Unexplained diarrhoea in HIV-1 infected individuals

Oude Munnink, Bas B; Canuti, Marta; Deijs, Martin; de Vries, Michel; Jebbink, Maarten F; Rebers, Sjoerd; Molenkamp, Richard; van Hemert, Formijn J; Chung, Kevin; Cotten, Matthew; Snijders, Fransje; Sol, Cees JA; van der Hoek, Lia

To investigate how many diarrhoea cases of HIV-1 infected individuals could be explained by infections with known pathogens, real time PCR, bacteria culture and microscopy was performed on stool samples of 196 HIV-1 infected patients of whom 29 had severe diarrhoea. The known diarrhoea agents parechovirus, astrovirus, rotavirus or adenovirus 40, 41 or 52 were not found in any of the 196 HIV-infected patients (see Table 2 ). Sapovirus was found in 3 patients with diarrhoea (10%) and once in the control group (patients without diarrhoea), whereas norovirus was present in 10 patients with diarrhoea (34%) compared to 13 controls (7.8%). Statistical analysis showed that norovirus as well as sapovirus are associated with diarrhoea (p value: 0.0006 and 0.02 respectively). Enterovirus was present in 3 patients with diarrhoea (10%) and in 5 patients in the control group (3.0%), which is statistically not significantly different. Five patients with diarrhoea (16.8%) were infected with bacteria: Salmonella n = 1, Mycobacterium n = 1 and Campylobacter n = 3. On the other hand, bacteria were also observed in 6 patients (3.6%) without diarrhoea (Clostridium difficile n = 1 and Campylobacter n = 5). Shigella and Yersinia were not detected in patients with or without diarrhoea. None of the bacterial infections were significantly associated with diarrhoea. Parasites were found in 6 patients (21%) with diarrhoea (Cryptosporidia n = 3, Giardia lamblia n = 1 and Microsporidia n = 2), and in 9 patients (5.4%) of the control group without diarrhoea (Cryptosporidia n = 1, Giardia lamblia n = 1 and Microsporidia n = 7). Of all parasitic infections, only Cryptosporidia was significantly associated with diarrhoea (p = 0.02). We also screened for Cyclospora, Isospora, worm eggs and cysts but these pathogens were not significantly associated with diarrhoea in our study population (data not shown).