Résumé
Parmi les diarrhées chroniques, certaines sont de mécanisme infectieux ou dysimmunitaire. L’orientation diagnostique est largement guidée par le terrain sur lequel elles surviennent. Chez le patient infecté pour le VIH, le degré d’immunodépression doit être important pour être responsable d’une diarrhée infectieuse opportuniste. Celleci peut être d’origine parasitaire (cryptosporidies, microsporidies, Isospora belli, giardiase) ou bactérienne (mycobactéries atypiques, tuberculose, Clostridium difficile). Lors d’un déficit immunitaire primitif, la diarrhée chronique peut être la manifestation d’une atrophie villositaire associée ou d’une surinfection chronique. Quel que soit le statut immunitaire du patient, la giardiase peut être responsable d’une diarrhée et d’une malabsorption. Elle doit être systématiquement recherchée. Les antécédents du patient (montage chirurgical, diabète, achlorhydrie, immunodépression, etc.) peuvent également orienter vers une pullulation microbienne intestinale. La maladie de Whipple, bien que très rare, doit être évoquée facilement, car son traitement est simple et prévient une évolution fatale.
Abstract
Clinical background is an essential data to achieve diagnosis of chronic diarrhea from infectious or immune dysfunction etiology. In HIV patients when the immune deficiency is important, diarrhea can be related to opportunistic infection. This diarrhea may be due to parasitic or bacterial infection. In primary immunodeficiency disorders, villous atrophy may also explain chronic diarrhea. Giardiasis, responsible for diarrhea and malabsorption, should always be looked for, because immune competent patients are not spared. Some specific clinical data (surgery history, achlorhydria, diabetes, immune deficiency, etc.) may be relevant to diagnose gut microbial pullulation. Whipple disease, although rare, should be kept in mind as treatment is easy and prognosis without treatment is very poor.
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Polin, V., Hagège, H. Diarrhées chroniques infectieuses et dysimmunitaires. Colon Rectum 4, 108–114 (2010). https://doi.org/10.1007/s11725-010-0222-4
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DOI: https://doi.org/10.1007/s11725-010-0222-4
Mots clés
- Immunodépression
- Infection par le VIH
- Déficit immunitaire primitif
- Giardiase
- Pullulation microbienne intestinale
- Maladie de Whipple