Textbook-Atlas of Intestinal Infections in AIDS

Springer-Verlag Italia

Daniele Dionisio (Ed)

Textbook-Atlas of Intestinal Infections in AIDS

Daniele Dionisio, M.D. Director Unit of Infectious Diseases Pistoia Hospital, Italy

This volume is published under the auspices of

The Liverpool School of Tropical Medicine The Centers for Disease Control and Prevention (CDC) The International AIDS Society (IAS) The International Association of Physicians in AIDS Care (IAPAC) The International Society of Travel Medicine (ISTM) The Italian Society for Infectious and Tropical Diseases (SIMIT) The National Association for the Fight Against AIDS (ANLAIDS) The Italian Society of Migration Medicine (SIMM) CUAMM (Doctors with Africa) The Tuscan Regional Government The Tuscan Regional Federation of the Italian Physicians

The Editor and Authors wish to thank Boehringer Ingelheim International for its generous contribution to this book.

© Springer-Verlag Italia 2003 Originally published by Springer-Verlag Italia, Milano in 2000 Softcover reprint of the hardcover 1st edition 2000 ISBN 978-88-470-2166-2 ISBN 978-88-470-2091-7 (eBook) DOI 10.1007/978-88-470-2091-7

Library of Congress Cataloging-in-Publication Data: applied for

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in databanks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law in its current version and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law.

The use of general descriptive names, registered names, trademarks, etc., in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

Product liability: The publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.

Typesetting: Compostudio, Cernusco sul Naviglio (Milano)

Cover design: Simona Colombo (Milano)

SPIN: 10875237

In memory of a generous colleague and teacher, Dr. Domenico Milo,

infectious disease specialist (Florence, March 20, 1937 - August 8, 2000)

keen fighter of the AIDS epidemic and humanitarian who always

helped the sick and disadvantaged

Foreword

The Textbook-Atlas of Intestinal Infections in AIDS occupies a unique niche in medical publishing.

This is a textbook that provides the most compre­hensive, scholarly review of gastrointestinal condi­tions found with HIV infection published to date. The work is authoritative and encyclopedic with sev­eral unique features: leading scholars are the authors, there is an extraordinary collection of photomicro­graphs, and contributions come from ten countries giving an unusual international appeal.

The authors of the chapters represent well-estab­lished authorities in the field. They bring diverse expertise to the work including substantial experi­ence in pathology, gastroenterology, infectious dis­eases, microbiology and, of course, HIV / AIDS.

An especially strong and unusual feature of the book is the photomicrographs, which represent a lo-year collection and provide the reader with an unusual level of high-quality visual documentation.

Particularly important is the geographic distribu­tion of the authorship. Gastrointestinal infections are very different in distinct geographic areas and this is well expressed in the diversity of clinical syndromes seen with AIDS, a difference that is now magnified by the distinctive features of the untreated disease in

resource-limited countries and HAART-treated dis­ease in developed countries. Thus, the reader is treat­ed to reviews by authorities from regions where the experience is most rich and extensive.

The gastrointestinal tract has always been one of three organ systems with the most extensive clinical and pathologic expression of HI V infection, primari­ly reflecting the consequences of depressed cell­mediated immunity. The work is comprehensive, including sections on epidemiology, clinical presen­tation, microbiology, pathology, and treatment.

This multidisciplinary, multinational review appears to be the most comprehensive treatise sum­marizing the 20-plus years of experience with extraordinarily diverse, serious and sometimes unique clinical and pathologic expressions as the gas­troenterologic complications of what is evolving as the most important epidemic of the past century.

John G. Bartlett, MD Department of Medicine, Johns Hopkins University

School of Medicine, Baltimore, USA

Foreword

Opportunistic intestinal infections have always played a major role in the clinical manifestations of acquired immunodeficiency syndrome (AIDS). Despite the dramatic decrease in HIV-related mor­bidity and mortality rates observed in the last few years in industrialized countries with the introduc­tion of potent antiretroviral therapy, relapsing intes­tinal parasitoses remain a potential threat in patients whose CD4 cell count decreases following treatment failure or discontinuation.

Because of the unavailability of antiretroviral treatments in low-income countries, these infections are a major cause of morbidity and mortality in AIDS patients in sub-Saharan Africa and other regions highly affected by HIV such as Latin America, the Caribbean, and central and Southeast Asia.

