DIARRHEOGENIC BACTERIAL ENTERITIS IN ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME - A LIGHT AND ELECTRON-MICROSCOPY STUDY OF 52 CASES

被引：22

作者：

ORENSTEIN, JM ^{[1
]}

KOTLER, DP ^{[1
]}

机构：

[1] COLUMBIA UNIV, ST LUKES ROOSEVELT HOSP CTR, COLL PHYS & SURG, DIV GASTROENTEROL, NEW YORK, NY USA

来源：

HUMAN PATHOLOGY | 1995年 / 26卷 / 05期

关键词：

ESCHERICHIA COLI; DIARRHEA; INTESTINE; COLON; TRANSMISSION ELECTRON MICROSCOPIC; BIOPSY; ACQUIRED IMMUNODEFICIENCY SYNDROME; ENTEROADHERENT BACTERIA; ENTEROPATHOGENIC BACTERIA;

D O I：

10.1016/0046-8177(95)90243-0

中图分类号：

R36 [病理学];

学科分类号：

100104 ;

摘要：

Diarrhea, the etiology of which often is obscure, is a major complication of human immunodeficiency virus (HIV) disease. Diarrheogenic bacterial infections (eg, enteropathogenic: Escherichia coli) are diagnosed traditionally by stool analysis rather than by examination of endoscopic biopsy specimens. Although E coli rarely have been associated with diarrhea in HIV/acquired immunodeficiency syndrome (AIDS) patients, neither have they routinely been sought. Endoscopic deal and colorectal biopsy specimens from AIDS-positive patients with chronic diarrhea were analyzed by light and transmission electron microscopy (TEM). The surface epithelium of many large intestinal biopsy specimens previously diagnosed with, for example, nonspecific colitis, regularly showed disarray, degeneration, and necrosis, often with polymorphonuclear neutrophils (PMNs) and eosinophils, irregular cell aggregates, cell shedding, and defects. The crypts were not involved nor were consistent changes noted in the lamina propria. Closer scrutiny of 52 of these biopsy specimens showed gram-negative coliform bacteria intimately associated with histopathology in four distinct patterns. In 22 biopsy specimens, including two from infants, fear morphological types of bacilli were observed that adhered to and effaced the brush border in the classic manner with cytoskeletal rearrangement and pedestals. Other bacterial morphologies and/or patterns of epithelial interaction also were observed (ie, thin bacilli intercalated between microvilli [n = 7], loosely associated bacilli [n = 21], and enterocyte invasion by long rods [n = 2]). Three patients also had minor ileal involvement. Infection was greatest in the right colon and coinfections (eg, microsporidia, Mycobacterium avium complex, adenovirus, and especially cytomegalovirus) were documented in 37% (19 of 52) of specimens. Diarrheogenic bacterial infections, some of the E coli type, may be an important cause of diarrhea in HIV disease. Their precise characterization is needed so that stool samples, not endoscopic biopsy specimens, can be used for diagnosis. Copyright (C) 1995 by W.B. Saunders Company

引用

页码：481 / 492

页数：12

共 59 条

[1]

Colebunders, Francis, Mann, Persistent diarrhea, strongly associated with HIV infection in Kinshasa, Zaire, Am J Gastroenterol, 82, pp. 859-864, (1987)

[2]

Connolly, Shanson, Hawkins, Non-cryptosporidial diarrhea in human immunodeficiency virus (HIV) infected patients, Gut, 30, pp. 195-200, (1989)

[3]

Rene, Marche, Regnier, Intestinal infections in patients with acquired immunodeficiency syndrome A prospective study in 132 patients, Digestive Diseases and Sciences, 34, pp. 773-780, (1989)

[4]

Keusch, Thea, Kamenga, Persistent diarrhea associated with AIDS, Acta Pediatr, 381, pp. 45-48, (1992)

[5]

Pavia, Long, Ryder, Diarrhea among African children born to human immunodeficiency virus 1-infected mothers: Clinical, microbiologic and epidemiologic features, Pediatr Infect Dis J, 11, pp. 996-1003, (1992)

[6]

Thea, St Louis, Atido, Et al., Prospective study of diarrhea and HIV-1 infection among 429 Zairian infants, N Eng J Med, 329, pp. 1696-1702, (1993)

[7]

Janoff, Orenstein, Manischewitz, Et al., Adenovirus colitis in the acquired immunodeficiency syndrome, Gastroenterology, 100, pp. 976-979, (1991)

[8]

Maddox, Francis, Moss, Adenovirus infection of the large bowel in HIV positive patients, J Clin Pathol, 45, pp. 684-688, (1992)

[9]

Orenstein, Chiang, Steinberg, Et al., Intestinal microsporidiosis as a cause of diarrhea in human immunodeficiency virus-infected patients A report of 20 cases, Human Pathology, 21, pp. 475-481, (1990)

[10]

Orenstein, Tenner, Cali, Et al., A microsporidian previously undescribed in humans, infecting enterocytes and macrophages and associated with diarrhea in an AIDS patient, Hum Pathol, 23, pp. 722-728, (1992)

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