INTESTINAL FUNCTION AND INJURY IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME - RELATED CRYPTOSPORIDIOSIS

Background/Aims: The pathogenesis of the diarrhea in acquired immunode ficiency syndrome (AIDS)-retated cryptosporidiosis is not known. The h ypothesis of this study was that the intestinal dysfunction and injury are related to the number of organisms infecting the intestinal mucos a, The aim of this study was to study the influence of intensity of in fection on intestinal function and injury in AIDS-related cryptosporid iosis. Methods: In 16 patients with AIDS with intestinal Cryptosporidi um infection, the intensity of infection was quantified by counting th e total number of fecal oocysts excreted in 24 hours and by determinin g the percent of duodenal epithelium covered by organisms. Intestinal function was assessed by vitamin B-12 absorption and serum D-xylose te st, Intestinal injury was assessed by morphology of duodenal mucosa, d ifferential urinary excretion of lactulose and mannitol, and fecal alp ha(1)-antitrypsin sin clearance, Measurements were repeated after trea tment with paromomycin. Results: Vitamin B-12 and D-xylose absorption negatively correlated with intensity of infection, Villus atrophy occu rred only in patients with oocyst excretion of >10(8) oocyst/24 hours. Lactulose/mannitol urinary excretion ratio showed a positive correlat ion with intensity of infection, Intestinal function and injury improv ed in patients whose oocyst counts were reduced by treatment with paro momycin, Conclusions: Cryptosporidium infection in patients with AIDS causes malabsorption and intestinal injury in proportion to the number of organisms infecting the intestine.