The Textbook-Atlas of Intestinal Infections in AIDS tackles these problems from a practical point of view and meets the needs of clinicians, students, and healthcare workers in both industrialized and in developing countries. As an international collabora-

tive work, the book provides high-level education and guidance, specifically addressing the epidemio­logical and immunological aspects, the reservoirs and ways of transmission from animal to man, as well as the diagnostic advances and changing patterns of prophylaxis and treatment. The effects of HIV on the gastrointestinal function, etiological and clinical aspects, and histologic and electron microscopic fea­tures are also detailed. Moreover, as a link between the past and the future, notes on intestinal para­sitoses in previous centuries and on worldwide trends and perspectives are included.

I truly believe that this book represents the most extensive review in the field, and that it fills a gap in the medical literature. It should become a standard of reference in the educational programs of industrial­ized and developing countries alike.

Stefano Vella, MD Istituto Superiore di Sanitd, Rome, Italy

Past President of the International AIDS Society

Contents

List of Contributors .

Introduction Daniele Dionisio.

Intestinal Parasitoses: A History of Scientific Progress and Endemic Disease in Society Esther Diana . ..................................... .

Natural History of HIV Infection Mauro Moroni, Stefano Rusconi, Agostino Riva

Immunopathogenesis of AIDS Fernando Aiuti, Marco Marziali, Antonella Isgro, Ivano Mezzaroma.

Advances in the Knowledge ofHIV-Related Impairment of Mucosal Immunity Roberto Manetti, Sergio Romagnani. . . . . . . . . . . . . . . . . . . . . . .

Effects of HIV Infection on Gastrointestinal Function Leon L. Lai, Tamsin A. Knox, Sherwood L. Gorbach . .

Cryptosporidiosis, Microsporidiosis, Isosporiasis, Cyclosporiasis, Leishmaniasis, Pneumocystosis and Toxoplasmosis From Animal to Man: Reservoirs and Ways of Transmission Ynes R. Ortega . ....................................... .

An Introduction to Mycobacterial Taxonomy, Structure, Drug Resistance, and Pathogenesis Nalin Rastogi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worldwide Epidemiology and Risk for International Travelers Giampiero Carosi, Francesco Castelli . ............. .

Oral Infections Peter A. Reichart.

Gut Infections: Etiopathogenetic and Clinical Remarks Daniele Dionisio. . . . . . . . . . . . . . . . . . . . .

Pathology Simonetta Di Lollo, Silvia Tozzini .

Ultrastructural Pathology Lidia Ibba Manneschi . . .

Sonographic Features of Intestinal Infections in AIDS Marcello Caremani, Emma Laura Lapini, Danilo Tacconi .

XI

1

7

35

47

59

65

79

117

127

137

211

233

253

X Contents

Imaging of Intestinal Manifestations of AIDS Michael Macari ............... .

Bacteria Kashi Nath Prasad, Jyotsna Agarwal.

Mycobacteria Enrico Tortoli .

Microsporidia Ingo Sobottka, Christel Schmetz, Justus Schottelius .

Leishmania, Cryptosporidium, Amoebae, Giardia, Blastocystis Massimo Scaglia, Simonetta Gatti . . . . . . . . . . . . . . .

Isospora belli and Cyclospora cayetanensis Mark L. Eberhard, Michael J. Arrowood ..

Fungal Infections of the Gastrointestinal Tract Edward J. Bottone, Shirish S. Huprikar.

Strongyloides stercoralis David I. Grove. . . . .

Human Herpesviruses Nazzarena Labo, Gianluca Vago, Giuseppe Gerna .

Enteric Viruses C. Anthony Hart, Nigel A. Cunliffe.

Latest Advances and Trends in PCR-Based Diagnostic Methods Alexandre J. da Silva, Norman J. Pieniazek. . . . . . . . . . . .

Changing Patterns of Prophylaxis and Treatment of Bacterial and Viral Intestinal Infections Saurabh Mehandru, Edmund J. Bini, Douglas T. Dieterich. . . . . . . . . . . . . . . . . . .

Treatment and Prophylaxis of Opportunistic Parasitic Intestinal Infections in HIV-Infected Patients Francis Derouin, Jean-Pierre Gangneux . . . . . . . .

Parasites Commonly Associated with Recognized Agents of AIDS-Related Chronic Diarrhea in Developing Countries Daniele Dionisio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Epidemiology and Comprehensive Management of HI V-Related Diarrhea in Africa Elly T. Katabira . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unique Clinical Problems in Latin America Eduardo Gotuzzo, Alejandro Bussalleu . ...

