Multiple tubercular ulcer perforation of ileum in an AIDS patient: case report

Intestinal perforation is an extremely uncommon complication of Mycobacterium tuberculosis (MTB) infection. We report a case of HIV infection in a male injecting drug user (IDU) with intestinal tuberculosis complicated with multiple ileal perforations at the Regional Institute of Medical Sciences Hospital, Imphal, Manipur. The emergency surgical therapy supported by antitubercular drugs (ATT) and parenteral nutrition saved the life of this patient who presented in a critical state of shock. The patient manifested with extrapulmonary tuberculosis, which is one of the criteria of AIDS. The authors stress the possibility that in future, tubercular complication till now considered atypical, may become more frequent.     

Intestinal perforation due to cytomegalovirus infection in patients with AIDS

Intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. Colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic uleration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. Postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by Pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.     

2011—2020年长沙市MTB/HIV双重感染流行特征分析

目的: 分析长沙市MTB/HIV双重感染流行特征,以完善相关防控策略。方法: 从《结核病管理信息系统》和《TB/HIV双重感染防治管理工作年度报表》中提取2011—2020年长沙市MTB/HIV双感者相关资料,建立长沙市MTB/HIV感染特征分布综合数据库。分析MTB/HIV双重感染的检出情况,描述其随年度变化的趋势以及在不同时间、性别、年龄和地区的流行分布特征。结果: 2011—2020年,长沙市累计发现MTB/HIV双重感染者280例,患者发现率随年度呈波动性上升[4.29%(12/280)~15.36%(43/280)]。其中,在结核病患者中检出HIV感染者39例,年均检出率为0.10%(39/38990),不同年度HIV阳性检出率[0.03%(1/3759)~0.22%(9/4057)]呈波动性上升趋势(Z=2.347,P=0.019);在HIV/AIDS患者中检出MTB感染者241例,年均检出率为0.68%(241/35381),不同年度肺结核检出率[0.41%(19/4639)~2.13%(13/610)]呈波动性下降趋势(Z=-6.126,P=0.001)。在280例MTB/HIV双重感染者中,性别分布以男性为主[85.71%(240/280)];年龄分布以25~44岁年龄组为主[46.78%(131/280)],其次是45~64岁年龄组[32.50%(91/280)];地区分布以浏阳市为最多[26.07%(73/280)],其次为长沙县和宁乡市[均为16.43%(46/280)]。结论: 长沙市MTB/HIV双重感染水平较低,但在结核病患者中筛查HIV感染者的年均检出率呈波动上升趋势,在HIV/AIDS者中筛查MTB感染者的检出率呈波动下降趋势。应以男性、25~44岁年龄组以及AIDS及结核病疫情分布较高地区的人群为防控重点。     

HIV感染/AIDS者结核感染的影响因素分析

目的 分析HIV感染/AIDS者结核感染情况及其影响因素。方法 于2017年1—7月采用随机整群抽样的方法,抽取江苏省常州地区3家社区医院,以其10年累计登记的HIV感染/AIDS者作为研究对象,最终纳入475例,平均年龄(44.44±13.85)岁,其中,男378例(79.58%),女97例(20.42%);HIV感染者273例(57.47%),AIDS患者202例(42.53%)。收集研究对象的社会人口学信息及临床相关信息;采集研究对象外周静脉血,检测HIV病毒载量,并选取CD4 ⁺T细胞计数>200个/μl者采用QuantiFERON ^®-TB Gold (QFT)检测结核感染情况;分析研究对象结核感染情况,并采用多因素非条件logistic回归分析结核感染的影响因素。结果 研究对象中CD4 ⁺T细胞计数>200个/μl者有429例,结核感染率为10.02%(43/429)。单因素分析显示,CD4 ⁺T细胞计数>200个/μl者中有结核病接触史者结核感染率(30.30%,10/33)高于无接触史者(8.33%,33/396);CD4 ⁺T细胞计数>500个/μl者结核感染率(13.15%,33/251)高于CD4 ⁺T细胞计数为200~500个/μl者(5.62%,10/178),差异均有统计学意义(χ ²分别为16.30、6.55,P值均<0.05)。进一步的非条件logistic回归分析显示,CD4 ⁺T细胞计数>200个/μl的HIV感染/AIDS者中,有结核病患者接触史者结核感染风险是无接触史者的4.61倍[调整OR值(95%CI值)为4.61(2.00~10.63)];CD4 ⁺T细胞计数>500个/μl的HIV感染/AIDS者结核感染风险是CD4 ⁺T细胞计数200~500个/μl者的2.47倍[调整OR值(95%CI值)为2.47(1.17~5.21)]。结论 免疫水平低下的HIV感染/AIDS者结核感染检出率低;结核病患者接触史、免疫水平是HIV感染/AIDS者结核感染的重要影响因素。     

