Schistosomiasis as IRES in HIV

By Carol A. Kemper, MD, FACP

Dr. Kemper is Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center.

Dr. Kemper does research for GSK Pharmaceuticals, Abbott Laboratories, and Merck. Editor Stan Deresinski, MD, FACP, Clinical Professor of Medicine, Stanford, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, serves on the speaker's bureau for Merck, Pfizer, Wyeth, Ortho-McNeill (J&J), Schering-Plough, and Cubist, does research for the National Institutes of Health, and is an advisory board member for Schering-Plough, Ortho-McNeil (J&J), and Cepheid. Peer reviewer Connie T. Price, MD, Assistant Professor, University of Colorado School of Medicine, reports no financial relationships relevant to this field of study.

Source: Psevdos G Jr. Schistosoma mansoni colitis in an AIDS patient. The AIDS Reader. December 16, 2009.

This article originally appeared in the March 2010 issue of Infectious Disease Alert.

An increasing number of HIV-positive immigrants and refugees, many from Africa, are cared for in the United States. The standard battery of HIV-related blood studies does not include screening studies for strongyloides and schistosomiasis. HIV co-infection with these two parasites is common in certain countries. At least 20% of HIV+ patients with bloody diarrhea in Zimbabwe had schistosomiasis. In a 10-year post-mortem survey in Puerto Rico, histologic evidence of S. mansoni was found in 10% of AIDS patients who died.

This author describes a patient with newly diagnosed AIDS, who had just started antiretroviral therapy four weeks earlier, who developed non-bloody diarrhea, fever, and peripheral eosinophilia (13%). Stool studies for bacteria, C. difficile, and ova and parasites were negative, and he failed to respond to an empiric course of metronidazole. Colonoscopy showed diffuse hyperemia, and biopsy showed an intense granulomatous response to schistosoma ova. Within days of starting praziquantel, his diarrhea resolved. A second, similar case described elsewhere also presented with diarrhea within weeks of initiation of HAART therapy. Colonoscopy revealed patchy colitis with a granulomatous response to schistosoma ova.

Schistosoma infection may result in acute symptomatic enteritis in patients with HIV as a manifestation of immune reactivation.