Gut Infection in HIV: Past, Present and Future Simon Portsmouth, Justin Stebbing, Brian Gazzard

Subject Index . . . . . . . . . . . . . . . . . . .

271

305

325

347

359

373

397

413

427

439

479

491

List of Contributors

Authors Jyotsna Agarwal Department of Microbiology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow-226014, India

Fernando Aiuti Department of Clinical Medicine University of Rome "La Sapienza" Azienda Policlinico Umberto I Viale dell'Universita 37 00185 Roma, Italy

Michael J. Arrowood Division of Parasitic Diseases F22 National Center for Infectious Diseases CDC 4770 Buford Hwy, NE Atlanta, GA 30341-3724, USA

John G. Bartlett Department of Medicine Johns Hopkins University School of Medicine 1830 E. Monument St., Room 437 Baltimore, USA

Edmund J. Bini Division of Gastroenterology V A New York Harbor Healthcare System and NYU School of Medicine 423 East 23rd Street New York, NY 10010, USA

Edward J. Bottone Department of Medicine Division of Infectious Diseases Box 1090 Mount Sinai School of Medicine One Gustave L Levy place New York, NY 10029, USA

Alejandro Bussalleu Instituto de Medicina Tropical "Alexander von Humboldt" Universidad Peruana Cayetano Heredia Lima, Peru

Marcello Caremani Infectious Disease Department San Donato Hospital ASL 8 Arezzo, Italy

Giampiero Carosi Institute of Infectious and Tropical Diseases University of Brescia Piazza Spedali Civili 1 25123 Brescia, Italy

Francesco Castelli Institute of Infectious and Tropical Diseases University of Brescia Piazza Spedali Civili 1 25123 Brescia, Italy

Nigel A. Cunliffe Department of Medical Microbiology and Genito­urinary Medicine Medical School, University of Liverpool Duncan Building, Daulby Street Liverpool, L69 3GA, United Kingdom

Alexandre J. da Silva CDC-Division of Parasitic Diseases 4700 Buford Highway NE Atlanta GA, 30341-3724 Mail Stop F36, USA

Francis Derouin Laboratoire de Parasitologie-Mycologie H6pital Saint-Louis 1 Avenue Claude Vellefaux 75475 Paris Cedex 10, France

XII List of Contributors

Esther Diana Documentation Centre for Florentine Health History Borgognissanti 20 50123 Firenze, Italy

Douglas T. Dieterich Department of Medicine Box 1118 The Mount Sinai Medical Center One Gustave L. Levy Place New York NY 10029-6574, USA

Simonetta Di Lollo Department of Human Pathology and Oncology University of Florence Viale Morgagni 85 50134 Firenze, Italy

Daniele Dionisio Unit of Infectious Diseases Pistoia Hospital Piazza Giovanni XXIII 51100 Pistoia, Italy

Mark L. Eberhard Division of Parasitic Diseases F22 National Center for Infectious Diseases CDC 4770 Buford Hwy, NE Atlanta, GA 30341-3724, USA

Jean-Pierre Gangneux Laboratoire de Parasitologie-Mycologie H6pital Pontchaillou 1 Rue Henri Ie Guilloux 35400 Rennes, France

Simonetta Gatti Laboratory of Parasitology Virology Service IRCCS Policlinico San Matteo Viale Taramelli 5 27100 Pavia, Italy

Brian Gazzard Chelsea and Westminster Hospital 369 Fulham Rd London SW109NH, UK

Giuseppe Gerna Servizio di Virologia IRCCS Policlinico San Matteo 27100 Pavia, Italy

Sherwood L. Gorbach Departments of Community Health and Medicine Tufts University School of Medicine 150 Harrison Avenue, Jaharis 268 Boston, MA 02111, USA

Eduardo Gotuzzo Instituto de Medicina Tropical "Alexander von Humboldt" Universidad Peruana Cayetano Heredia Lima, Peru

David I. Grove Department of Clinical Microbiology and Infectious Diseases Institute of Medical and Veterinary Science The Queen Elizabeth Hospital Adelaide, South Australia Australia 5011

C. Anthony Hart Department of Medical Microbiology and Genito­urinary Medicine Medical School, University of Liverpool Duncan Building, Daulby Street Liverpool, L69 3GA, UK

