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Clostridium difficile and HIV and Outcomes

David B Gootenberg, Jeffrey M Paer, Jesus-Mario Luevano, Douglas S Kwon
PURPOSE OF REVIEW: Despite HIV therapy advances, average life expectancy in HIV-infected individuals on effective treatment is significantly decreased relative to uninfected persons, largely because of increased incidence of inflammation-related diseases, such as cardiovascular disease and renal dysfunction. The enteric microbial community could potentially cause this inflammation, as HIV-driven destruction of gastrointestinal CD4 T cells may disturb the microbiota-mucosal immune system balance, disrupting the stable gut microbiome and leading to further deleterious host outcomes...
February 2017: Current Opinion in Infectious Diseases
John V Gahagan, Wissam J Halabi, Vinh Q Nguyen, Joseph C Carmichael, Alessio Pigazzi, Michael J Stamos, Steven D Mills
BACKGROUND: HIV has become a chronic disease, which may render this population more prone to developing the colorectal pathologies that typically affect older Americans. METHODS: A retrospective review of the Nationwide Inpatient Sample was performed to identify patients who underwent colon and rectal surgery from 2001 to 2010. Multivariate analysis was used to evaluate outcomes among the general population, patients with HIV, and patients with AIDS. RESULTS: Hospital admissions for colon and rectal procedures of patients with HIV/AIDS grew at a faster rate than all-cause admissions of patients with HIV/AIDS, with mean yearly increases of 17...
June 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Colleen R Kelly, Chioma Ihunnah, Monika Fischer, Alexander Khoruts, Christina Surawicz, Anita Afzali, Olga Aroniadis, Amy Barto, Thomas Borody, Andrea Giovanelli, Shelley Gordon, Michael Gluck, Elizabeth L Hohmann, Dina Kao, John Y Kao, Daniel P McQuillen, Mark Mellow, Kevin M Rank, Krishna Rao, Arnab Ray, Margot A Schwartz, Namita Singh, Neil Stollman, David L Suskind, Stephen M Vindigni, Ilan Youngster, Lawrence Brandt
OBJECTIVES: Patients who are immunocompromised (IC) are at increased risk of Clostridium difficile infection (CDI), which has increased to epidemic proportions over the past decade. Fecal microbiota transplantation (FMT) appears effective for the treatment of CDI, although there is concern that IC patients may be at increased risk of having adverse events (AEs) related to FMT. This study describes the multicenter experience of FMT in IC patients. METHODS: A multicenter retrospective series was performed on the use of FMT in IC patients with CDI that was recurrent, refractory, or severe...
July 2014: American Journal of Gastroenterology
Tadashi Kikuchi, Michiko Koga, Shoichi Shimizu, Toshiyuki Miura, Haruhiko Maruyama, Mikio Kimura
The clinical management of amebiasis is a growing concern, particularly among human immunodeficiency virus (HIV)-infected individuals who are predisposed to severe illness. Treatment with a luminal amebicide is strongly recommended following acute-stage treatment with a nitroimidazole. In 2004, the Japanese Research Group on Chemotherapy of Tropical Diseases introduced paromomycin, which was not nationally licensed, and offered it to a number of patients. From 2004 to 2011, 143 case records of amebiasis (123 with amebic colitis, 16 with amebic liver abscess, and 4 with both) in which patients were treated with paromomycin, mainly 1,500 mg/day for 9 or 10 days following metronidazole treatment, were submitted...
December 2013: Parasitology International
Charles F Haines, Richard D Moore, John G Bartlett, Cynthia L Sears, Sara E Cosgrove, Karen Carroll, Kelly A Gebo
OBJECTIVE: Clostridium difficile is the most commonly reported infectious diarrhoea in HIV-infected patients in the United States. We set out to determine the incidence, risk factors and clinical presentation of C. difficile infections (CDIs) in a cohort of HIV-infected individuals. DESIGN: We performed a nested, case-control analysis with four non-CDI controls randomly selected for each case. METHODS: We assessed the incidence of CDI in the Johns Hopkins HIV Clinical Cohort between 1 July 2003 and 31 December 2010...
November 13, 2013: AIDS
Paul J Collini, Ed Kuijper, David H Dockrell
Clostridium difficile infection (CDI) affects significant numbers of hospitalized patients and is an increasing problem in the community. It is also among the most commonly isolated pathogens in HIV patients with diarrheal illness and is ≥2 fold more common in HIV-seropositive individuals. This association is stronger in those with low absolute CD4 T cell counts or meeting clinical criteria for an AIDS diagnosis, and was most pronounced before the wide availability of highly active antiretroviral therapy...
