Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus

A study of the etiologies of diarrhea in adults in relation to their human immunodeficiency virus (HIV) serostatus and number of CD4+ cells was carrie d out in the Central African Republic. In cases and controls, multi-parasit ism was observed. Salmonella spp. were identified mainly during acute diarr hea, with 50% of the S. enteritidis isolated during the study being respons ible for septicemia and/or urinary tract infection in immunodeficient patie nts. Enteroaggregative Escherichia coli (EAggEC) were the most frequently i dentified agent in HIV+ patients with persistent diarrhea; 42.8% of the pat ients with EAggEC as sole pathogens had bloody diarrhea, and these strains were negative for the presence of a virulence plasmid. Coccidia were found in those with acute and persistent diarrhea. Blood was observed in 53.3% of infections involving coccidia as the sole pathogen. Microsporidium spp. an d Blastocystis hominis were found only in HIV+ patients with persistent dia rrhea. Shigella spp., Campylobacter spp., and Entamoeba histolytica were fo und in HIV+ and HIV- dysenteric patients; bacteria resembling spirochetes t hat could not be cultivated were identified only in HIV+ cases with dysente ry. Shiga-like toxin-producing E. coli O157:N was isolated from two cases w ith hemolytic-uremic syndrome. Fungi were identified as the sole pathogen i n 6.4% of the HIV+ patients with persistent diarrhea. Most of enteropathoge nic bacteria identified were resistant to ampicillin and trimethoprim-sulfa methoxazole, remained susceptible to ampicillin plus clavulanic acid, and w ere susceptible to amikacin, gentamicin, and ciprofloxacin.