Shirish S. Huprikar Department of Medicine Division of Infectious Diseases Box 1090 Mount Sinai School of Medicine One Gustave L Levy Place New York, NY 10029, USA

Antonella Isgro Department of Clinical Medicine University of Rome "La Sapienza" Azienda Policlinico Umberto I Viale dell'Universita 37 00185 Roma, Italy

Elly T. Katabira Department of Medicine Makerere University Medical School P.O. Box 7072 Kampala, Uganda

Tamsin A. Knox Division of Gastroenterology Tufts New England Medical Center Boston, Massachusetts, USA

Nazzarena Labo Servizio di Virologia IRCCS Policlinico San Matteo 27100 Pavia, Italy

Emma Laura Lapini Infectious Disease Department San Donato Hospital ASL8 Arezzo, Italy

Leon 1. Lai Division of Infectious Diseases Tufts New England Medical Center Boston, Massachusetts, USA

Michael Macari Department of Radiology New York University Tisch Medical Center New York, NY, USA

Roberto Manetti Dep~rtment of Internal Medicine Section of Immunoallergology and Respiratory Diseases Viale Morgagni 85 50134 Firenze, Italy

Lidia Ibba Manneschi Department of Anatomy, Histology and Forensic Medicine Viale Morgagni, 85 University of Florence 50134 Firenze, Italy

Marco Marziali Department of Clinical Medicine University of Rome "La Sapienza" Azienda Policlinico Umberto I Viale dell'Universita 37 00185 Roma, Italy

Saurabh Mehandru Department of Medicine V ANew York Harbor Healthcare System and NYU School of Medicine 423 East 23rd Street New York, NY 10010, USA

Ivano Mezzaroma Department of Clinical Medicine University of Rome "La Sapienza" Azienda Policlinico Umberto I Viale dell'Universita 37 00185 Roma, Italy

List of Contributors XIII

Mauro Moroni Institute of InfectioUs and Tropical Diseases University of Milan 1. Sacco Hospital Via G. B. Grassi 74 20157 Milano, Italy

Y nes R. Ortega University of Georgia CFS, Dept. Food Science and Technology 1109 Experiment st. Griffin, GA 30223, USA

Norman J. Pieniazek CDC-Division of Parasitic Diseases 4700 Buford Highway NE Atlanta GA, 30341-3724 Mail Stop F36, USA

Simon Portsmouth Chelsea and Westminster Hospital 369 Fulham Rd London SWI09NH, UK

Kashi Nath Prasad Department of Microbiology Sanjay Gandhi Post-Graduate Institute of Medical Sciences Lucknow-226014, India

Nalin Rastogi Unite de la Tuberculose et des Mycobacteries, Institut Pasteur, Pointe a Pitre Cedex, Morne Joliviere BP 484, 97l65, Guadeloupe

Peter A. Reichart Charite, Campus Virchow Klinikum Zentrum fUr Zahnmedizin Abteilung Oralchirugie und zahnarztliche Rontgenologie Augustenburger Platz 1 D-13353 Berlin, Germany

Agostino Riva Institute of Infectious and Tropical Diseases University of Milan 1. Sacco Hospital Via G. B. Grassi 74 20157 Milano, Italy

XIV List of Contributors

Sergio Romagnani Department of Internal Medicine Section of Immunoallergology and Respiratory Diseases Viale Morgagni 85 50134 Firenze, Italy

Stefano Rusconi Institute of Infectious and Tropical Diseases University of Milan L. Sacco Hospital Via G. B. Grassi 74 20157 Milano, Italy

Massimo Scaglia Laboratory of Clinical Parasitology Department of Infectious Diseases University-IRCCS Policlinico San Matteo Viale Taramelli 5 27100 Pavia, Italy

Christel Schmetz Department of Parasitology Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany

Justus Schottelius Department of Parasitology Bernhard Nocht Institute for Tropical Medicine Hamburg, Germany

Ingo Sobottka Institute of Medical Microbiology and Immunology University Hospital Hamburg-Eppendorf Martinistr. 52 D-20246 Hamburg, Germany

Justin Stebbing Chelsea and Westminster Hospital 369 Fulham Rd London SWI09NH, UK

Danilo Tacconi Infectious Disease Department San Donato Hospital ASL8 Arezzo, Italy

Enrico Tortoli Regional Reference Center for Mycobacteria Microbiology and Virology Laboratory Careggi Hospital Viale Morgagni 85 50134 Firenze, Italy

