Gastric involvement in AIDS associated cryptosporidiosis

Abstract

Background-Cryptosporidiosis has been shown to be a common cause of diarrhoea in both immunocompetent and immunosuppressed individuals. There are very few data on the distribution of Cryptosporidium parvum along the gastrointestinal tract. Aims-To evaluate the location of Cryptosporidium parasites in the digestive tract of patients with AIDS. Methods-Gastrointestinal localisation of C parvum was studied in 71 patients with AIDS who underwent upper and/or lower endoscopy with biopsy for chronic diarrhoeal illness and/or other gastrointestinal disorders of unexplained origin. Results-Twenty four individuals (33.8%) were positive for C parvum, of which 16 (88.9%) had parasites in the gastric epithelium. Most patients with gastric localisation of C parvum did not show specific symptoms indicating the presence of this parasite in the stomach. Conclusions-Gastric involvement in AIDS related cryptosporidiosis is more frequent than expected, but no clear correlation between gastric location and related clinical and pathological features was observed. (Gut 1998;43:476-477) Keywords: Cryptosporidium parvum; AIDS; gastric location Cryptosporidium parvum is a coccidian protozoon with a worldwide distribution. It causes watery diarrhoea, which is self limiting in immunocompetent people but which can be prolonged and life threatening in severely immunocompromised individuals.1 The parasite mainly develops in the enterocytes of the small intestine, causing villus atrophy and crypt hyperplasia in patients with high intensity infections.2 To date, the extent of gastric involvement has not been studied; in fact, only a few cases have been described. 3 Our recent experience suggests that gastric location may be more frequent than previously reported. MethodsWe enrolled in this study all patients with AIDS (as defined by the criteria of the US Centers for Disease Control and Prevention) who underwent gastrointestinal endoscopy with biopsy at the Infectious Disease Clinic of the University of Modena, in the period 1986-1996. The cause for referral was chronic diarrhoeal illness and/or other gastrointestinal disorders of unexplained origin (epigastric pain, abdominal pain, vomiting, etc.), or the follow up of other pathologies. Endoscopic procedures were performed either by a gastroscope for upper endoscopy or by a colonoscope for lower endoscopy. Multiple biopsy specimens were taken from the oesophagus, stomach, duodenum, jejunum-ileum, colon, and rectum. Formalin fixed biopsy specimens were routinely processed for histological examination. Faecal samples were examined by modified acid fast staining and by immunofluorescence for C parvum, after formalin-ether concentration. Results and discussionSeventy one patients with AIDS underwent gastrointestinal endoscopy with biopsy during the study period. Most individuals (n=63, 88.7%) were young men (mean age 37 years, range 27-69), with an average of 62 CD4+/ mm 3 (range 0-499). A total of 215 biopsy specimens were examined. Some individuals underwent complete oesophagogastrod...

Epidemiology and Clinical Features ofCryptosporidiumInfection in Immunocompromised Patients

“…In an endoscopic study of 71 patients with AIDS and chronic diarrheal illness or other gastrointestinal disorders of unexplained origin, 24 individuals were positive for cryptosporidiosis. Of these 24 patients, 16 (67%) had parasites in the gastric epithelium (104). Few of the patients reported any symptoms that could be correlated with this gastritis, and the authors concluded that there was no clear correlation between gastric colonization and related clinical and pathological features.…”

A low prevalence ofH pyloriand endoscopic findings in HIV-positive Chinese patients with gastrointestinal symptoms

“…Our result showed a high infection rate of Candida esophagitis in HIV-positive patients (19/122; 15.6%), which may be a possible explanation. Studies showed that the incidence of Cryptosporidium infection has been estimated to be 16%-33% in the AIDS patients in north America with chronic diarrhea [20,21] . In developing countries, the infection of Cryptosporidium was 55% among AIDS patients [22] .…”

Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients

“…There is no specific pathognomonic endoscopic appearance. Gastric hyperemia, edema and erosions, especially in the antrum, have all been reported [24,27] . Gastric cryptosporidiosis may also occur in normalappearing mucosa [24] .…”

“…Although not frequent, gastritis and/or gastric ulcers have been reported to be associated with some viral, helminthic, protozoan, and fungal pathogens [25][26][27][28] .…”