THE INCIDENCE OF ENTEROPATHOGENS IN PATIE NTS INFECTED BY THE HUMAN-IMMUNODEFICIENCY-VIRUS

BACKGROUND: To establish the prevalence of diarrhea and its evolution over time, the causal microorganisms, recurrence and associated mortal ity in patients with AIDS or severe immunologic alterations (CD4 lymph ocytes lower than 0.5 x 10(9)/l). METHODS: A prospective longitudinal study was carried out from 1984 to 1992 The following patients were in cluded in the study: 1) all those patients with diarrhea in whom a pat hogenic microorganism was identified in the stools, and 2) patients wi th fever and positive blood cultures for enteropathogenic bacterias. T he patients belonged to a series of 1,456 patients with infection by H IV. RESULTS: Of the 1,456 controlled patients, 253 (17 %) had infectio n by enteropathogenic microorganisms. The prevalence was greater in ho mosexual patients (26 %) than in drug addicts (12 %). The most frequen t germs were Cryptosporidium, in 104 episodes and Salmonella sp. in 78 episodes (31 as isolated bacteria). The mortality in the 15 days foll owing isolation was 2 %, the refered microorganisms being the most fre quent responsibles for the deaths. The mean of CD4 lymphocytes in the patients with enteropathogens was 0.17 x 10(9)/l), SD 0.14 x 10(9)/l). In patients with infection by Cryptosporidium the CD4 lymphocyte coun t was lower than that observed in the cases of infection by Isospora b elli. Prior to 1988, 21 % of the patients had infection by enteropatho genic bacteria and 23 % by parasites, those percentages being 3 % and 6 %, respectively in 1991. CONCLUSIONS: Infections by enteropathogenic microorganisms in patients with infection by the human immunodeficien cy virus in an advanced stage are frequent, particularly, in homosexua ls. The patients with enteritis by Cryptosporidium have a greater grad e of immunosuppression (CD4 lymphocytes lower than 0.1 x 10(9)/l) than patients with infection by other enteropathogenic microorganisms. In the last few years, the prevalence of enteropathogenic bacterias, espe cially Salmonella sp. and protozoa has decreased.