Intestinal microsporidiosis in diarrheal patients infected with human immunodeficiency virus-1 in Addis Ababa, Ethiopia

Intestinal microsporidiosis is most commonly associated with persistent diarrhea in advanced AIDS cases. To determine the prevalence and clinical manifestations of this infection in HIV/AIDS patients, a single fresh stool sample and blood were collected from 243 (214 HIV-positive and 29 HIV-negative) diarrheal patients. The presence of intestinal microsporidiosis in the stool was determined by Uvitex-2B staining and a PCR-based detection method. HIV screening was done by using ELISA, and reactive samples were confirmed by Western blotting. The CD4+ cell count was analyzed using FACScan. Out of 243 diarrheal patients, 39 (16.0%) cases were positive for intestinal microsporidial infection by either of the methods used. Of the 39, only 18 cases positive by microscopy were also positive by PCR. Based on PCR and microscopic analyses the microsporidial parasites were identified as Enterocytozoon bieneusi (30), Ecephalitozoon intestinalis (6), and double infections (3). All microsporidia-positive cases were HIV-positive, and 92.3% had diarrhea for over 4 weeks. The diarrhea was watery in 79.5% of the patients. Weight loss >10% was recorded in 37 (94.9%) cases. The CD4+ cell count was <100 cells/mm(3) in 84.4% of subjects, and 59.4% of the patients had a CD4+ cell count of < or =50 cells/mm(3), with a mean of 22.8 cells/mm(3). This study revealed that intestinal microsporidiosis is a common cause of chronic diarrhea and severe weight loss in advanced AIDS patients in Ethiopia. This condition is attributable mainly to E. bieneusi. Thus, early diagnosis of intestinal microsporidiosis in HIV/AIDS patients would certainly be helpful in the understanding and management of diarrheal illness.     

Intestinal microsporidiosis in HIV-infected children with diarrhea

Intestinal microsporidiosis is a common opportunistic disease associated with diarrhea in adult AIDS patients in Thailand; the data regarding this infection in children are scarce. The present study was designed to investigate the prevalence and clinical features of intestinal microsporidiosis in hospitalized HIV-infected and uninfected (free of HIV) children with diarrhea. Of the 95 HIV-infected children and 87 uninfected children, 24 (25.3%) and 13 (14.9%) respectively were diagnosed with intestinal microsporidiosis. Species identification of microsporidia spores, by transmission electron microscopy, demonstrated Enterocytozoon bieneusi in 5 cases. Cryptosporidium parvum was a common coinfective parasite; pneumonia was the most frequent concurrent disease found in children with intestinal microsporidiosis. Malnutrition was commoner in the HIV-infected group (79.2% vs 23.1%; p = 0.003). This study indicates that intestinal microsporidiosis is an important disease in both HIV-infected and uninfected Thai children with diarrhea.     

