PROCAARE: CLINICAL SCIENCE--GI MANIFESTATIONS--INDIA

[Albert Shaw <ashaw@usa.healthnet.org>]

KEYWORDS: GASTROINTESTINAL INFECTION/ CYTOMEGALOVIRUS/ CRYPTOSPORIDIUM/ 
STRONGYLOIDES/ CRYPTOCOCCUS/ M. TUBERCULOSIS/ INDIA
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Reference: Lanjewar, D.N., Anand, B.S., Genta, R., Maheshwari, M.B., 
Ansari, M.A., Hira, S.K., DuPont, H.L. (1996).  Major differences in the 
spectrum of gastrointestinal infections associated with AIDS in India 
versus the West: an autopsy study.  Clin. Infect. Dis. 23: 482-5.

This report describes an autopsy study of 49 patients (37 male and 12 
female) dying of AIDS at two hospitals in Bombay, India  between 1988 and 
1993.  35 of 49 had a clinical history of chronic diarrhea; the diarrhea 
in each case consisted of watery stools, with no histories of bloody 
stools.  A pathogen was detected by histologic examination in 29 of the 49.

Cytomegalovirus (CMV) was the most frequently detected pathogen, and was 
found in 13 patients; the esophagus was involved in 4 patients, the 
stomach in 7, the small intestine in 8, and the colon in 6.  All of these 
subjects had intranuclear inclusions, with less frequent intracytoplasmic 
inclusions; mucosal disease, however, in the form of ulceration or 
hemorrhage, was not found.  Nine individuals had parasitic infection, 
with Cryptosporidium species found in five patients (4 with diarrhea),  
Strongyloides stercolis in 3, and hookworm in 1.  Candida albicans was 
noted in 5 patients, mainly in the esophagus, and disseminated 
Cryptococcal infection was detected in 3 subjects.  31 of 49 had 
extensive M. tuberculosis infection, and seven had gastrointestinal tract 
involvement  Only one patient was found to have Kaposi's sarcoma of the 
GI tract, and no cases of GI lymphoma were reported.

Interestingly, organisms such as microsporidia (though electron 
microscopy was not performed), Isospora, and Mycobacterium avium complex 
were not reported in this study, and may reflect differences in the range 
of organisms present in India in contrast to those reported in the west.