Prevalencia de microsporidios intestinales y otros enteroparásitos en pacientes con VIH positivo de Maracaibo, Venezuela / Prevalence of intestinal microsporidia and other intestinal parasites in hiv positive patients from Maracaibo, Venezuela.

Introducción. Desde 1985, los microsporidios se consideran parásitos causantes de infecciones emergentes y oportunistas en individuos inmunocomprometidos en todo el mundo. Objetivo. Detectar la presencia de microsporidios y otros enteroparásitos en pacientes con VIH/sida del Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM), donde no existían estudios previos en este campo. Materiales y métodos. Las muestras fecales se analizaron mediante examen directo, método de concentración con formol-éter, coloración de Kinyoun y coloración Gram-cromotropo rápida. Se realizaron PCR separadas para diferenciar Entamoeba histolytica o Entamoeba dispar , cuando se observó el complejo E. histolytica/dispar al microscopio. Mediante historia clínica se obtuvo información del paciente. Resultados. De los 56 individuos participantes, 38 (67,86 %) presentaron alguna especie parasitaria comensal o patógena en su muestra fecal. Predominaron los individuos portadores de especies parásitas patógenas (26/38). Fueron diagnosticados protozoos como Isospora belli (17,65 %), Blastocystis spp .(17,65 %), Cryptosporidium spp. (7,84 %), complejo Entamoeba histolytica/dispar (5,88 %) , Entamoeba coli (3,92 %) , Giardia lamblia (3,92 %) , Endolimax nana (3,92 %) , Cyclospora cayetanensis (3,92 %) y Chilomastix mesnili (1,96 %). Entre los helmintos, Ascaris lumbricoides, Trichuris trichiura y Strongyloides stercoralis, presentaron un porcentaje de 27,27 % cada uno, e Hymenolepis nana , de 18,18 %. Solo se detectó E. histolytica en uno de los tres casos que presentaron el complejo al examen microscópico. Mediante Gram-cromotropo, 17 muestras evidenciaron esporas del filo Microsporidia, lo que equivale a un 33,33 % de prevalencia. Conclusión. Los microsporidios pueden ocupar el primer lugar de prevalencia en pacientes con VIH positivo, cuando se utilizan técnicas diagnósticas específicas.

Objective: To detect the presence of microsporidia and other enteric parasites in patients with HIVAIDS of the Autonomous Services University Hospital of Maracaibo (SAHUM), where there are no previous studies in this field. Materials and methods: Fecal samples were analyzed by means of direct exam, concetration method with formal-ether, Kinyoun coloration and fast Gram-Chromotrope coloration. Separate PCR were perfomed to differentiate Entamoeba histolytica and Entamoeba dispar , when the E. histolytica/E. dispar complex was observed in the microscope. Information on the patient was obtained trough clinical history. Results: Of 56 individuals that participated, 38 (67.86%) presented some commensal parasite and/ or pathogenic species in their fecal sample. Carriers of pathogenic species were predominat (26/38). Protozoa such as Isospora belli protozoa (17.65%), Blastocystis spp. (17.65%), Cryptosporidium spp. (7.84%), E. histolytica/E. dispar (5.88%), Entamoeba coli (3.92%), Giardia lamblia (3.92%), Endolimax nana (3.92%), Cyclospora cayetanensis (3.92%), and Chilomastix mesnilli (1.96%) were diagnosed. Among the helminths, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercoralis , had a percentage of 27.27% each, and Hymenolepis nana , 18.18%. Entamoeba histolytica was only detected in one of three cases presenting complex microscopic examination. By Gram-chromotrope, 17 samples showed spores of the Microsporidia phylum, equivalent to 33.33% prevalence. Conclusion: Microsporidia may be first prevalente in HIV positive patients when specific diagnostic techniques are used.

Oral colonization by yeasts in HIV-positive patients in Brazil / Colonização oral por leveduras em pacientes HIV-positivos no Brasil

INTRODUCTION: In HIV-infected patients, colonization of the oral cavity by potential pathogenic yeast may lead to development of systemic fungemia. We evaluated the prevalence of yeast in the oral cavity of Brazilian HIV-positive patients and verified whether or not the species characterized were enzymatically active. Furthermore, the species identified were tested for their susceptibility to antifungal treatment. METHODS: Patient saliva and oropharyngeal candidiasis samples were collected from 60 seropositive HIV patients and identified by the API20C system. Enzymatic activity was evaluated by the production of proteinase and phospholipase. Susceptibility to antifungal treatments were determined using the broth microdilution method. RESULTS: the most commonly isolated species were C. albicans (51.56 percent) followed by non-albicans Candida species (43.73 percent), Trichosporon mucoides (3.12 percent) and Kodamaea ohmeri (1.56 percent). Oral colonization by association of different species was observed in 42 percent of the patients. Enzymatic activity was verified in most of species isolated, except for C. glabrata, C. lusitaniae and C. guilliermondii. Resistance to Fluconazole and Amphotericin B was observed in isolates of C. albicans, C. glabrata, C. parapsilosis, C. krusei, and K. ohmeri. CONCLUSION: HIV-positive patients are orally colonized by single or multiple species of yeast that are occasionally resistant to Fluconazole or Amphotericin B.