肺结核与艾滋病

目的 了解结核病院人类免疫缺陷病毒(HIV)/结核分枝杆菌(MTB)双重感染发病情况及发现病例的临床表现?治疗对策?方法 对1995年2月～1999年2月3707例住院结核病患者常规检测HIV抗体?结果 3707例中HIV(+)4例,阳性率108‰?男3例,女1例?平均年龄295岁,占21～40岁年龄组的314‰?4例中血源性感染1例,异性间感染2例,另1例血源性?异性间感染难以确定?4例均可诊断为艾滋病(AIDS)?结论 对具有HIV感染危险因素的结核患者,特别是中青年,应常规进行HIV抗体检测,对HIV/MTB双重感染患者抗结核治疗时应特别注意药物副反应?在抗痨同时并用中西药抗AIDS治疗,结核病取得较好近期疗效?     

肺结核与艾滋病(附四例报告)

目的 了解结核病院人类免疫缺陷病毒(HIV)/结核分枝杆菌(MTB)双重感染发病情况及发现病例的临床表现?治疗对策?方法 对1995年2月～1999年2月3707例住院结核病患者常规检测HIV抗体?结果 3707例中HIV(+)4例,阳性率108‰?男3例,女1例?平均年龄295岁,占21～40岁年龄组的314‰?4例中血源性感染1例,异性间感染2例,另1例血源性?异性间感染难以确定?4例均可诊断为艾滋病(AIDS)?结论 对具有HIV感染危险因素的结核患者,特别是中青年,应常规进行HIV抗体检测,对HIV/MTB双重感染患者抗结核治疗时应特别注意药物副反应?在抗痨同时并用中西药抗AIDS治疗,结核病取得较好近期疗效?     

结核病患者人类免疫缺陷病毒感染的检测

目的人类免疫缺陷病毒（ＨＩＶ）和结核分支杆菌（ＭＴＢ）双重感染已引起广泛关注。通过对住院肺结核患者ＨＩＶ检测,了解住院肺结核患者中ＨＩＶ感染及艾滋病（ＡＩＤＳ）发病状况。方法对２９７３例住院肺结核患者常规采用明胶颗粒凝集试验法或ＨＩＶ１＋２抗体金标快速测试法进行初筛,阳性者抽血复测,并由北京市检测中心确定。结果２９７３例中ＨＩＶ（＋）３例,阳性率１．０１‰。男２例,女１例。年龄分别为２３、４０、２７岁,平均年龄３０岁,占２１～４０岁年龄组的２．８６‰。通过静脉吸毒血源性感染１例,异性间性乱２例。３例均已发展为ＡＩＤＳ。结论结核病防治工作者对ＨＩＶ／ＭＴＢ双重感染的危险性要有充分认识与高度重视。对具有ＨＩＶ感染危险因素的肺结核患者,特别是其中的中青年患者应常规进行ＨＩＶ抗体检测,有助于ＡＩＤＳ的早期发现、治疗,防止ＡＩＤＳ的传播流行     

Intussusception in adults: an unusual and challenging condition for surgeons

Background and aims Intestinal intussusception in adults is a rare entity and there is an ongoing controversy regarding the optimal management of this problem. The purpose of this study was to determine the causes and management of intussusception in adults.Patients and methods A retrospective review of patients more than 18 years of age with a diagnosis of intestinal intussusception between January 1996 and December 2003 was conducted. Data related to presentation, diagnosis, treatment, and pathology were analyzed.Findings A total of 13 patients were operated on due to intestinal intussusception. There were 6 men and 7 women with a mean age of 45 years (range 24–61 years). Abdominal pain was the most common presenting complaint (100%). Eight (61.5%) patients presented with acute symptoms and underwent emergency laparotomy. The diagnosis of gastrointestinal intussusception was made preoperatively only in 4 (30.7%) patients by abdominal ultrasonography and computerized tomography. The lead point of intussusception was located in the small intestine in 10 (76.9%) patients, in the colon in 2 (15.4%), and in the ileocecal valve in 1 (7.7%). A pathologic cause for the intussusception was identified in 12 (92.3%) cases and 1 (7.7%) was idiopathic. Of the cases with a defined cause, 58% of the cases were benign and 42% were malignant. Forty percent of cases of small bowel intussusception and 33.3% of cases of colonic intussusception were due to malignant lesions. All cases of small intestinal intussusception were reduced and no perforation occurred. Segmental intestinal resection was performed in 9 patients and excision of the Meckels diverticulum was made in 1. In cases of colonic intussusception, reduction was not attempted and en-bloc resection was carried out. No perforation or spillage of the contents of the intussusception was observed. There was no surgical mortality.Conclusion Adult intussusception is an unusual and challenging condition that represents a preoperative diagnostic difficulty. We think that colonic intussusceptions should be resected in an en-bloc manner without reduction due to the risk of perforation and spillage of micro-organisms and malignant cells, whereas cases of small intestinal intussusception can be reduced without complications unless there is strangulation.     

