Document 0965
 DOCN  M94A0965
 TI    Impact of a community-wide outbreak of cryptosporidiosis on patients
       with AIDS.
 DT    9412
 AU    Gilson I; Buggy BP; Brummitt CF; Busalacchi M; Ivantic K; Wisconsin
       Community-Based Research Consortium, Milwaukee.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(2):24 (abstract no. 390B). Unique
       Identifier : AIDSLINE ICA10/94371610
 AB    OBJECTIVE: To study the impact of a community-wide outbreak of
       waterborne cryptosporidiosis (CS) on a cohort of AIDS patients,
       including morbidity, mortality, cost of care, and outcome of therapy.
       METHODS: Retrospective cohort study of all HIV-infected patients in two
       practices with CD4 count < 200 at the time of the outbreak (a city-wide
       CS outbreak due to failure of a water filtration plant which resulted in
       approximately 400,000 cases of CS in Milwaukee, WI, in April 1993).
       Comparison of groups with definite (stool +, n = 24) or suspected
       (clinical, n = 9) CS (C) vs. no CS (n = 40) (N) at 6 months
       post-exposure. Therapy included paromomycin (PA) 500 mg qid and
       azithromycin (AZ) 600 mg qd or bid; responses were complete (CR),
       partial (PR), and none (NR). RESULTS: Of 73 pts with CD4 < 200, 33
       developed CS (C) and 40 did not (N); incidence = 45% (comparable to
       community incidence of 40%). The groups had comparable mean initial
       Karnofsky score (C 81, N 83, p = .7), mean CD4 count (C 43, N 58, p =
       .13), and baseline CDC class C3 diagnosis (C 88%, N 68%, p = .08);
       baseline mean weight in pounds (C 162, N 151, p = .04) was higher in C.
       Overall 6 mo mortality rate was 26%. Mortality in C was higher than N (C
       = 39%, N = 15%, p = .05); CS was responsible for 68% of all deaths in
       the cohort, with a 6 mo excess mortality rate of 24/100 due to CS. 52%
       of C were either dead or terminally ill at 6 mo; 12/13 CS deaths
       occurred in pts with CD4 < 50. Mean wt change (C -18, N -8, p = .05),
       increase in alkaline phosphatase (C 2.1x, N 1.2x, p = .05), decline in
       Karnofsky score (C -40, N -13, p = .0006), and TPN use (C 27%, N 5%, p =
       .02) were greater in C. Biliary disease occurred in 24% of C. Mean
       hospital days (C 12.1, N 1.1, p < .0001) were greater in C; 400 of 444
       total hospital days, or 90%, occurred in C. Mean total care charges (C
       $36020, N $11908, p < .0001) were 3x greater in C; CS accounted for
       extra charges of $795,699 for the cohort. Response to PA (n = 19) was
       37% (1 CR, 6 PR, 12 NR); response to AZ (n = 12) was 42% (1 CR, 4 PR, 7
       NR). CONCLUSION: A municipal waterborne outbreak of CS resulted in a
       dramatic increase in morbidity, mortality, and costs in a group of
       exposed AIDS pts. Both PA and AZ were partially effective; further
       studies are indicated. Municipalities must properly monitor and treat
       community water supplies for cryptosporidia in order to protect this
       vulnerable population.
 DE    Acquired Immunodeficiency Syndrome/*EPIDEMIOLOGY
       Azithromycin/THERAPEUTIC USE  Cohort Studies  Comorbidity  Comparative
       Study  Cryptosporidiosis/DRUG THERAPY/*EPIDEMIOLOGY  *Disease Outbreaks
       Disease Susceptibility  Health Care Costs  Human  Immunocompromised Host
       Leukocyte Count  Paromomycin/THERAPEUTIC USE  Retrospective Studies
       Survival Rate  Treatment Outcome  T4 Lymphocytes  Urban Population
       *Water Pollution  *Water Supply  Wisconsin/EPIDEMIOLOGY  MEETING
       ABSTRACT

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