Indian J Sex Transm Dis Indian J Sex Transm Dis
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CASE REPORT
Year : 2007  |  Volume : 28  |  Issue : 1  |  Page : 36-37
 

Mixed microbial gastrointestinal tract infection in a case of HIV-positive patient


Department of Microbiology, Government Medical College, Nagpur, India

Correspondence Address:
Meena Mishra
S-01, Shri Sunder Apts., Opp. TB ward, Rajabaxa Road, Wanjari Nagar, Nagpur - 440 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.35711

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   Abstract 

A case of human immunodeficiency virus-positive patient having tuberculosis and oral thrush with diarrhea was investigated for gastrointestinal pathogens. The stool specimen of the patient, whose CD 4 count was 162/cuÁl, revealed as many as four microbes including fertilized eggs of Ascaris lumbricoides , larvae of Strongyloides stercoralis , cysts of Cryptosporidium parvum and Salmonella typhimurium . A comprehensive stool examination for different pathogens in acquired immunodeficiency syndrome patients with diarrhea is recommended.


Keywords: Acquired immunodeficiency syndrome, human immunodeficiency virus, mixed microbial infections


How to cite this article:
Mishra M, Kurhade A M, Powar R M. Mixed microbial gastrointestinal tract infection in a case of HIV-positive patient. Indian J Sex Transm Dis 2007;28:36-7

How to cite this URL:
Mishra M, Kurhade A M, Powar R M. Mixed microbial gastrointestinal tract infection in a case of HIV-positive patient. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Aug 3];28:36-7. Available from: http://www.ijstd.org/text.asp?2007/28/1/36/35711



   Introduction Top


Human immunodeficiency virus (HIV)-positive patients are known to suffer from a wide range of infections, one of them being diarrhea which can be a presenting manifestation or a life threatening complication of infection with HIV. [1] A large number of pathogens including protozoa ( Giardia lamblia , E. histolytica , Cryptosporidium parvum , Isospora belli ), bacteria (  Salmonella More Details species, Shigella species,  Yersinia More Details, Campylobacter) and viruses (hepatitis A, hepatitis B, cytomegalovirus, Herpes simplex virus) are common infections seen in HIV-positive patients. This study presents a case of an HIV-positive patient with gastroenteritis of diverse etiology.


   Case Report Top


A 38-year-old HIV-positive male laborer on treatment for pulmonary tuberculosis was admitted to the medicine ward of Government Medical College and Hospital, Nagpur. He presented with intermittent diarrhea, vomiting, fever with chills and profound weight loss since the past 2 months. The patient was moderately dehydrated, cachexic and with oral candidiasis. Patient had watery diarrhea with blood and mucus. The stool sample received was examined for saline mount, iodine mount and modified ZN stain. Culture was done on blood agar, MacConkey agar and salmonella shigella agar and processed as per the standard protocol. [2] Blood culture was done during the peak of fever. Other investigations like hemogram, renal function test, liver function test and random blood sugar were done. CD 4 count was also done.

The reports of biochemistry investigations were normal. The peripheral smear showed eosinophilia with eosinophil count of 20%. The CD 4 count was 162/cuml. The wet film examination of stool revealed fertilized eggs of Ascaris lumbricoides and larvae of strongyloides stercoralis. Modified ZN stain showed cysts of Cryptosporidium parvum . On culture, Salmonella typhimurium was isolated. Blood culture was sterile. Patient was put on antimicrobial agents. However, the relatives got the patient discharged against medical advice.


   Discussion Top


As the largest lymphoid organ of the body, the gastrointestinal tract is a potential reservoir for HIV and is an important site for HIV-induced immunodeficiency. [3] Diarrhea is often the presenting symptom of full-blown AIDS and is characterized by large volume, presence of blood and abdominal pain, as seen in this patient. This patient already had tuberculosis and oral thrush. Along with these, he now had no less than four microbes detected in the stool. It is difficult to ascertain whether one particular pathogen was causing diarrhea as they were acting in tandem. Hence each one of them needs to be treated with specific drug. Patient of AIDS with multiple concomitant enteric pathogens have been reported. [4] In African HIV patients also, similar picture is seen and it is referred to as 'slim disease,' which reflects the presence of intestinal infection caused by opportunistic pathogens superimposed on underlying gastrointestinal infection caused by 'traditional' tropical pathogens. [5] Moreover, the presenting signs and symptoms do not help predict the etiology. It is therefore recommended that for patients of AIDS with diarrhea, a comprehensive examination for pathogenic bacteria, protozoa, helminths, etc., must be done.

 
   References Top

1.Smith PD, Lane HC, Gill VJ, Manischewitz JF, Quinnan GV, Fauci AS, et al . Intestinal infections in patients with the acquired immunodeficiency syndrome (AIDS). Etiology and response to therapy. Ann Intern Med 1988;108:328-33.  Back to cited text no. 1    
2.Old DC. Salmonella. In : Collee JG, Fraser AG, Marmoin BP, Simmons A, editors. Mackie and McCartney practical medical microbiology. 14 th ed. Churchill Livingstone: Edinburgh; 1996. p. 385-404.  Back to cited text no. 2    
3.Smith PD, Quinn TC, Stroper W, Janoff EN, Masur H. Gastrointestinal infections in AIDS. Ann Intern Med 1992;116:63-77.  Back to cited text no. 3    
4.Soave R, Johnson WD. Cryptosporidium and Isospora belli infections. J Infect Dis 1988;157:225-9  Back to cited text no. 4    
5.Serwadda D, Mugerwa RD, Sewankambo NK, Lwegaba A, Carswell JW, Kirya GB, et al . Slim disease: A new disease in Uganda and its association with HTLV-III infection. Lancet 1985;2:849-52.  Back to cited text no. 5  [PUBMED]  




 

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