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Small Intestinal Injury and Parasitic Diseases in AIDS

Donald P. Kotier, MD; Armel Francisco, BS; Frederic Clayton, MD; John V. Scholes, MD; and Jan M. Orenstein, MD, PhD
[+] Article, Author, and Disclosure Information

Some of the cases described in our study have been presented in another paper: Orenstein JM, Chiang J, Steinberg W, Smith P, Rotterdam H, Kotier DP. Intestinal microsporidiosis as a cause of diarrhea in HIV-infected patients: a report of 20 cases. Hum Pathol. 1990;21:475-81.

Grant Support: By grant AI21414 from the National Institutes of Health.

Requests for Reprints: Donald P. Kotier, MD, GI Division/S&R 12, St. Luke's-Roosevelt Hospital Center, 114th Street and Amsterdam Avenue, New York, NY 10025.

Current Author Addresses: Dr. Kotier: GI Division/S&R 12, St. Luke's-Roosevelt Hospital Center, 421 W. 113th Street, New York, NY 10025.

Drs. Clayton and Scholes: Department of Pathology, St. Luke's-Roosevelt Hospital Center, 421 W. 113th Street, New York, NY 10025. Dr.

Orenstein: Department of Pathology, Ross 502, George Washington University Medical Center, 901 23rd Street N.VV., Washington, DC 20037.

Mr. Francisco: 529 Teaneck Rd. Ridgefield Park, NJ 07660.

© 1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;113(6):444-449. doi:10.7326/0003-4819-113-6-444
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Objectives: To examine jejunal biopsies from patients with the acquired immunodeficiency syndrome (AIDS), chronic diarrhea, and weight loss, and to correlate the presence of small intestinal injury with pathogens, histopathologic changes, and absorption.

Design: Prospective analysis of jejunal biopsies from 43 patients with AIDS, 10 patients with AIDS-related complex, and 6 heterosexual control volunteers. The biopsies were examined for pathogens; electron microscopy was used in 22 patients. The results of quantitative histologic measurements were correlated with histopathologic features and D-xylose absorption.

Setting: A university-affiliated teaching hospital with many AIDS patients of varying demographic characteristics.

Measurements and Main Results: Jejunal biopsies in 62% of the patients with AIDS had partial villus atrophy with or without crypt hyperplasia unlike those of controls, a result implying small intestinal injury. Small intestinal injury was associated with lymphoplasmacytic infiltration and cytopathic change of the villus epithelium. Light and electron microscopic examination detected cryptosporidia or microsporidia in 19 of 27 patients with small intestinal injury. The presence of these parasites was associated with significantly diminished D-xylose absorption when compared with absorption in controls or in patients with AIDS, diarrhea, weight loss, and no parasites.

Conclusion: A significant proportion of patients with AIDS with severe small intestinal injury have enterocyte infections. Like cryptosporidiosis, intestinal microsporidiosis may be an important cause of enteropathy in patients with AIDS.





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