Granulomatous Lymphadenitis as a Manifestation of Q Fever

five of the patients with watery chronic diarrhea (one patient died), improved within 10 days of treatment. In Dakar, during the study describing ordinary and opportunistic enteropathogens associated with diarrhea in adults (5), stool samples were collected from five HIV-infected adults with watery chronic diarrhea. In all cases, heavy K. pneumoniae growth was observed on the primary culture media, and no other known pathogens were recovered. These K. pneumoniae strains were subjected to the same phenotypic and genotypic tests as the strains isolated in Bangui. HEp2–adherent K. pneumoniae was identified in four of these five samples. The condition of all the patients rapidly improved after treatment with ofloxacin. In Bangui and Dakar, repeated stool cultures were negative for K. pneumoniae by the end of treatment, providing further evidence that these K. pneumoniae were of etiologic importance, especially the HEp-2– adherent K. pneumoniae strains. Only seven patients (four with mild, two with watery, and one with bloody chronic diarrhea) had not taken antibiotics during the 2 weeks before stool collection. The stool specimens from these seven patients yielded pure primary cultures of HEp2–adherent K. pneumoniae and no other bacterial enteric pathogens. None of these seven participants was diagnosed with pseudomembranous colitis. The HEp-2–adherent K. pneumoniae strains isolated from the two participants with watery chronic diarrhea induced the accumulation of fluid in ligated rabbit ileal loops, and the HEp-2–adherent strains isolated from three of the participants with mild chronic diarrhea carried the astA gene, which is associated with pathogenic EAEC. Among the five patients with pseudomembranous colitis, all of whom had received antibiotics before the onset of illness, we found that the four isolates from the patients with bloody chronic diarrhea were cytopathogenic; the one isolate from the patient with watery chronic diarrhea had the pathogenic marker for enteroaggregative E. coli. These findings suggest that not only is K. pneumoniae associated with chronic diarrhea in HIV-infected persons but also that infection with particular HEp-2adherent K. pneumoniae subtypes may be associated with specific clinical illness.