Chronic diarrhoea among HIV-infected adult patients in Nairobi, Kenya
Chronic diarrhoea among HIV-infected adult patients in Nairobi, Kenya
复制标题
DOI：
10.1016/s0163-4453(98)90561-8
复制
发表时间：
1998-07-01
影响因子：
28.2
通讯作者：
Gilks, CF
中科院分区：
文献类型：
--
作者：
Mwachari, C;Batchelor, BIF;Gilks, CF
目的：慢性腹泻和消瘦是非洲艾滋病公认的特征，但是，由于资源有限，在撒哈拉以南非洲很少进行全面的病原学研究，其中包括广泛的微生物调查。我们对肯尼亚内罗毕一家政府医院收治的成人患者进行了一项前瞻性横断面研究，以确定腹泻的可能细菌、分枝杆菌、寄生虫和病毒原因;考虑哪些可以治疗;并将微生物学结果与临床结果联系起来。方法：从75个连续的HIV-对内罗毕医院收治的慢性腹泻血清反应阳性患者进行了微生物调查，并将结果与临床发现和结果进行了比较。粪便样本进行细菌和分枝杆菌培养，并进行光学和电子显微镜检查;大肠杆菌菌苔进行病原类型探测，并对等分试样进行艰难梭菌细胞毒素检测。血培养的分枝杆菌和其他细菌病原体进行clinicalindic.Results：三十九（52%）患者产生了假定的病原体，最常见的是隐孢子虫属（17%），鼠伤寒沙门氏菌（13%），结核分枝杆菌（13%）。在41例进行致病性大肠埃希菌检查的患者中，肠聚集性大肠埃希菌。大肠杆菌和弥漫性粘附B。大肠杆菌各4例。31例（41%）患者死亡。隐孢子虫包囊的检出是死亡的唯一最显著的预测因子（X-2 = 5.2，P < 0.05）。许多患者没有改善（21; 28%）或自行出院，而仍然生病（5; 7%），但五个（7%）被诊断为生前结核病和治疗，进一步13（17%）显示出改善出院时。结论：在内罗毕，患有慢性腹泻的艾滋病毒感染者的总体结果很差，即使进行了广泛的调查，也只在一半以上的患者中确定了假定的病原体。最重要的一步是排除结核;最有用的检查似乎是Ziehl-Neelsen染色。其他潜在的可治疗的革兰氏阴性细菌病原体，S。鼠伤寒、志贺氏菌和粘附性大肠杆菌。然而，大肠杆菌是常见的，但需要培养设施，这是不广泛的确定性鉴定。进一步的研究集中在简单的方法来确定可治疗的感染患者的亚组是必要的。
Objectives: Chronic diarrhoea and wasting are well recognized features of AIDS in Africa, However, because of resource constraints few comprehensive aetiological studies have been conducted in sub-Saharan Africa which have included a broad range of microbiological investigations. We undertook a prospective cross-sectional study of adult patients admitted to a government hospital in Nairobi, Kenya, to determine possible bacterial, mycobacterial, parasitic and viral causes of diarrhoea; to consider which may be treatable; and to relate microbiological findings to clinical outcome.Methods: Stool specimens from 75 consecutive HIV-seropositive patients with chronic diarrhoea admitted to a Nairobi hospital were subjected to microbiological investigation and results were compared with clinical findings and outcome. Stool samples were cultured for bacteria and mycobacteria and underwent light and electron microscopy; lawns of Escherichia coli were probed for pathogenic types and aliquots were tested for the presence of Clostridium difficile cytotoxin. Blood cultures for mycobacteria and other bacterial pathogens were performed as clinically indicated.Results: Thirty-nine (52%) patients yielded putative pathogens, the most common being Cryptosporidium sp. (17%), Salmonella typhimurium (13%), and Mycobacterium tuberculosis (13%). Of 41 patients investigated for pathogenic Escherichia coli, enteroaggregative E. coli and diffusely adherent B. coli were each found in four patients. Thirty-one (41%) patients died. Detection of cryptosporidium cysts was the single most significant predictor of death (X-2 = 5.2, P < 0.05). Many patients did not improve (21; 28%) or self-discharged whilst still sick (5; 7%) but five (7%) were diagnosed ante mortem with tuberculosis and treated and a further 13 (17%) showed improvement by time of discharge.Conclusions: HIV-infected patients with chronic diarrhoea in Nairobi have a poor outcome overall, and even with extensive investigation a putative pathogen was identified in only just over half the patients. The most important step is to exclude tuberculosis; and the most useful investigation appears to be Ziehl-Neelsen staining. Other potentially treatable Gram-negative bacterial pathogens, S. typhimurium, Shigella sp. and adherent E. coli were, however, common but require culture facilities which are not widely accessible for definitive identification. Further studies focussing on simple ways to identify sub-groups of patients with treatable infections are warranted.