A clinicopathologic analysis of AIDS-related cryptosporidiosis

Jeanne Ann Lumadue, Yukari C. Manabe, Richard D. Moore, Peter C. Belitsos, Cynthia L. Sears, Douglas P. Clark

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objective: To characterize the histology of AIDS-associated cryptosporidiosis and identify features that explain the clinical variability. Design: A retrospective analysis of HIV-positive individuals with cryptosporidiosis who underwent endoscopy at the Johns Hopkins Hospital between 1985 and 1996. Methods: The histologic features (intensity of Cryptosporidium infection, inflammation, mucosal damage, copathogens) of gastrointestinal biopsies from 37 HIV-positive individuals with cryptosporidiosis were systematically graded. These histologic features were correlated with the severity of the diarrheal illness obtained from a patient chart review. Results: Histologic features associated with Cryptosporidium infection include a neutrophilic infiltrate in the stomach, villus blunting in the duodenum, cryptitis and epithelial apoptosis in the colon, and reactive epithelial changes in the stomach and duodenum. The nature and intensity of the inflammatory response varied widely; however, duodenal biopsies from a subset of patients (37%) revealed marked acute inflammation that was associated with concomitant cytomegalovirus infection. Although duodenal infection was common (93% of individuals), infection of other sites was variable (gastric cryptosporidiosis in 40% and colonic cryptosporidiosis in 74%). Widespread infection of the intestinal tract, which included both the large and small intestine, was associated with the most severe diarrheal illness. Conclusions: Cryptosporidium infection produces histologic evidence of gastrointestinal mucosal injury. The inflammatory response to the infection is variable, and may be modified by copathogens such as cytomegalovirus. The clinical manifestations are influenced, in part, by the anatomic distribution of the infection, with extensive infections involving both small and large intestines producing the most severe illness.

Original languageEnglish (US)
Pages (from-to)2459-2466
Number of pages8
JournalAIDS
Volume12
Issue number18
DOIs
StatePublished - Dec 24 1998

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Cryptosporidiosis
Acquired Immunodeficiency Syndrome
Infection
Cryptosporidium
Stomach
Large Intestine
Duodenum
Small Intestine
HIV
Inflammation
Biopsy
Cytomegalovirus Infections
Cytomegalovirus
Endoscopy
Histology
Colon
Apoptosis

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Lumadue, J. A., Manabe, Y. C., Moore, R. D., Belitsos, P. C., Sears, C. L., & Clark, D. P. (1998). A clinicopathologic analysis of AIDS-related cryptosporidiosis. AIDS, 12(18), 2459-2466. https://doi.org/10.1097/00002030-199818000-00015
Lumadue, Jeanne Ann ; Manabe, Yukari C. ; Moore, Richard D. ; Belitsos, Peter C. ; Sears, Cynthia L. ; Clark, Douglas P. / A clinicopathologic analysis of AIDS-related cryptosporidiosis. In: AIDS. 1998 ; Vol. 12, No. 18. pp. 2459-2466.
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abstract = "Objective: To characterize the histology of AIDS-associated cryptosporidiosis and identify features that explain the clinical variability. Design: A retrospective analysis of HIV-positive individuals with cryptosporidiosis who underwent endoscopy at the Johns Hopkins Hospital between 1985 and 1996. Methods: The histologic features (intensity of Cryptosporidium infection, inflammation, mucosal damage, copathogens) of gastrointestinal biopsies from 37 HIV-positive individuals with cryptosporidiosis were systematically graded. These histologic features were correlated with the severity of the diarrheal illness obtained from a patient chart review. Results: Histologic features associated with Cryptosporidium infection include a neutrophilic infiltrate in the stomach, villus blunting in the duodenum, cryptitis and epithelial apoptosis in the colon, and reactive epithelial changes in the stomach and duodenum. The nature and intensity of the inflammatory response varied widely; however, duodenal biopsies from a subset of patients (37{\%}) revealed marked acute inflammation that was associated with concomitant cytomegalovirus infection. Although duodenal infection was common (93{\%} of individuals), infection of other sites was variable (gastric cryptosporidiosis in 40{\%} and colonic cryptosporidiosis in 74{\%}). Widespread infection of the intestinal tract, which included both the large and small intestine, was associated with the most severe diarrheal illness. Conclusions: Cryptosporidium infection produces histologic evidence of gastrointestinal mucosal injury. The inflammatory response to the infection is variable, and may be modified by copathogens such as cytomegalovirus. The clinical manifestations are influenced, in part, by the anatomic distribution of the infection, with extensive infections involving both small and large intestines producing the most severe illness.",
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Lumadue, JA, Manabe, YC, Moore, RD, Belitsos, PC, Sears, CL & Clark, DP 1998, 'A clinicopathologic analysis of AIDS-related cryptosporidiosis', AIDS, vol. 12, no. 18, pp. 2459-2466. https://doi.org/10.1097/00002030-199818000-00015

A clinicopathologic analysis of AIDS-related cryptosporidiosis. / Lumadue, Jeanne Ann; Manabe, Yukari C.; Moore, Richard D.; Belitsos, Peter C.; Sears, Cynthia L.; Clark, Douglas P.

In: AIDS, Vol. 12, No. 18, 24.12.1998, p. 2459-2466.

Research output: Contribution to journalArticle

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T1 - A clinicopathologic analysis of AIDS-related cryptosporidiosis

AU - Lumadue, Jeanne Ann

AU - Manabe, Yukari C.

AU - Moore, Richard D.

AU - Belitsos, Peter C.

AU - Sears, Cynthia L.

AU - Clark, Douglas P.

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N2 - Objective: To characterize the histology of AIDS-associated cryptosporidiosis and identify features that explain the clinical variability. Design: A retrospective analysis of HIV-positive individuals with cryptosporidiosis who underwent endoscopy at the Johns Hopkins Hospital between 1985 and 1996. Methods: The histologic features (intensity of Cryptosporidium infection, inflammation, mucosal damage, copathogens) of gastrointestinal biopsies from 37 HIV-positive individuals with cryptosporidiosis were systematically graded. These histologic features were correlated with the severity of the diarrheal illness obtained from a patient chart review. Results: Histologic features associated with Cryptosporidium infection include a neutrophilic infiltrate in the stomach, villus blunting in the duodenum, cryptitis and epithelial apoptosis in the colon, and reactive epithelial changes in the stomach and duodenum. The nature and intensity of the inflammatory response varied widely; however, duodenal biopsies from a subset of patients (37%) revealed marked acute inflammation that was associated with concomitant cytomegalovirus infection. Although duodenal infection was common (93% of individuals), infection of other sites was variable (gastric cryptosporidiosis in 40% and colonic cryptosporidiosis in 74%). Widespread infection of the intestinal tract, which included both the large and small intestine, was associated with the most severe diarrheal illness. Conclusions: Cryptosporidium infection produces histologic evidence of gastrointestinal mucosal injury. The inflammatory response to the infection is variable, and may be modified by copathogens such as cytomegalovirus. The clinical manifestations are influenced, in part, by the anatomic distribution of the infection, with extensive infections involving both small and large intestines producing the most severe illness.

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Lumadue JA, Manabe YC, Moore RD, Belitsos PC, Sears CL, Clark DP. A clinicopathologic analysis of AIDS-related cryptosporidiosis. AIDS. 1998 Dec 24;12(18):2459-2466. https://doi.org/10.1097/00002030-199818000-00015