September 2013: Current HIV/AIDS Reports
Pooneh Salari, Shekoufeh Nikfar, Mohammad Abdollahi
OBJECTIVES: Diarrhea the second leading cause of death in childhood is caused by a variety of organisms. Rehydration reduces the risk of death but it is not effective in shortening duration of disease. Recently, probiotics have been recommended for prevention or treatment of gastrointestinal disorders including diarrhea. Considering existing documents from different aspects, it seems that results are somehow controversial or non-conclusive. Thus, we aimed to meta-analyze clinical trials to show actual benefit of probiotics in treatment of diarrhea...
February 2012: Inflammation & Allergy Drug Targets
Paul J Collini, Martijn Bauer, Ed Kuijper, David H Dockrell
Immunocompromise is a commonly cited risk factor for Clostridium difficile infection (CDI). We reviewed the experimental and epidemiological literature on CDI in three immunocompromised groups, HIV-seropositive individuals, haematopoietic stem cell or bone marrow transplant recipients and solid organ transplant recipients. All three groups have varying degrees of impairment of humoral immunity, a major factor influencing the outcome of CDI. Soluble HIV proteins such as nef and immunosuppressive agents such as cyclosporin, azathioprine and mycophenalate mofetil modify signalling from the key cellular pathways triggered by C...
February 2012: Journal of Infection
I Ramon, M Libert, M P Guillaume, F Corazza, R Karmali
We describe a case of recurrent haemophagocytic syndrome (HS) in an HIV-infected patient.The first episode was associated with active human herpesvirus 8 infection and progressive Kaposi's sarcoma which was successfully treated with splenectomy, foscarnet and chemotherapy. The second episode was triggered by a Clostridium difficile colitis and resolved completely after treatment with metronidazole only. Recurrent HS has rarely been described in adult patients out of the setting of relapsing malignancy or autoimmune disease...
July 2010: Acta Clinica Belgica
M Nieuwdorp, E van Nood, P Speelman, H A van Heukelem, J M Jansen, C E Visser, E J Kuijper, J F W M Bartelsman, J J Keller
OBJECTIVE: To study the effect of treating recurrent Clostridium difficile-associated diarrhoea (CDAD) with a suspension of donor faeces. DESIGN: Uncontrolled interventional study. METHOD: Patients that, despite adequate antibiotic therapy, had developed at least 2 recurrences ofCDAD, including at least one recurrence that had been treated with a vancomycin tapering regimen, were included in the study. Relatives or volunteers served as faeces donor...
August 30, 2008: Nederlands Tijdschrift Voor Geneeskunde
Maria T Abreu, Noam Harpaz
The evaluation of patients with colitis of recent onset is a relatively common clinical challenge. The main considerations are infectious colitides, idiopathic IBD, ie, ulcerative and Crohn's colitis, and colonic ischemia. An initial risk assessment on the basis of such factors as concurrent symptoms in contacts, travel history, medications, and human immunodeficiency virus risk factors should be followed by a thorough clinical history, physical examination, stool studies, blood tests, and, in selected cases, endoscopic examination and serologic tests...
March 2007: Clinical Gastroenterology and Hepatology
Frederico G S De Toledo, Stephen N Symes
The clinical presentation of colitis associated with Clostridium difficile infection in immunosuppressed patients with acquired immunodeficiency syndrome (AIDS) has not been completely characterized. Previous reports suggest that these patients present with low blood leukocyte counts, consistent with the impaired myelopoiesis that can occur with human immunodeficiency virus (HIV) infection. In contrast, we describe the cases of two patients with colitis associated with C difficile infection who developed intense leukemoid reactions despite being in advanced stages of AIDS...
April 2004: Southern Medical Journal
Christer Lidman, Lars G Burman, Asa Lagergren, Ake Ortqvist
Current guidelines recommend microbiological diagnostic procedures as a part of the management of patients hospitalized for community-acquired pneumonia (CAP), but the value of such efforts has been questioned. Patients hospitalized for CAP were studied retrospectively, focusing on the use of aetiological diagnostic methods and their clinical impact. Adult patients, without known human immunodeficiency virus infection, admitted to hospital for CAP during 12 months, were evaluated with regard to the importance of aetiological diagnosis for tailoring antibiotic therapy, antibiotic-associated diarrhoea, Clostridium difficile disease, length of hospital stay and mortality...