A double-blind placebo-controlled pilot study of glutamine therapy for abnormal intestinal permeability in patients with AIDS

Objectives: Up to 20% of patients with AIDS have abnormal intestinal permeability (IP). Glutamine seems to play an important role in preventing the increase in IP and loss of intestinal mucosal mass associated with total parenteral nutrition, and may be superior to glucose for oral rehydration in the setting of intestinal infection. This study was designed to see if supplemental glutamine could alter the abnormal IP of AIDS.
Methods: Randomly chosen patients with AIDS from the Jacobi Medical Center human immunodeficiency virus (HIV) clinic underwent IP testing using lactulose and mannitol. Those with abnormal IP were enrolled. Duodenal biopsies were performed with a Crosby capsule and the patients were randomized in a double-blind fashion to receive placebo or glutamine (4 g/day or 8 g/day) for 28 days, after which intestinal permeability tests and duodenal biopsies were repeated. Intestinal morphology was graded by ratio of villus height to crypt depth, and by degree of inflammation.
Results: All patients complied with the therapy and there were no dropouts or reported side effects. The results showed less worsening of IP with the 4 g/day dose, compared with placebo. At the 8 g/day dose, there was stabilization of IP and improved absorption of mannitol. Intestinal morphology and inflammation did not change in any group.
Conclusions: These results, although not significant, suggest a trend towards improved IP and enhanced intestinal absorption with glutamine. Glutamine doses of at least 20 g/day may be necessary to improve IP. We recommend further studies at higher doses and for longer durations.     

Clinical research on patients with typhoid and paratyphoid fever (1984-1987). Research Group for Infectious Enteric Diseases, Japan

Patients with typhoid or paratyphoid fever, admitted to 14 hospitals for infectious diseases during 1984-1987, were epidemically and clinically studied. Of the total number of 183 typhoid, 49 paratyphoid fever patients, those infected overseas was 44.3% and 71.4% respectively, giving an overall annual decrease, yet marking an increased ratio of overseas infection. Patients aged 20s-30s and males were dominant. One hundred and seventy six cases (96.2%) of typhoid and all the paratyphoid fever cases were bacteriologically diagnosed. The period from the onset to the diagnosis was around 14 days in most cases, but beyond 29 days in over 10% of the cases. We would like to emphasize that enteric fever, focusing on high fever, bradycardia, roseola, hepatosplenomegaly, leukopenia, elevated serum-GOT GPT and LDH, can be easily diagnosed by blood/stool culture before beginning chemotherapy. Intestinal bleeding was recognized in 24 cases (13.1%) of typhoid and 4 (8.2%) of paratyphoid fever, intestinal perforation in 2 (1.1%) and death in 1 (0.5%) of typhoid fever. CP was most commonly used in chemotherapy. Bacteriological relapse was recognized in 7/127 cases (5.5%) of typhoid, 6/48 (13.0%) of paratyphoid fever those followed beyond 3 weeks, though eradication was attained by retreatment. One strain of S. typhi resistant to CP.ABPC.KM.SM was isolated in 1986 from a patient infected overseas. New quinolones seem reliable in our preliminary studies.     

