Diarrhea In AIDS Patients Research Articles

Diclazuril in the treatment of severe cryptosporidial diarrhoea in AIDS patients

Diclazuril in the treatment of severe cryptosporidial diarrhoea in AIDS patients

Treatment with bovine hyperimmune colostrum of cryptosporidial diarrhea in AIDS patients

Cryptosporidium parvum may cause severe, debilitating diarrhea in patients with AIDS. Recent anecdotal reports have suggested that hyperimmune bovine colostrum may be effective. We conducted a double-blind, controlled pilot study of hyperimmune bovine colostrum for diarrhea due to cryptosporidiosis in five AIDS patients. The patients were randomized to receive either hyperimmune or control colostrum by continuous nasogastric infusion for 10 days. All stools were collected, graded, and weighed, and the concentration of oocysts excreted was determined daily. One of the three patients treated with hyperimmune colostrum had a reduction in diarrhea and in the concentration of oocysts excreted. A second treated patient had a modest decrease in the concentration of oocysts excreted. Two patients who received control colostrum also had decreases in the volume of diarrhea but no change in the concentration of oocysts excreted. We conclude that hyperimmune colostrum with high titers of specific anti-Cryptosporidium antibody could be effective in treating patients with cryptosporidiosis. However, more studies of cow colostral immunoglobulin need to be performed so that the efficacy of this treatment can be assessed more thoroughly.

Radiological features of AIDS related cholangitis

Cryptosporidial infection is one of the recognised causes of diarrhoea in AIDS patients. It may also produce biliary tract disease. Fifteen out of 250 (6%) AIDS patients seen at our hospital had Cryptosporidial enteritis and five of the 15 (2% total) had clinical evidence of biliary tract disease. The radiological findings in these five patients are presented. Ultrasound examination of all five patients showed abnormalities in the biliary tree; five had dilatation and irregularity of the intra- and extrahepatic bile ducts with focal strictures, four had gall-bladder wall thickening, two had thickening of the common bile duct wall, two patients showed areas of increased reflectivity in the periductal regions of the liver and two had pancreatic duct dilatation. ERCP in one patient confirmed the ultrasound findings and Cryptosporidium oocytes were isolated from the collected bile. We conclude that Cryptosporidial infection in the biliary tree can produce distinctive appearances on ultrasound which may well obviate the need for more invasive investigations such as ERCP.

New developments in infectious diarrhea

The past decade has produced exciting advances in our knowledge of infectious diarrhea. The list of potential enteric pathogens continues to grow with both the identification of new organisms, e.g., E. coli serotype O157:H7, and the recognition that previously characterized microorganisms, e.g., M. avium-intracellulare, can also cause gastrointestinal disease in immunosuppressed patients. Multiple investigations have led to a greater understanding of the epidemiology and clinical features of these illnesses. Application of modern biological techniques has yielded a number of diagnostic assays that are just now becoming clinically relevant. New drugs and treatment modalities for enteric infections have been developed and are now being evaluated in clinical trials. Despite these advancements, however, many questions still remain unanswered. For example, the etiology of the debilitating diarrhea in AIDS patients in whom no known intestinal pathogen can be identified remains unknown. The mechanism of diarrhea due to Cryptosporidium, Isospora, and Giardia remains elusive. And last, will new intestinal vaccines be effective in preventing diarrheal disease? Certainly, the next decade of research in enteric diseases should prove to be even more interesting than the last.