diarrhea in patients with AIDS
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Introduction
The majority of AIDS patients with diarrhea have one or more identifiable pathogens.
Etiology
- viral
- bacteria
- fungi
- protozoa
- human immunodeficiency virus (HIV-1) itself can cause diarrhea
Laboratory
initial studies
- examination of stool for leukocytes
- stool cultures (at least 3 specimens)
- stool examination for ova & parasites
- stool assay for Clostridium difficile
additional testing as indicated Special labooratory:
as needed
- uppper GI endoscopy
- gastric aspirate & biopsy
- duodenal aspirate for parasites & culture
- duodenal biopsy with culture for Mycobacterium & cytomegalovirus
- colonoscopy
- visualization
- biopsy
- culture for cytomegalovirus, adenovirus, mycobacteria, Herpes simplex
- stains
- hematoxylin-eosin for protozoa & viral inclusions
- methenamine silver or Giemsa for fungi
- Fite stain for mycobacterium
- electron microscopy
- duodenal biopsy for Microsporidia
- colon biopsy for adenovirus
Management
- specific treatment for specific etiology
- empiric treatment with loperamide unless contraindicated
- general measures
- elimination of lactose-containing foods
- soluble fiber, i.e. rice or psyllium