Gastrointestinal infections in immunocompromised hosts

Curr Opin Gastroenterol. 2006 Jan;22(1):18-23. doi: 10.1097/01.mog.0000196149.29077.0d.


Purpose of review: Gastrointestinal infections in the immunocompromised host continue to have significant morbidity and mortality throughout the world. They all have similar exposures to viruses, bacteria and parasites and respond to these infections in a similar way. This review will summarize the latest reports on the epidemiology, diagnosis and treatment of known and emerging infections over the last 12 months.

Recent findings: Highly active antiretroviral therapy has reduced esophageal opportunistic infections in HIV patients compared to patients who are not taking this therapy. Esophageal candidiasis responds to escalating doses of micafungin as effectively as fluconazole. HIV-infected patients with untreated Mycobacterium avium-complex diarrhea are associated with a wasting syndrome that disrupts the somatostatin axis. Polymerase chain reaction testing has improved diagnosis of microsporidial infections. Cytomegalovirus polymerase chain reaction of tissue may improve the diagnosis of cytomegalovirus disease of the gastrointestinal tract in organ-transplant recipients. The treatment of hypogammaglobulinemia in transplant recipients with recurrent cytomegalovirus gastrointestinal disease may resolve their symptoms. Community viruses are an emerging threat to transplant recipients and may affect drug levels. Lastly, anti-tumor necrosis factor alpha therapy in the treatment of inflammatory conditions may cause Listeria monocytogenes to disseminate.

Summary: Immunocompromised hosts remain at risk for severe gastrointestinal and even disseminated infections. Management includes an early rapid diagnosis with rapid restoration of the immune system and appropriate anti-infective therapy. With the immunocompromised population rapidly increasing, prevention of these infections remains the greatest challenge.

Publication types

  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / epidemiology*
  • Anti-Infective Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Cytomegalovirus Infections / diagnosis
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / epidemiology*
  • Diarrhea / drug therapy
  • Diarrhea / epidemiology
  • Diarrhea / microbiology
  • Drug Therapy, Combination
  • Female
  • Gastrointestinal Diseases / epidemiology*
  • Gastrointestinal Diseases / microbiology
  • Gastrointestinal Diseases / virology
  • Humans
  • Immunocompromised Host*
  • Incidence
  • Male
  • Prevalence
  • Prognosis
  • Risk Assessment
  • Severity of Illness Index
  • Survival Rate


  • Anti-Infective Agents
  • Antiviral Agents