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Chronic bacterial enteropathy in patients with AIDS
D P Kotler1, T T Giang, M Thiim
1Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York 10025.
Abstract:
Enteric infection with adherent bacteria has been seen in a person with chronic diarrhea who was infected with the human immunodeficiency virus. In this study, adherent bacteria were seen in 17% of all patients with AIDS evaluated during a 1-year period. The infection was centered in the cecum and right colon. Three distinct histopathologic patterns of adherence were observed: attaching and effacing lesions, bacteria intercalated between microvilli, and aggregates of bacteria more loosely attached to the damaged epithelium. The infections were associated with weight loss (P < .005) and peripheral blood CD4+ cell of counts < 100/mm3 (P < .05). Eight of 9 patients treated with antibiotics had symptomatic improvement. Bacterial cultures of rectal biopsies frozen at endoscopy yielded Escherichia coli in 12 of 18 cases; aggregative adherence was seen in 6. Isolates from 2 cases hybridized with a DNA probe encoding aggregative properties. These results suggest that chronic infection with adherent bacteria may produce a syndrome of AIDS-associated diarrhea and wasting.
Insights
Adherent bacterial infections cause chronic diarrhea and wasting in people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Antibiotic treatment improved symptoms in most patients, suggesting a treatable cause of AIDS-related gastrointestinal issues.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Chronic diarrhea and wasting are common in individuals with human immunodeficiency virus (HIV).
- Enteric infections with adherent bacteria are implicated in gastrointestinal pathology.
Purpose of the Study:
- To investigate the prevalence and characteristics of adherent bacterial infections in patients with acquired immunodeficiency syndrome (AIDS).
- To determine the association between these infections and clinical outcomes.
- To identify potential causative agents and evaluate treatment efficacy.
Main Methods:
- Evaluated 17% of AIDS patients over one year for enteric adherent bacteria.
- Examined histopathologic patterns of bacterial adherence in the colon.
- Assessed associations with weight loss and CD4+ T-cell counts.
- Conducted bacterial cultures and DNA probe hybridization on rectal biopsies.
- Monitored symptomatic response to antibiotic treatment.
Main Results:
- Adherent bacteria were found in 17% of evaluated AIDS patients, primarily in the cecum and right colon.
- Three histopathologic patterns of adherence were identified.
- Infections correlated with weight loss and low CD4+ counts (<100/mm³).
- Escherichia coli was identified in 12 of 18 cases, with aggregative adherence noted in some.
- Eight of nine patients showed symptomatic improvement with antibiotics.
Conclusions:
- Chronic infection with adherent bacteria may manifest as a distinct syndrome of AIDS-associated diarrhea and wasting.
- This condition appears to be treatable with antibiotics.
- Identifying and targeting these bacterial infections could improve management of gastrointestinal complications in AIDS patients.