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Transcript
Internal Medicine
Mechanism of diarrhea
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Adhesion to mucosal surface
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Enterotoxin
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Entero-invasion
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Atrophy of mucosal surface
Chronic Diarrheas
Definition – Diarrhea lasting for more than two weeks with a single watery bowel motion and or
three or more loose stools per day
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Diarrhea occurs in 30-90% HIV-positive cases in Europe and USA and in 90% of cases
in the developing countries
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Frequency of diarrhea increases as the CD4 count falls
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With HAART, incidence of chronic diarrhea decreases
Protozoa that cause chronic Diarrhia in HIV patients:
Cryptosporidia
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Isospora belli
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Microsporidium
HIV enteropathy: (AIDS enteropathy)
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Chronic diarrheal syndrome for which no etiologic agent other than HIV can be identified
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It is most likely a direct result of HIV infection
Clinical features
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Early stage : intermittent self limiting diarrhea however in advanced stage, persistent life
threatening diarrhea
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Copious amount of stool several times per/day associated with abdominal cramp.
nausea and vomiting may also be present
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Significant weight loss ( wasting ) may occur due to the associated malabsorption
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Fluid and electrolyte depletion
Diagnostic investigation
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Stool Microscopy
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Culture
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Intestinal biopsy
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Special stains: Modified AFB stain
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