Acid-alcohol fast bacilli in sputa of HIV-infected patients.

We identified 34 HIV-infected patients with sputum smear positive for acid-alcohol fast bacilli (AAFB) to determine any factors predictive of subsequent species identification. There were 20 cases of Mycobacterium tuberculosis (MTB), 9 cases of Mycobacterium avium-intracellulare (MAI), 3 cases of Mycobacterium kansasii and one each of Mycobacterium malmoense and Mycobacterium fortuitum. Factors associated with isolation of MAI were lower CD4 cell count, a higher incidence of previous AIDS diagnosis, a history of dyspnoea and a normal chest X-ray. The organism was isolated from blood cultures in 58% of patients with MTB and 78% of patients with MAI infection. Disseminated disease was diagnosed in 45% of MTB patients and 33% of MAI patients.     

43例腹腔结核并发肠穿孔患者的外科治疗效果分析

目的 分析外科治疗腹腔结核致肠穿孔患者的临床情况。方法 收集河北省胸科医院2008—2016年收治的43例经手术病理确诊的腹腔结核伴肠穿孔患者,所有患者经胸部X线摄影或CT扫描检查均为可疑肺结核。描述性总结分析其术前临床表现、实验室检测及各项检查、术中探查及手术方式、术后治疗及并发症、治疗结果、随访结果等临床资料。结果 43例患者术后病理证实均存在腹腔结核,其中32例非急诊患者临床诊断明确者18例,11例急诊患者术前均未明确诊断;术中探查均存在肠穿孔,其中术前考虑单纯肠梗阻3例、肠梗阻伴肠穿孔30例(8例急诊和22例非急诊患者术前经诊断性穿刺诊断肠穿孔)、单纯肠穿孔10例。40例(93.0%)因病变范围广泛、感染严重行Ⅰ期肠切除+造瘘术,其中12例切口感染患者经切口换药、引流后治愈;8例发生肠瘘患者除2例(保守治疗、二次手术各1例,年龄均>65岁)因多脏器功能衰竭死亡外,余6例经治疗后预后良好;2例发生肠梗阻患者1例行二次手术、1例保守治疗后治愈;余18例患者造瘘术后恢复良好。2例(回盲部肿物伴穿孔1例,腹腔感染较轻1例)行回盲部切除+回结肠吻合术;1例因近回盲部出现回肠局部单一穿孔,且同时并发腹腔淋巴结结核、局部淋巴结节和穿孔部位回肠粘连,但腹腔感染较轻的患者行回肠部分切除+肠吻合术,术后无严重并发症。抗结核治疗12个月后均治愈停药。37例患者停药后随访18~24个月,4例患者失访,随访期内16例患者有间断轻微腹痛症状,其他患者一般情况均良好。结论 腹腔结核伴肠穿孔是严重的消化道结核并发症,规范的抗结核药物治疗是基础,而外科手术是有效治疗的首选方式,治疗效果良好。     

