Document 0846
 DOCN  M9480846
 TI    Clostridium difficile-associated diarrhea (CDAD) in HIV positive (HIV+)
       patients.
 DT    9410
 AU    Fischer S; Pulvirenti J; Lisowski J; Citronberg R; Lollar R; Rice T;
       Goodman L; Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL.
 SO    Abstr Gen Meet Am Soc Microbiol. 1994;94:491 (abstract no. C-3). Unique
       Identifier : AIDSLINE ASM94/94313099
 AB    Because the clinical course of CDAD in HIV+ pts. is not well
       characterized, we conducted a retrospective study of pts. with this
       co-infection occurring between 1/92 and 8/93 at two urban medical
       centers. Case definition included diarrhea (loose or watery stools), a
       positive HIV test, and evidence of C. difficile toxin A by EIA. A total
       of 71 cases in 60 HIV+ pts. (57 men, 3 women) were identified. HIV risk
       factors included 29 homo/bisexual males and 16 IVDU. All but one pt. had
       AIDS (mean CD4 count = 14.5/cc3). All but one pt. had received recent
       antimicrobial therapy including TMP-SMX in 35 episodes and a third
       generation cephalosporin in 23. Forty-one of the episodes were
       nosocomial. Stool WBC's were detected in 26/56 specimens tested. Because
       of the retrospective nature of this review, accurate severity of illness
       assessment was not possible. Initial response to therapy with
       metronidazole or vancomycin could be assessed in 34 patients. The median
       time to a 50% or better decrease in stool frequency was 6 days (range
       1-21 days). Concurrent bowel pathogens were found in 18 episodes and
       included: CMV (8), Cryptosporidium (3), Campylobacter (3), Shigella (1),
       MAC (1), Microsporidium (1), Giardia (1), Blastocystis hominis (1), and
       adenovirus (1). Relapse or reinfection could be assessed in 19 episodes;
       of these, reinfection occurred in 5 and relapse in 3. Our results do not
       indicate that HIV+ pts. have a course of CDAD distinct from other pts.
       Although half of the episodes persisted beyond 6 days of therapy,
       concurrent antibacterial therapy for other causes, co-infection with
       other pathogens, and difficulty in accurately assessing the patient's
       return to baseline bowel habits are important confounding factors which
       should be addressed in a prospective study.
 DE    Acquired Immunodeficiency Syndrome/EPIDEMIOLOGY  AIDS-Related
       Opportunistic Infections/EPIDEMIOLOGY/  *PHYSIOPATHOLOGY  Bisexuality
       *Clostridium difficile  Cross Infection/EPIDEMIOLOGY
       Diarrhea/*EPIDEMIOLOGY/ETIOLOGY  Enterocolitis,
       Pseudomembranous/COMPLICATIONS/EPIDEMIOLOGY/  *PHYSIOPATHOLOGY  Female
       Homosexuality  Human  HIV Seropositivity/*COMPLICATIONS  Male
       Recurrence  Retrospective Studies  Risk Factors  Substance Abuse,
       Intravenous  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).