Laughon B E, Druckman D A, Vernon A, Quinn T C, Polk B F, Modlin J F, Yolken R H, Bartlett J G
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore.
Gastroenterology. 1988 Apr;94(4):984-93. doi: 10.1016/0016-5085(88)90557-4.
We studied 388 homosexual or bisexual men from the Baltimore-Washington area to define the spectrum of enteric pathogen carriage in a population at high risk for "gay bowel syndrome" in association with human immunodeficiency virus infection. Seventy-seven patients with acquired immunodeficiency syndrome, 68 gay men with symptoms of acute diarrhea or proctitis, and 243 gay men without gastrointestinal symptoms and participating in a natural history study of human immunodeficiency virus infection were selected for study. Approximately 12% of the asymptomatic men harbored at least one enteric pathogen; the most frequently recovered were Chlamydia trachomatis, herpes simplex virus, and Giardia lamblia. Men carrying a pathogen were more likely to be human immunodeficiency virus seropositive (48%) than men without a pathogen (25%) (p = 0.018), more likely to have fewer T helper cells (p = 0.015), and more likely to have a mucopurulent exudate (p = 0.014). We recovered an agent of enteric disease from 68% of gay men presenting with diarrhea or proctitis. Campylobacter species, herpes simplex virus, Neisseria gonorrhoeae, C. trachomatis, G. lamblia, and Shigella species were identified most frequently. The most common pathogen associated with diarrhea in acquired immunodeficiency syndrome was Cryptosporidium (16% of 49 cases). Other agents identified were Clostridium difficile, Vibrio parahemolyticus, Campylobacter species, G. lamblia, Isospora, and cytomegalovirus. Approximately half of the identifiable etiologic agents of diarrhea in acquired immunodeficiency syndrome patients were treatable with antibiotics, but these agents required special culture procedures for detection.
我们研究了来自巴尔的摩-华盛顿地区的388名同性恋或双性恋男性，以确定在与人类免疫缺陷病毒感染相关的“同性恋肠道综合征”高危人群中肠道病原体携带情况的范围。我们选择了77名获得性免疫缺陷综合征患者、68名有急性腹泻或直肠炎症状的男同性恋者以及243名无胃肠道症状且参与人类免疫缺陷病毒感染自然史研究的男同性恋者进行研究。约12%的无症状男性携带至少一种肠道病原体；最常检出的是沙眼衣原体、单纯疱疹病毒和蓝氏贾第鞭毛虫。携带病原体的男性比未携带病原体的男性更有可能为人类免疫缺陷病毒血清阳性（48% 对25%）（p = 0.018），更有可能T辅助细胞数量较少（p = 0.015），也更有可能有黏液脓性渗出物（p = 0.014）。我们从68%有腹泻或直肠炎症状的男同性恋者中分离出一种肠道疾病病原体。弯曲杆菌属、单纯疱疹病毒、淋病奈瑟菌、沙眼衣原体、蓝氏贾第鞭毛虫和志贺菌属是最常被鉴定出的病原体。获得性免疫缺陷综合征中与腹泻相关的最常见病原体是隐孢子虫（49例中的16%）。其他鉴定出的病原体有艰难梭菌、副溶血性弧菌、弯曲杆菌属、蓝氏贾第鞭毛虫、等孢球虫和巨细胞病毒。获得性免疫缺陷综合征患者中约一半可鉴定的腹泻病原体可用抗生素治疗，但这些病原体需要特殊培养程序来检测。
