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  • Title: [Severe digestive complications of AIDS in a group of patients from Zaire].
    Author: Jonas C, Van de Perre P, Reding P, Burette A, Deprez C, Clumeck N, Deltenre M.
    Journal: Acta Gastroenterol Belg; 1984; 47(4):396-402. PubMed ID: 6524266.
    Abstract:
    Severe digestive complications of acquired immune deficiency syndrome (AIDS) were observed in 9 patients among a group of 17 patients from Zaire treated for AIDS in Belgium between May 1979-April 1983. Among the 9 cases, there were 10 ailments of the upper digestive tract, 7 of intestinal disorders, 3 of hepatic disorders, and 2 of pancreatic disorders. The average age of affected patients was 35 years. 4 men averaged 32 years and 5 women averaged 39 years. Their average stay in Belgium was 8 months. All 9 were anorexic and had lost at least 10 kg over the past year. 6 were pyretic and developed palpable adenopathies. 7 patients had episodic or continuous diarrhea in the early stages of illness and 8 had diarrhea in the later phase. 1 patient had bloody diarrhea. None were homosexual or drug addicted or had histories of transfusions. None was dysphagic. The patients exhibited lymphopenia affecting primarily the helper T lymphocytes. 7 patients had Candida albicans infections of upper digestive tract. 1 patient had an esophageal herpes infection. 4 patients had enterocolitis caused by opportunistic organisms: Cryptosporidium, Isospora Belli, cytomegalovirus, Clostridium Difficile, or Salmonella. 2 patients had septicemia caused by Salmonella and 1 had septicemia caused by Shigella. All 9 patients had at least 1 of the markers of hepatitis B. By April 1984, 8 patients had died and 1 who returned to Zaire had been lost to follow-up. The cause of death of the 3 patients for whom it was known was generally a nondigestive complication. Analysis of stool samples was found to be most useful means of diagnosing digestive complications of AIDS. Systemic infection with cytomegalovirus is very frequent in AIDS. The case in this series was diagnosed after discovery of inclusions in the intestinal mucus after repeated noncontributory analyses of the stools. In cases of enterocolitis, the endoscopic appearance of the mucus is not very specific and colposcopy is less useful than of stool samples. Upper endoscopy is very useful in diagnosis of Candida, which responds well to treatment. Hepatic biopsy and laparoscopy appear to be of limited usefulness, since liver and pancreatic involvement are usually self-limited with slight clinical manifestations. Endoscopic examinations pose the problem of possible contaminatin. The endoscope and all accessories should be systematically disinfected before and after use.
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