Enteric Coccidiosis among Patients with the Acquired Immunodeficiency Syndrome

Mark E. WhitesideDivision of Tropical Medicine, Department of Epidemiology and Public Health, and the Divisions of Gastroenterology and General Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101

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Jamie S. BarkinDivision of Tropical Medicine, Department of Epidemiology and Public Health, and the Divisions of Gastroenterology and General Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101

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Richard G. MayDivision of Tropical Medicine, Department of Epidemiology and Public Health, and the Divisions of Gastroenterology and General Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101

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Stephen D. WeissDivision of Tropical Medicine, Department of Epidemiology and Public Health, and the Divisions of Gastroenterology and General Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101

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Margaret A. FischlDivision of Tropical Medicine, Department of Epidemiology and Public Health, and the Divisions of Gastroenterology and General Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101

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Caroline L. MacLeodDivision of Tropical Medicine, Department of Epidemiology and Public Health, and the Divisions of Gastroenterology and General Medicine, Department of Medicine, University of Miami School of Medicine, Miami, Florida 33101

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Ten patients were identified at Jackson Memorial hospital/University of Miami Hospitals and Clinics with enteric coccidial infection due to Cryptosporidium spp. or Isospora belli. All had the acquired immunodeficiency syndrome as manifested by Kaposi's sarcoma or multiple opportunistic infections, or both. They presented with profuse diarrhea associated with weakness, anorexia, and weight loss. Routine examinations of stools for eggs and parasites as performed by the hospital laboratory were negative in all patients. Sugar flotation and modified acid fast techniques were used in the Tropical Disease Laboratory to identify oocysts of Cryptosporidium spp. in stools of seven patients. Malabsorption, characterized by a low 5-hour D-xylose and positive fecal fat, was observed in 6/6 of these patients. In three other patients Isospora belli oocysts were identified in stool specimens or via a duodenal string test. Spiramycin was the only drug found to be effective in treating patients with cryptosporidiosis. Patients with Isospora belli responded to a prolonged course of trimethoprim-sulfamethoxazole.

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