Peculiarities of chronic diarrhea in Enugu, southeastern Nigeria

Adult patients admitted with chronic diarrhea to the various wards of the University of Nigeria Teaching Hospital, Enugu, from August 1996 to October 1997 were evaluated further by detailed history-taking, thorough physical examination, serological testing for HIV infection, and stool microscopy. Of 189 patients with chronic diarrhea seen during the study period, 161 had human immunodeficiency virus (HIV) infection (85.2%) whereas 28 were HIV negative (14.9%). Other clinical findings such as weight loss, persistent cough, skin rash prolonged fever, genital ulcers, sore throat, chronic ear discharge, chronic vaginal discharge, oral thrush, herpes zoster, and sinusitis were significantly more frequent in the HIV-infected group. Diarrhea was equally more severe in this group than in the HIV-negative controls. Only Entamoeba histolytica (E. histolytica) was significantly more frequently identified in the HIV-infected patients compared with the HIV-negative group. However, since the E. histolytica was present mainly in its cyst form, it cannot be said to have any pathogenic role in the diarrhea. No acid-fast organism was identified. The microbial causes of chronic diarrhea in HIV-infected patients in Enugu may be significantly different from those reported in other parts of Africa and the developed world.