CHRONIC DIARRHEA AMONG ADULTS IN KIGALI, RWANDA - ASSOCIATION WITH BACTERIAL ENTEROPATHOGENS, RECTOCOLONIC INFLAMMATION, AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

One hundred patients with chronic diarrhea were seen in the Department of Internal Medicine at the Centre Hospitalier de Kigali, Rwanda; sto ol and/or rectal swab culture was performed for these patients, and th ey underwent rectoscopy and serological testing for human immunodefici ency virus type 1 (HIV-1). Enteropathogenic bacteria were isolated fro m 39 (39%) of the patients: Shigella species (22 of 100 patients teste d), non-typhi Salmonella (11/100), Aeromonas species (5/60), and Campy lobocter species (4/60). Rectocolitis was seen in 70 (70%) of the pati ents. HIV-1 antibodies were detected in 82 (94%) of 87 patients tested . Cytomegalovirus was not found in rectal biopsy specimens from 29 pat ients. Entamoeba histolytica was detected in two of 31 rectal smears. Idiopathic ulcerative colitis was diagnosed for two HIV-l-seropositive patients. One or more AIDS-defining diseases were found in 32 (32%) o f the patients, and 72 (72%) fulfilled the World Health Organization's clinical case definition criteria for AIDS. Chronic diarrhea, as seen in a hospital setting in a region highly endemic for HIV-1 infection, is strongly associated with HIV-1 infection, with rectocolonic inflam mation, and with infection due to enteropathogenic bacteria.