2002: Scandinavian Journal of Infectious Diseases
Joseph J Pulvirenti, Tarun Mehra, Irfan Hafiz, Patricia DeMarais, Dayle Marsh, Frank Kocka, Peter M Meyer, Staci A Fischer, Larry Goodman, Dale N Gerding, Robert A Weinstein
Clostridium difficile causes diarrhea in HIV infected patients but reports of prevalence, risk factors, and outcome vary. We studied the impact of C. difficile in 161 HIV infected inpatients admitted to Cook County Hospital. Patients with C. difficile had more hospital admissions in the previous 6 months (p =.04), spent more days in the hospital in the previous 3 months (p =.02), more often had previously received H2 blockers or treatment for Pneumocystis carinii (p <.05), and had a more frequent history of herpesvirus (p =...
December 2002: Diagnostic Microbiology and Infectious Disease
Arden M Morris, Blair A Jobe, Mark Stoney, Brett C Sheppard, Clifford W Deveney, Karen E Deveney
HYPOTHESIS: The diagnosis of Clostridium difficile colitis is increasing in frequency, with worsening patient outcomes. DESIGN: Retrospective cohort study. SETTING: University hospital. PATIENTS: One hundred fifty-seven patients diagnosed with C difficile colitis between 1994-2000. MAIN OUTCOME MEASURES: Resolution of disease, operative intervention, and death. RESULTS: Compared with our previous 10-year experience, overall cases of C difficile colitis have risen by more than 30%, and immunocompromised patients comprise a larger proportion of those affected...
October 2002: Archives of Surgery
P Fric
Probiotics are defined as live microorganisms of human origin. Their use may favorably influence human health and ameliorate or prevent certain diseases. Prebiotics are non-digestible foodstuffs (fiber, oligofructans - "colonic foods"), which enter the colon and are metabolized by the probiotics. Probiotics should fulfill the following criteria: Phenotypic and genotypic classification, no pathogenic properties, human origin, application in the living state, resistance to gastric acid and bile, ability to adhere to colonocytes, ability to colonize the gut, clinically proved favorable health-effect, and safety...
March 2002: Zeitschrift Für Gastroenterologie
A M Buchner, A Sonnenberg
OBJECTIVES: The aim of this study was to examine the associations of Clostridium difficile colitis with other comorbid conditions and procedural interventions among hospitalized patients. METHODS: The Patient Treatment File of the Department of Veterans Affairs contains the computerized records of all inpatients treated in 172 Veterans Affairs hospitals distributed throughout the United States. The computerized medical records of 15,091 cases with C. difficile colitis and 61,931 controls without the diagnosis were extracted from the annual files between 1993 and 1998...
March 2001: American Journal of Gastroenterology
C Mwachari, B I Batchelor, J Paul, P G Waiyaki, C F Gilks
OBJECTIVES: Chronic diarrhoea and wasting are well recognized features of AIDS in Africa. However, because of resource constraints few comprehensive aetiological studies have been conducted in sub-Saharan Africa which have included a broad range of microbiological investigations. We undertook a prospective cross-sectional study of adult patients admitted to a government hospital in Nairobi, Kenya, to determine possible bacterial, mycobacterial, parasitic and viral causes of diarrhoea; to consider which may be treatable; and to relate microbiological findings to clinical outcome...
July 1998: Journal of Infection
L Beaugerie, Y Ngô, F Goujard, S Gharakhanian, F Carbonnel, J Luboinski, M Malafosse, W Rozenbaum, Y Le Quintrec
We report six cases of toxic megacolon in patients with human immunodeficiency virus (HIV). One case, at an early stage of HIV infection, mimicked a severe attack of Crohn's disease, with a negative search for infectious agents. Subtotal colectomy was successfully performed with an uneventful postoperative course. The five other cases concerned patients with acquired immunodeficiency syndrome at a late stage of immunodeficiency. They were related to Clostridium difficile or cytomegalovirus (CMV) intestinal infection in two and three patients, respectively...
September 1994: Gastroenterology
M Tumbarello, E Tacconelli, F Leone, R Cauda, L Ortona
OBJECTIVE: To evaluate the prevalence of, risk factors for, treatment and outcome of Clostridium difficile-associated diarrhoea (CDAD) in patients with human immunodeficiency virus (HIV) infection. DESIGN: A prospective case-control study, conducted between January 1992 and April 1994. SETTING: Department of Infectious Diseases in a large university hospital with HIV in- and out-patient units. PATIENTS AND METHODS: The study included 124 patients grouped as follows: 31 HIV-infected patients with CDAD (group A); 31 HIV-seronegative patients with CDAD (group B) and 62 HIV-infected patients without CDAD (group C)...
March 1995: European Journal of Gastroenterology & Hepatology
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