{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T12:06:17Z","timestamp":1765627577359,"version":"3.48.0"},"reference-count":13,"publisher":"BMJ","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1990,8]]},"abstract":"<jats:p>Thirty three consecutive patients infected by human immunodeficiency virus type 1 (HIV1) with persistent diarrhoea which remained undiagnosed after microbiological examination of six stool samples and rectal histology were investigated for malabsorption. All had xylose and Schilling tests, distal duodenal biopsy, comprehensive barium studies, microbiological examination of six further stool samples, and repeat rectal histology. A microbiological or histological diagnosis of infection was made in 12 patients (multiple organisms in three). Cryptosporidia were identified on five occasions, cytomegalovirus on four, Giardia lamblia on two, and herpes simplex, Campylobacter jejuni, Salmonella enteritidis, and Entamoeba histolytica once each. No organism was found when weight loss was less than 5 kg or stool volume less than 400 ml\/day (n = 9). Pathogens were identified in nine of 13 patients (69%) with weight loss greater than 10 kg and stool volume more than 800 ml\/day. Barium studies were normal except for ileal flocculation in two patients with cryptosporidiosis. Evidence for malabsorption existed in 24 patients--impaired xylose absorption (n = 19) and abnormal Schilling test (n = 21). Of the patients with a severely abnormal Schilling test, a pathogen was identified in 11 (79%) (including all five with cryptosporidia, and two of the patients with only moderate diarrhoea and weight loss). A simple scoring system based on degree of weight loss and Schilling test result may help to identify the HIV positive patient with seemingly pathogen-negative diarrhoea in whom further investigations are likely to show a specific cause.<\/jats:p>","DOI":"10.1136\/gut.31.8.886","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"886-889","source":"Crossref","is-referenced-by-count":63,"title":["Investigation of seemingly pathogen-negative diarrhoea in patients infected with HIV1."],"prefix":"10.1136","volume":"31","author":[{"given":"G M","family":"Connolly","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B G","family":"Gazzard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1990,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/BF01535791","article-title":"Infectious diarrhea in patients with AIDS","volume":"33","author":"Antony, M.A.; Brandt, L.J.; Klein, R.S.; Bernstein, L.H.","year":"1988","unstructured":"Antony MA, Brandt LJ, Klein RS, Bernstein LH. Infectious diarrhea in patients with AIDS. Dig Dis Sci 1988; 33: 1141-6.","journal-title":"Dig Dis Sci"},{"key":"ref_2","first-page":"259","article-title":"Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms","volume":"i:","author":"Nelson, J.A.; Wiley, C.A.; Reynolds-Kohler, C.; Reese, C.E.; Margaretten, W.; Levy, J.A.","year":"1988","unstructured":"Nelson JA, Wiley CA, Reynolds-Kohler C, Reese CE, Margaretten W, Levy JA. Human immunodeficiency virus detected in bowel epithelium from patients with gastrointestinal symptoms. Lancet 1988; i: 259-62.","journal-title":"Lancet"},{"key":"ref_3","first-page":"334","article-title":"Centers for Disease Control. Classification system for human T-lymphotropic virus type III\/lymphadenopathy-associated virus infections","volume":"35","year":"1986","unstructured":"Centers for Disease Control. Classification system for human T-lymphotropic virus type III\/lymphadenopathy-associated virus infections. MMWR 1986; 35: 334-9.","journal-title":"MMWR"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1128\/JCM.18.1.185-190.1983","article-title":"Techniques for the recovery and identification of cryptosporidium oocysts from stool specimens","volume":"18","author":"Garcia, L.S.; Bruckner, D.A.; Brewer, T.C.; Shimizu, R.Y.","year":"1983","unstructured":"Garcia LS, Bruckner DA, Brewer TC, Shimizu RY. Techniques for the recovery and identification of cryptosporidium oocysts from stool specimens. 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Br J Radiol 1987; 60: 1071-81.","journal-title":"Br J Radiol"},{"key":"ref_7","first-page":"553","article-title":"Selection and interpretation of diagnostic tests and procedures: principles and applications","volume":"94","author":"Griner, P.F.; Mayewski, R.J.; Al, Mushlin; Greenland, P.","year":"1981","unstructured":"Griner PF, Mayewski RJ, Mushlin Al, Greenland P. Selection and interpretation of diagnostic tests and procedures: principles and applications. Ann Intern Med 1981; 94: 553-600.","journal-title":"Ann Intern Med"},{"key":"ref_8","first-page":"1392","article-title":"Diagnostic systems as an aid to clinical decision making","volume":"295","author":"Knill-Jones, R.P.","year":"1987","unstructured":"Knill-Jones RP. Diagnostic systems as an aid to clinical decision making. BrMedJ 1987; 295: 1392-6.","journal-title":"BrMedJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/gut.30.2.195","article-title":"Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients","volume":"30","author":"Connolly, G.M.; Shanson, D.; Hawkins, D.A.; Harcourt-Webster, J.N.; Gazzard, B.G.","year":"1989","unstructured":"Connolly GM, Shanson D, Hawkins DA, Harcourt-Webster JN, Gazzard BG. Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients. Gut 1989; 30: 195-200.","journal-title":"Gut"},{"key":"ref_10","first-page":"209","article-title":"Intestinal microsporidiosis as a cause of diarrhoea in AIDS","volume-title":"Vth International Conference on AIDS, Montreal","volume":"1989","author":"Orenstein, J.; Steinberg, W.; Chiang, J.; Smith, P.; Rotterdam, H.; Kotler, D.","unstructured":"Orenstein J, Steinberg W, Chiang J, Smith P, Rotterdam H, Kotler D. Intestinal microsporidiosis as a cause of diarrhoea in AIDS. Vth International Conference on AIDS, Montreal, 1989: 209 (Abstract)."},{"key":"ref_11","first-page":"358","article-title":"Variable localization of intestinal cryptosporidiosis in AIDS","volume-title":"Vth International Conference on AIDS, Montreal","volume":"1989","author":"Heller, T.D.; Tierney, A.R.; Kotler, D.","unstructured":"Heller TD, Tierney AR, Kotler D. Variable localization of intestinal cryptosporidiosis in AIDS. Vth International Conference on AIDS, Montreal, 1989: 358 (Abstract)."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1097\/00002030-198907000-00009","article-title":"Investigation of upper gastrointestinal symptoms in patients with AIDS","volume":"3","author":"Connolly, G.M.; Forbes, A.; Gleeson, J.A.; Gazzard, B.G.","year":"1989","unstructured":"Connolly GM, Forbes A, Gleeson JA, Gazzard BG. Investigation of upper gastrointestinal symptoms in patients with AIDS. AIDS 1989; 3: 453-6.","journal-title":"AIDS"},{"key":"ref_13","first-page":"735","article-title":"Value of barium enema and colonoscopy in HIV positive patients with diarrhoea","volume":"30","author":"Connolly, G.M.; Forbes, A.; Gazzard, B.G.","year":"1989","unstructured":"Connolly GM, Forbes A, Gazzard BG. Value of barium enema and colonoscopy in HIV positive patients with diarrhoea. 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