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1 October 2006

Volume 43, Number 7
Clinical Infectious Diseases 2006;43:925–932
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4307-0021$15.00
DOI: 10.1086/507531
HIV/AIDS MAJOR ARTICLE

Etiology of Chronic Diarrhea in Antiretroviral‐Naive Patients with HIV Infection Admitted to Norodom Sihanouk Hospital, Phnom Penh, Cambodia

Senya Chhin,1

Joseph I. Harwell,3

Joanna D. Bell,7

Gregory Rozycki,8

Tom Ellman,2

J. Mark Barnett,4

Honorine Ward,9

Steven E. Reinert,6 and

David Pugatch5

1Department of Infectious Diseases, Preah Bat Norodom Sihanouk Hospital, Phnom Penh, Cambodia; 2Médecins Sans Frontiéres, London, United Kingdom; Divisions of 3Infectious Diseases and 4Hematology and Oncology, Department of Medicine and 5Division of Pediatric Infectious Diseases, Department of Pediatrics, Brown Medical School, 6Lifespan Information Services, Rhode Island Hospital, Providence, Rhode Island; 7Division of Infectious Diseases and HIV/AIDS Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; 8Department of Pediatrics, Kaiser Permanente Hospital, Hayward, California; and 9Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts–New England Medical Center, Boston, Massachusetts

Background.Although both human immunodeficiency virus (HIV) infection and diarrhea are considerable problems in Cambodia, there have not been any studies to determine the history, clinical presentation, and etiology of chronic diarrhea in patients with HIV infection in Cambodia. In this article, we present a case‐control study involving 40 HIV‐infected patients with chronic diarrhea and 40 HIV‐infected patients without diarrhea.

Methods.Clinical, demographic, and laboratory data were collected. Stool samples were examined for parasites, including Cryptosporidium species (by partial acid‐fast stain), bacterial pathogens, and rotavirus. Samples from 10 case patients and 10 control subjects were also analyzed for Cryptosporidium species by polymerase chain reaction–restriction fragment–length polymorphism.

Results.The median CD4+ cell count was 11.5 cells/mm3. A potential pathogen was found in 30 case patients (75%) and 29 control subjects (72.5%). Cryptosporidium was the most common pathogen, present in 16 case patients (40%) and 20 control subjects (53.3%). The presence of Cryptosporidium was confirmed by polymerase chain reaction–restriction fragment–length polymorphism, with a prevalence of 40% in each of the 2 groups of 10 subjects who were enrolled for Cryptosporidium evaluation.

Conclusions.Subjects in this cohort had severe immunosuppression. The prevalence of pathogens, including Cryptosporidium, was extremely high but did not differ significantly between the case patients with diarrhea and the control subjects without diarrhea. Further studies are needed to examine factors associated with Cryptosporidium carriage and the natural history of asymptomatic infection.

Received 6 December 2005; accepted 8 June 2006; electronically published 24 August 2006.

Reprints or correspondence: Dr. Joanna D. Bell, Drexel University College of Medicine, Div. of Infectious Diseases and HIV/AIDS Medicine, 1427 Vine St. 5th Fl., Philadelphia, PA 19102 ().
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