COINFECTION WITH GIARDIA-LAMBLIA AND ENTEROCYTOZOON-BIENEUSI IN A PATIENT WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME AND CHRONIC DIARRHEA

Diarrhea is an important clinical problem in immunosuppressed patients with acquired immunodeficiency syndrome (AIDS). There are numerous cl assical as well as emerging enteric pathogens that can produce diarrhe a; however, these agents can be missed when only one method, such as m icrobiological examination of stool, is used for diagnosis. The endosc opic biopsy is a sensitive method for diagnosis of many viral, fungal, and parasitic infections of the gastrointestinal tract. Although only one agent is often identified in mucosal biopsies from these immunosu ppressed patients, coinfection with multiple microbial agents is being increasingly recognized. Giardia infection is not as prevalent as oth er pathogens in patients with AIDS, but it remains an important diarrh eal agent that is potentially curable. However, there have been only r are reports of coinfections with giardiasis and other infectious agent s. This report describes a patient with AIDS and chronic diarrhea who had repeated negative stool examinations for ova and parasites. Light and electron microscopic examination of subsequent endoscopically obta ined small intestinal biopsies revealed coinfection with two parasites , Enterocytozoon bieneusi and Giardia lamblia. Following treatment wit h metronidazole for giardiasis, the diarrhea persisted, but was less s evere. This report also describes the diagnostic features of Giardia a nd Enterocytozoon infections in biopsy tissues and emphasizes the impo rtance of identifying enteric coinfections in patients with AIDS to en sure timely and specific modes of therapy.