       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).

