Clostridium difficile-associated diarrhea (CDAD) in HIV positive (HIV+) patients.

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

Clostridium difficile-associated diarrhea (CDAD) in HIV positive (HIV+) patients.

Abstr Gen Meet Am Soc Microbiol. 1994;94:491 (abstract no. C-3). Unique Identifier : AIDSLINE ASM94/94313099
Fischer S; Pulvirenti J; Lisowski J; Citronberg R; Lollar R; Rice T; Goodman L; Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL.

Abstract: Because the clinical course of CDAD in HIV+ pts. is not well characterized, we conducted a retrospective study of pts. with this co-infection occurring between 1/92 and 8/93 at two urban medical centers. Case definition included diarrhea (loose or watery stools), a positive HIV test, and evidence of C. difficile toxin A by EIA. A total of 71 cases in 60 HIV+ pts. (57 men, 3 women) were identified. HIV risk factors included 29 homo/bisexual males and 16 IVDU. All but one pt. had AIDS (mean CD4 count = 14.5/cc3). All but one pt. had received recent antimicrobial therapy including TMP-SMX in 35 episodes and a third generation cephalosporin in 23. Forty-one of the episodes were nosocomial. Stool WBC's were detected in 26/56 specimens tested. Because of the retrospective nature of this review, accurate severity of illness assessment was not possible. Initial response to therapy with metronidazole or vancomycin could be assessed in 34 patients. The median time to a 50% or better decrease in stool frequency was 6 days (range 1-21 days). Concurrent bowel pathogens were found in 18 episodes and included: CMV (8), Cryptosporidium (3), Campylobacter (3), Shigella (1), MAC (1), Microsporidium (1), Giardia (1), Blastocystis hominis (1), and adenovirus (1). Relapse or reinfection could be assessed in 19 episodes; of these, reinfection occurred in 5 and relapse in 3. Our results do not indicate that HIV+ pts. have a course of CDAD distinct from other pts. Although half of the episodes persisted beyond 6 days of therapy, concurrent antibacterial therapy for other causes, co-infection with other pathogens, and difficulty in accurately assessing the patient's return to baseline bowel habits are important confounding factors which should be addressed in a prospective study.

Keywords: Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY AIDS-Related Opportunistic Infections/EPIDEMIOLOGY/ *PHYSIOPATHOLOGY Bisexuality *Clostridium difficile Cross Infection/EPIDEMIOLOGY Diarrhea/*EPIDEMIOLOGY/ETIOLOGY Enterocolitis, Pseudomembranous/COMPLICATIONS/EPIDEMIOLOGY/ *PHYSIOPATHOLOGY Female Homosexuality Human HIV Seropositivity/*COMPLICATIONS Male Recurrence Retrospective Studies Risk Factors Substance Abuse, Intravenous ABSTRACT
941030
M94A0855

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