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1996-02-27
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Document 0509
DOCN M9630509
TI Biliary cryptosporidiosis in HIV-infected people after the waterborne
outbreak of cryptosporidiosis in Milwaukee.
DT 9603
AU Vakil NB; Schwartz SM; Buggy BP; Brummitt CF; Kherellah M; Letzer DM;
Gilson IH; Jones PG; Department of Medicine, University of Wisconsin
Medical School,; Milwaukee, USA.
SO N Engl J Med. 1996 Jan 4;334(1):19-23. Unique Identifier : AIDSLINE
MED/96105279
AB BACKGROUND. In March 1993, the municipal water supply in Milwaukee
became contaminated with cryptosporidium and a widespread outbreak of
cryptosporidiosis occurred. METHODS. We retrospectively studied the
relations among the clinical presentation, CD4 count, and survival in a
group of 82 patients infected with the human immunodeficiency virus
(HIV) in whom cryptosporidiosis developed during the outbreak. Infection
was documented by the finding of cryptosporidium in stool. RESULTS.
There was a sharp increase in the number of HIV-infected patients with
cryptosporidiosis after the period of water contamination. Four of 24
patients with biliary symptoms (17 percent) and 30 of 58 without biliary
symptoms (52 percent) were alive one year after the outbreak (P =
0.003). Twenty-one of the patients with biliary symptoms had CD4 counts
< or = 50 per cubic millimeter, as compared with 36 of 57 patients
without biliary symptoms (88 percent vs. 63 percent, P = 0.03). The CD4
count was not available for one patient in the latter group. Within one
year, 41 of the patients with CD4 counts < or = 50 per cubic millimeter
had died, as compared with 6 of those with higher counts (72 percent vs.
25 percent, P < 0.001). After adjustment for the CD4 count, independent
predictors of death were older age and the presence of nausea and
vomiting. CONCLUSIONS. When HIV-infected patients are exposed to
cryptosporidium, those with CD4 counts < or = 50 per cubic millimeter
are at increased risk for biliary symptoms and for death within one year
after the infection.
DE Acquired Immunodeficiency Syndrome/COMPLICATIONS/IMMUNOLOGY/ MORTALITY
Adult Animal AIDS-Related Opportunistic
Infections/EPIDEMIOLOGY/ETIOLOGY/ *MORTALITY Biliary Tract
Diseases/EPIDEMIOLOGY/ETIOLOGY/*MORTALITY/ PARASITOLOGY
Cryptosporidiosis/EPIDEMIOLOGY/ETIOLOGY/*MORTALITY CD4 Lymphocyte Count
Disease Outbreaks Human HIV
Infections/COMPLICATIONS/IMMUNOLOGY/*MORTALITY Minnesota/EPIDEMIOLOGY
Retrospective Studies Risk Factors Support, Non-U.S. Gov't Survival
Analysis JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).