Tacconelli E, Tumbarello M, Ventura G, Leone F, Cauda R, Ortona L
Department of Infectious Diseases, Catholic University, Rome, Italy.
Ital J Gastroenterol Hepatol. 1998 Apr;30(2):167-72.
To define the potential risk factors, prognostic indicators, and quality of life of HIV-infected patients with enteric salmonellosis.
A five-year matched (1:2) case-control study was performed. Thirty cases and 60 matched controls were studied.
Univariate analysis (p < 0.05) identified six risk factors for enteric salmonellosis: 1) increasing value of APACHE II score, 2) altered nutritional status, 3) previous antibiotic therapy, 4) ingestion of "risk" foods, 5) multiple (> or = 2) previous opportunistic infections, 6) stage C of HIV infection. Using the multivariate analysis, the most powerful predictors for developing an enteric salmonellosis were: increasing value of APACHE II score and altered nutritional status. The response to therapy was favourable in all episodes. Five (17%) patients suffered from one or more relapses. Multivariate analysis identified that a low number of circulating CD4+ (< 100/mm3) and a high APACHE II score (> 15) predict an increased risk of relapses.
HIV-associated enteric salmonellosis occurs more frequently in patients with advanced stage of HIV infection and with impaired nutritional status. We stress the need for a prompt and accurate diagnosis and treatment since the possible haematogenous spread and relapses appear reduced under early and prolonged antibiotic therapy.
确定感染人类免疫缺陷病毒（HIV）的肠型沙门氏菌病患者的潜在危险因素、预后指标及生活质量。
开展了一项为期五年的配对（1:2）病例对照研究。研究了30例病例和60例配对对照。
单因素分析（p<0.05）确定了肠型沙门氏菌病的六个危险因素：1）急性生理与慢性健康状况评分系统（APACHE II）评分升高；2）营养状况改变；3）既往抗生素治疗；4）摄入“危险”食物；5）既往有多次（≥2次）机会性感染；6）HIV感染C期。多因素分析显示，发生肠型沙门氏菌病的最有力预测因素为：APACHE II评分升高和营养状况改变。所有发作的治疗反应均良好。5例（17%）患者出现一次或多次复发。多因素分析确定，循环CD4+细胞数量低（<100/mm³）和APACHE II评分高（>15）预示复发风险增加。
HIV相关的肠型沙门氏菌病在HIV感染晚期且营养状况受损的患者中更常见。我们强调需要及时、准确的诊断和治疗，因为在早期和长期抗生素治疗下，可能的血行播散和复发似乎会减少。
