Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus.

Abstract

Abstract. A study of the etiologies of diarrhea in adults in relation to their human immunodeficiency virus (HIV) serostatus and number of CD4ϩ cells was carried out in the Central African Republic. In cases and controls, multiparasitism was observed. Salmonella spp. were identified mainly during acute diarrhea, with 50% of the S. enteritidis isolated during the study being responsible for septicemia and/or urinary tract infection in immunodeficient patients. Enteroaggregative Escherichia coli (EAggEC) were the most frequently identified agent in HIVϩ patients with persistent diarrhea; 42.8% of the patients with EAggEC as sole pathogens had bloody diarrhea, and these strains were negative for the presence of a virulence plasmid. Coccidia were found in those with acute and persistent diarrhea. Blood was observed in 53.3% of infections involving coccidia as the sole pathogen. Microsporidium spp. and Blastocystis hominis were found only in HIVϩ patients with persistent diarrhea. Shigella spp., Campylobacter spp., and Entamoeba histolytica were found in HIVϩ and HIVϪ dysenteric patients; bacteria resembling spirochetes that could not be cultivated were identified only in HIVϩ cases with dysentery. Shiga-like toxin-producing E. coli O157:HϪ was isolated from two cases with hemolytic-uremic syndrome. Fungi were identified as the sole pathogen in 6.4% of the HIVϩ patients with persistent diarrhea. Most of enteropathogenic bacteria identified were resistant to ampicillin and trimethoprim-sulfamethoxazole, remained susceptible to ampicillin plus clavulanic acid, and were susceptible to amikacin, gentamicin, and ciprofloxacin.

Intestinal parasitic infections and eosinophilia in an human immunedeficiency virus positive population in Honduras

“…C. parvum was found infecting 12.5% of 80 AIDS patients in Tegucigalpa (Kaminsky 1998) and 25.3% of 79 AIDS patients in San Pedro Sula (personal observations) but not 21 HIV positive nor 100 healthy commercial sex workers (Kaminsky 1999(Kaminsky , 2000. Such observations are consistent with studies of AIDS patients from Central African Republic, Brazil, and Venezuela (Chacin-Bonilla et al 1992, Costa Sauda et al 1993, Germani et al 1998.…”

Diarrheagenic Escherichia coli in sub-Saharan Africa: Status, Uncertainties and Necessities

“…Shigella showed no association with disease or with diarrhea in HIV-1-positive patients [142]. Similar findings were made in Senegal and the Central African Republic [143,144].…”

“…In one Central African Republic study, EAEC was isolated from 12.7% of 110 HIVpositive patients with diarrhea and none of 73 asymptomatic controls. EAEC was also strongly associated with persistent and bloody diarrhea [143]. In Senegal, EAEC were recovered from in 42 (27%) HIV-positive patients with diarrhea and was only rarely recovered in HIV-negative individuals [137].…”

“…Most other recommendations concur [174]. In addition to outbreaks, sporadic EHEC isolates have almost always been found when sought in Africa [14,21,65,89,133,143,172,[175][176][177]. Although the isolation rate was low in all these instances, they further emphasize the importance of considering EHEC in the differential diagnosis of bloody diarrhea.…”

Markers of enteric inflammation in enteroaggregative Escherichia coli diarrhea in travelers.

“…5 Enteroaggregative E. coli has also been reported as a cause of diarrhea in developed nations 6 and in AIDS patients, particularly those with low CD4 counts. 7 The reported clinical symptoms of EAEC infection vary from an acute syndrome of watery diarrhea to a more protracted form causing colicky abdominal cramps or at times dysentery. 5 Gross blood was present in the stool in as many as 33% of cases in one study.…”