Enteropathic AIDS in Uganda. An endoscopic, histological and microbiological study

Abstract

Twenty-three Ugandan patients with enteropathic acquired immunodeficiency syndrome (AIDS, 'slim' disease) were studied. Upper gastrointestinal (GI) endoscopy, colonoscopy, biopsy, stool parasitology and culture were performed. Endoscopy revealed oral and/or oesophageal candidiasis in 22 patients. Stool examination and histology of the upper GI tract showed that 11 patients had cryptosporidiosis and three had isosporiasis (total of 61% of patients with coccidian enteritis). One case of possible Mycobacterium avium mycobacteriosis was also identified. Enteropathic AIDS in Uganda presents with a spectrum of infections similar to that found in developed countries, but the incidence of cryptosporidiosis and isosporiasis is higher.

PIP: Of about 40 patients with presumed enteropathic Acquired Immune Deficiency Syndrome (AIDS), i.e., oral thrush, diarrhea, and weight loss, admitted to Mulago Hospital medical wards, Uganda, from October through November 985, 23 patients were studied with upper gastrointestinal tract endoscopy and stool examination. Those patients chosen for study suffered with diarrhea, weight loss, and oral candidiasis and were willing to tolerate endoscopy. Weight loss was not quantified in most patients, but generally it was profound. 10 of the patients gave a history of genital sores or venereal disease. There were 16 males and 7 females with an age range of 19-47 years. All were sexually active, and all denied homosexuality anal intercourse, and intravenous drug abuse. 4 patients had had blood transfusion. The 23 patients represented a cross-section of the population with most social classes included. 20 patients were seropositive with antibody to HIV. Specimens from 2 patients were lost. 1 patient was seronegative. Apart from 5 patients who had been treated with nystatin for oral thrush and clinically presumed esophageal candidiasis, all the patients had oral thrush at the time of endoscopy. 20 patients had obvious esophageal candidiasis, and 1 patient had the appearance of Kaposi's sarcoma in the esophagus. Stool examination and histology of the upper GI tract showed that 11 patients had cryptosporidiosis and 3 had isosporiasis (total of 61% of patients with coccidian enteritis). 1 case of Mycobacterium avium mycobacteriosis also was identified. The incidence of cryptosporidiosis and isosporiasis is higher in Uganda than in developed countries.