Smith P D, Lane H C, Gill V J, Manischewitz J F, Quinnan G V, Fauci A S, Masur H
Laboratory of Microbiology and Immunology, National Institute of Dental Research, Bethesda, Maryland.
Ann Intern Med. 1988 Mar;108(3):328-33. doi: 10.7326/0003-4819-108-3-328.
To determine the frequency of pathogenic gastrointestinal microorganisms in patients with the acquired immunodeficiency syndrome (AIDS) and diarrhea, and to determine if treatment for identifiable microorganisms improves symptoms.
Prospective, consecutive sample study.
Referral-based clinic and wards, National Institutes of Health.
Twenty of twenty-two consecutive homosexual males with AIDS and diarrhea, and 10 homosexual males with AIDS without diarrhea.
All patients had a complete physical examination; serial stool examinations for viral, bacterial, fungal, and protozoan pathogens; and esophagogastroduodenoscopy and colonoscopy to obtain duodenal fluid and mucosal tissue to analyze for enteric pathogens or histopathology. Patients with diarrhea had a malabsorption evaluation. Patients with treatable pathogenic microorganisms received standard antimicrobial therapy.
The 20 patients with AIDS and diarrhea had greater weight loss, lower mean numbers of helper-inducer (OKT4) lymphocytes, and a higher incidence of extraintestinal opportunistic infections than the 10 patients without diarrhea. One or more enteric pathogen was identified in 17 of 20 patients (85%; 95% confidence interval [CI], 65% to 96%) with diarrhea. Only 1 patient without diarrhea was infected with an enteric pathogen. Nineteen of twenty patients with diarrhea and all 10 patients without diarrhea had chronic inflammatory changes in their intestinal biopsy specimens. Sixteen patients with identifiable enteric pathogens and diarrhea were treated; 11 (69%; 95% CI, 43% to 87%) showed microbiologic, histologic, or clinical improvement.
Thorough diagnostic evaluation can lead to the identification of enteric pathogens in a high percentage of patients with AIDS and diarrhea. Specific therapy can lead to symptomatic improvement.
确定获得性免疫缺陷综合征（AIDS）合并腹泻患者中致病性胃肠道微生物的频率，并确定针对可识别微生物的治疗是否能改善症状。
前瞻性连续样本研究。
国立卫生研究院基于转诊的门诊和病房。
22例连续的患有AIDS和腹泻的同性恋男性中的20例，以及10例患有AIDS但无腹泻的同性恋男性。
所有患者均进行了全面的体格检查；对病毒、细菌、真菌和原生动物病原体进行系列粪便检查；以及食管胃十二指肠镜检查和结肠镜检查，以获取十二指肠液和黏膜组织，分析肠道病原体或进行组织病理学检查。腹泻患者进行了吸收不良评估。患有可治疗致病性微生物的患者接受了标准抗菌治疗。
20例患有AIDS和腹泻的患者比10例无腹泻的患者体重减轻更明显，辅助诱导（OKT4）淋巴细胞的平均数量更低，肠道外机会性感染的发生率更高。20例腹泻患者中有17例（85%；95%置信区间[CI]，65%至96%）鉴定出一种或多种肠道病原体。只有1例无腹泻的患者感染了肠道病原体。20例腹泻患者中有19例以及所有10例无腹泻的患者在肠道活检标本中出现慢性炎症改变。16例鉴定出肠道病原体并伴有腹泻的患者接受了治疗；11例（69%；95%CI，43%至87%）显示出微生物学、组织学或临床改善。
全面的诊断评估可在高比例的AIDS合并腹泻患者中鉴定出肠道病原体。特异性治疗可导致症状改善。
