CAMPYLOBACTER INFECTIONS IN HIV-INFECTED PATIENTS - CLINICAL AND BACTERIOLOGICAL FEATURES

Objective: To study the clinical and bacteriological features of Campy lobacter infections in HIV-infected patients. Design: A retrospective analysis (1989-1992), followed by a prospective analysis (1992-1994). Setting: Hospital HIV inpatient unit. Patients and methods: All patien ts with Campylobacter spp. identified by the laboratory of microbiolog y at Saint-Louis Hospital, Paris were studied, and their clinical feat ures as well as their response to therapy recorded. Results: During th e study period, Campylobacter infection was documented in 38 HIV-infec ted patients, 76% of whom had AIDS. Campylobacter spp. was isolated fr om stools in 36 cases and from blood cultures in four cases. Species i dentification yielded C. jejuni (84%) and C. coli (16%). High-level re sistance to quinolones was frequently observed (21%), but resistance t o erythromycin (3%) and tetracycline (5%) was rare. Diarrhoea, fever a nd abdominal pain were the main clinical features of infection. Other intestinal pathogens were found in 42% of patients. Most patients had an acute illness with rapid resolution under appropriate antimicrobial therapy. However, eight patients (21%), experienced chronic diarrhoea with persistent isolation of Campylobacter and in vivo selection of r esistant strains, requiring multiple courses of antibiotics. Conclusio ns: Campylobacter usually cause acute diarrhoea in patients with HIV i nfection. Antimicrobial therapy should be guided on in vitro susceptib ility testing because of the prevalence of antibiotic resistance. Desp ite appropriate therapy, some patients will present with prolonged dia rrhoea and in vivo selection of multiresistant isolates.