Silvia Tozzini Department of Pathology University of Florence Viale Morgagni 85 50134 Firenze, Italy

Gianluca Vago Unita di Anatomia Patologica Department of Clinical Sciences "L. Sacco" University of Milan 20100 Milano, Italy

Stefano Vella Italian HIV Clinical Research Program Istituto Superiore di San ita Viale Regina Elena 299 00161 Roma, Italy

The authors thank the many people who contributed significantly to the realization of this volume

Photograph Contributors

Prof. El Moukhtar Aliouat, Ph.D., Parasitology-Mycology Service, Lille-2 Pharmaceutical Sciences Faculty, Lille, France

Prof. Pierre Ambroise-Thomas, Fac. Medecine et Pharmacie, Parasitologie, Domaine de la Merci 38700 La Tronche, France

Prof. Bradley A. Connor, M.D., Weill Medical College of Cornell University, Medical Director The New York Center for Travel and Tropical Medicine, New York, New York, USA

Prof. Simon Croft, Ph.D., Department ofInfectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

List of Contributors XV

Prof. Eduardo Dei-Cas, M.D., Ph.D., Parasitology-Mycology Service, Lille-2 University Hospital & Lille Pasteur Institute, Lille, France

Prof. Simonetta Di Lollo, M.D., Department of Human Pathology and Oncology, University of Florence, Firenze, Italy

Prof. Herbert 1. Du Pont, M.D., Chief, Internal Medicine, St. Luke's Episcopal Hospital, Houston, TX, USA

Dr. Pietro 1. Garavelli, M.D., Director, Infectious Diseases Unit, Ospedale Maggiore della Carita, Novara, Italy

Prof. Lidia Ibba Manneschi, M.D, Department of Histology, Anatomy, and Forensic Medicine, University of Florence, Firenze, Italy

Dr. Francesco Leoncini, M.D., Director, Infectious Diseases Unit, Careggi Hospital, Firenze, Italy

Dr. Antonio Macor, M.D., Infectious Diseases Unit, Hospital Amedeo di Savoia, Torino, Italy

Prof. Augusto J. Martinez t, University of Pittsburgh, School of Medicine, Department of Pathology, Division of Neuropathology, UPMC Presbyterian, Pittsburgh, Pennsylvania USA

Dr. Wipawee Nittayananta, M.D., Faculty of Dentistry, Prince of Songkla University, Haadyai, Songkhla, Thailand

Prof. Jan Marc Orenstein, M.D., Ph.D., Department of Pathology, University of Washington, Washington DC, USA

Dr. Alessandra Orsi, Ph.D., Laboratory for Microbiology and Virology, Careggi Hospital, Firenze, Italy

Dr. Patrizia Pecile, Ph.D., Laboratory for Microbiology and Virology, Careggi Hospital, Firenze, Italy

Dr. Roberto Rossetti, Ph.D, Director, Laboratory for Microbiology and Virology, Pistoia Hospital, Pistoia, Italy

Dr. Ettore Torelli, M.D., Director, Digestive Endoscopy Service, Pistoia Hospital, Pi stoia, Italy

Prof. Tom Van Gool, M.D., Department of Medical Microbiology and Parasitology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Prof. Govinda S. Visvesvara, Division of Parasitic Diseases, National Center for Infectious Diseases Centers for Disease Control and Prevention, Atlanta, GA, USA

Prof. Rainer Weber, M.D., Acting Head, Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland

Prof. Joseph Wheat, M.D., Department of Medicine and Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA

Graphic Illustration Contributors

Natale Diana, Professional Designer, Firenze: Figs. 80, 85, 87, 99, 105, 128 (chapter by D. Dionisio "Gut Infections: Etiopathogenetic and Clinical Remarks")

Claudio Fabbri, M.D., Infectious Diseases Unit, Pistoia Hospital: Tables at pages 203, 204, 207, 209, 449, 450, 451, 452, 458, 459

XVI List of Contributors

Manuela Uberti, M.D., Infectious Diseases Unit, Pistoia Hospital: Tables at pages 200, 201, 202, 205, 206, 208, 453, 454, 455, 456, 457

We thank the following persons for suggestions and critical review of the text:

Francesco Esperti, M.D., Daniela Messeri, M.D., Angela Vivarelli, M.D., Infectious Diseases Unit, Pistoia Hospital