Mc Gowan et al, 1993;Manabe et al, 1998).…”

“…It is characterised by self-limiting gastroenteritis in otherwise healthy people, while it is more severe in immunocompromised subjects in HIV-infected patients and constitutes a serious threat leading to chronic or fulminant disease, wasting and death (Hunter & Nichols, 2002;Chen et al, 2002). While improved antiretroviral regimens have significantly reduced the prevalence of AIDS and AIDS-related opportunistic infections, cryptosporidiosis remains among the most common causes of diarrhoea in patients with AIDS (Hunter & Nichols, 2002;Morpeth & Thielman, 2006).…”

“…One therapeutic intervention that has a dramatic effect on cryptosporidiosis in AIDS patients is antiretroviral therapy leading to recovery of the CD4 count. (Foudraine, 1998;Maggi et al, 2000;Miao et al, 2000;Morpeth & Thielman, 2006). The authors noted that resolution of the diarrhea seemed to be related to an increased CD4 -cell count rather than www.intechopen.com…”

Nitazoxanide in the treatment of acquired immune deficiency syndrome‐related cryptosporidiosis: results of the United States compassionate use program in 365 patients

“…AIDS or common variable immunodeficiency), cryptosporidiosis constitutes a serious threat leading to chronic or fulminant disease, wasting and death 1, 2 . While improved antiretroviral regimens have significantly reduced the prevalence of AIDS and AIDS‐related opportunistic infections, cryptosporidiosis remains among the most common causes of diarrhoea in patients with AIDS 1, 4 …”