2006～2015年上海市公共卫生临床中心艾滋病患者的分枝杆菌培养阳性结果分析

目的 分析2006年～2015年上海市公共卫生临床中心病原培养分枝杆菌阳性的艾滋病患者结核分枝杆菌（MTB）与非结核分枝杆菌（NTM）的构成及耐药情况。方法 收集2006年1月～2015年12月入住我院且存在临床相应感染症状并具有分枝杆菌培养阳性结果的艾滋病患者816例,收集其年龄、性别等一般资料、耐药检测和NTM分型结果并进行分析。结果 816例分枝杆菌感染患者中男679例,女137例,中位年龄40岁。MTB感染患者364例（44.6%）,NTM感染患者377例（46.2%）。判定为MTB感染且有耐药检测资料患者共275例,对链霉素及异烟肼的耐药率均为24.0%（66例）,对乙胺丁醇的耐药率为17.1%（47例）,对利福平的耐药率为16.7%（46例）;耐多药结核病为42例（15.3%）。判定为NTM感染且有耐药检测资料患者共124例,对异烟肼的耐药率为91.1%（113例）,对链霉素的耐药率为83.9%（104例）,对利福平的耐药率为47.6%（59例）,对乙胺丁醇的耐药率38.7%（48例）。共102例NTM患者有分型资料,其中鸟-胞内分枝杆菌33例（32.3%）,戈登分枝杆菌29例（28.4%）,堪萨斯分枝杆菌25例（24.5%）。结论 对于分枝杆菌培养结果阳性的艾滋病患者,NTM比例明显高于普通人群,治疗上需根据药物敏感试验结果适当调整用药。     

Henoch-Sch?nlein purpura from vasculitis to intestinal perforation: A case report and literature review

Henoch-Sch?nlein purpura(HSP) is generally a selflimited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrastenhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.     

Henoch-Sch&ouml;nlein purpura from vasculitis to intestinal perforation: A case report and literature review

Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.     

Spontaneous Intestinal Perforation Due to Non-Hodgkin's Lymphoma: Evaluation of Eight Cases

Primary intestinal lymphoma with spontaneous perforation and after systemic chemotherapy is rare. The present study summarizes retrospectively the outcome of eight free intestinal perforated patients diagnosed with intestinal non-Hodgkin's lymphoma. Two patients had a history of systemic chemotherapy before perforation. The most common symptoms of the patients were abdominal pain, nausea, vomiting, weight loss, and fever. Sites of perforation were ileum in four, jejunum in two, cecum in one, and sigmoid colon in one patient. Synchronous lymphoma was present in three patients. The perforation was closed by primary closure in three patients. Resection/anastomosis was performed in four patients and sigmoid colostomy was performed in one patient. Three patients were lost due to leakage or septicemia. Intestinal lymphoma might be kept in mind as a cause in free intestinal perforations. Because of the high mortality rate early diagnosis and treatment are important to improve the prognosis of bowel perforation in patients with non-Hodgkin's lymphoma.     

Spontaneous free perforation of the small intestine in Crohn's disease.

Spontaneous free perforation of the small intestine is a rare but often dramatic event in the clinical course of Crohn's disease. Fifteen new cases of spontaneous free perforation of the small intestine--nine female patients and six male patients--were discovered in a series of 1000 consecutively evaluated patients with Crohn's disease seen during a period spanning 20 years, for an estimated frequency of 1.5%. Spontaneous free perforation was the presenting clinical feature of Crohn's disease in nine (60%) of the newly discovered cases. Most perforations were located in the ileum rather than in the jejunum, and there were no duodenal free perforations. One patient with extensive intestinal disease presented with concomitant free perforations of the jejunum and ileum, while a second patient had two free ileal perforations that developed independently, separated by about six years. No perforations were the result of a superimposed malignant process, ie, adenocarcinoma or lymphoma. There have been no mortalities, and the subsequent clinical course of these patients has been limited to a minority requiring corticosteroid or immunosuppressive medications, or further surgical resections.     

Parasitic infections of the intestines

Intestinal parasites remain extremely common worldwide. In developing countries, intestinal protozoans are important causes of childhood diarrhea. Cryptosporidiosis is a common cause of chronic diarrhea in patients with AIDS. With the advent of current active antiretroviral therapy the incidence of cryptosporidiosis in AIDS has decreased. By contrast, Cryptosporidium, Cyclospora, and Giardia outbreaks continue to be associated with contamination of food or water. The intestinal helminths Ascaris, hookworm, and Trichuris each infects over a thousand million people. While most of those infected experience only minor symptoms, recent data highlight subtle effects of parasitism on cognitive function and nutrition. Efforts at disease control in developing countries are increasingly focused on mass chemotherapy.