HIV diarrhea: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*Many workups will be non diagnostic | |||
*Start with stool WBCs, cultures, Ova and Parasites x3 | |||
*Acid fast smear to assess for Cryptosporidium, Isospora, and Cyclospora | |||
*CD4<100 - Microsporidium more likely, test with Trichrome staining | |||
*Blood cultures with fungal / acid fast if disseminated disease a concern | |||
*Endoscopy | |||
**Indicated if w/u is negative and severely immunocompromised | |||
**Small bowel bx to look for MAC, lymphoma, or microsporidiosis | |||
**Guaic postive stools and weight loss, consider Kaposi Sarcoma of bowel, dx with colonoscopy | |||
*Imaging | |||
**Generally not helpful, but could be indicated if severe tenderness, peritonitis, concern for biliary pathology, obstructing lesions. | |||
==Management== | ==Management== | ||
Revision as of 20:44, 18 March 2015
Background
- Chronic diarrhea (over 28 days), can be presenting symptom of AIDS, or in countries without HAART
- Less common after introduction of HAART
Clinical Presentation
- Ascertain whether small bowel vs large bowel diarrhea
- Small Bowel
- Diarrhea watery and copius
- Weight loss
- Bloating, gas, cramping
- Vit B12 deficient if terminal illeum involved
- Large Bowel
- Frequent small volume, possibly painful stools
- Hematochezia - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria (e. coli O157, campylobacter, shigella, salmonella, Yersinia)
- Small Bowel
- Weight loss is concerning for infiltrative disease, opportunistic infx
- Receptive anal sex - consider local HSV infx, Gonorrhea, Chamlydia, Entamoeba
Differential Diagnosis
CD4>400
- Consider routine pathogens causing Diarrhea
- Side effect of nelfinavir and ritonavir
- Cryptosporidium parvum (brief course of illness) - severe watery diarrhea
- C. diff if abx exposed
CD4<200
- M. tuberculosis
- Histoplasma
- Cryptococcus
- Lymphoma
- Kaposi
- Enteroaggregative Escherichia coli (EAEC) (can also affect immunocompetent children)
- HIV can directly infiltrate bowel wall leading to diarrhea
CD4 <100
- Cryptosporidium parvum (chronic course of illness)
- Mycobacterium avium complex (MAC) - infiltration of bowel assoc with malabsorption
- CMV
- Isospora
- Microsporidium
Diagnosis
- Many workups will be non diagnostic
- Start with stool WBCs, cultures, Ova and Parasites x3
- Acid fast smear to assess for Cryptosporidium, Isospora, and Cyclospora
- CD4<100 - Microsporidium more likely, test with Trichrome staining
- Blood cultures with fungal / acid fast if disseminated disease a concern
- Endoscopy
- Indicated if w/u is negative and severely immunocompromised
- Small bowel bx to look for MAC, lymphoma, or microsporidiosis
- Guaic postive stools and weight loss, consider Kaposi Sarcoma of bowel, dx with colonoscopy
- Imaging
- Generally not helpful, but could be indicated if severe tenderness, peritonitis, concern for biliary pathology, obstructing lesions.
Management
Disposition
See Also
References
UpToDate: "Evaluation of the HIV-infected patient with diarrhea"