INTRODUÇÃO: Em pacientes infectados pelo HIV, a colonização da cavidade bucal por leveduras patogênicas pode levar ao desenvolvimento de fungemias. No presente estudo, avaliamos a prevalência de leveduras na cavidade bucal de pacientes HIV-positivos e verificamos se as espécies isoladas foram enzimaticamente ativas. Além disso, as espécies identificadas foram testadas quanto à suscetibilidade a antifúngicos. MÉTODOS: Amostras de saliva e de candidose orofaríngea foram coletadas de 60 pacientes soropositivos para HIV e identificados pelo sistema API20C. A atividade enzimática foi avaliada pela produção de proteinase e fosfolipase. A suscetibilidade a antifúngicos foi determinada utilizando o método de microdiluição em caldo. RESULTADOS: As espécies mais comumente isoladas foram C. albicans (51,56 por cento), seguido por espécies de Candida não-albicans (43,73 por cento), Trichosporon mucoides (3,12 por cento) e Kodamaea ohmeri (1,56 por cento). A colonização bucal por associação de diferentes espécies foi observada em 42 por cento dos pacientes. A atividade enzimática foi verificada na maioria das espécies isoladas, com exceção de C. glabrata, C. lusitaniae e C. guilliermondii. Resistência ao fluconazol e anfotericina B foi observada em isolados de C. albicans, C. glabrata, C. parapsilosis, C. krusei, e K. ohmeri. CONCLUSÃO: Os pacientes HIV-positivos são colonizados por espécies únicas ou múltiplas de levedura que ocasionalmente são resistentes ao fluconazol ou anfotericina B.

Tumor cervical por Salmonella Typhimurium como forma de presentación clínica de SIDA en un paciente con infección por VIH / Cervical mass caused by Salmonella Typhimurium as a clinical presentation of AIDS in a HIV-positive patient

Infections due to non-typhi salmonellae (NTS) generally cause a mild and self-limited gastrointestinal disease. However, there have been reports of atypical and severe presentations in immunocompromised patients. We report the case of a male patient who consulted with a cervical mass. He was found to be HIV-positive and Salmonella Typhimurium was isolated in one blood culture and cervical mass tissue culture. We discuss the relevance of infections by NTS in immunodeficient patients because they present with more severe illness than normal population. We emphasize the importance of NTS bacteremia as a marker of underlying immunodeficiency. We present some localized infection sites reported in the literature and their relation with particular diseases. We discuss the future relevance that an early start of antiretroviral therapy (ART) may have in HIV patients with NTS acute bacteremia or focal infections. Because infections by NTS can be severe and highly lethal they must be considered in the differential diagnosis of causative organisms of localized infections and bacteremia in HIV patients.

Las infecciones por Salmonella no-Typhi (SNT) en general se tratan de cuadros gastrointestinales benignos y autolimitados en pacientes sin patología de base. Sin embargo, se han descrito presentaciones atípicas y más graves en pacientes con algún grado de compromiso inmunológico. Presentamos el caso de un paciente de sexo masculino el cual consultó por un tumor cervical de gran tamaño. Se diagnosticó infección por VIH y se aisló Salmonella Typhimurium en un hemocultivo y en un cultivo de tejido de masa cervical. Discutimos la importancia de las infecciones por Salmonella no Typhi en el grupo de pacientes con inmunosupresión debido a que presentan cuadros más graves que la población normal. Destacamos la importancia de la bacteriemia por Salmonella no Typhi como marcadoras de inmunosupresión subyacente. Presentamos algunos sitios de infección focal reportados en la literatura médica y su relación con algunas enfermedades particulares. Nos referimos a la importancia que podría tener en el futuro el inicio precoz de terapia anti-retroviral en pacientes con infección por VIH cursando bacteriemias o infecciones focales por Salmonella no Typhi. Debido a la gravedad y alta mortalidad que pueden presentar las infecciones por Salmonella no Typhi deben considerarse dentro del diagnóstico diferencial de microorganismos causantes de lesiones focales y bacteriemia en pacientes con infección por VIH.

Estudo descritivo da freqüência de micobactérias não tuberculosas na Baixada Santista (SP) / Descriptive study of the frequency of nontuberculous mycobacteria in the Baixada Santista region of the state of São Paulo, Brazil

OBJETIVO: Este estudo teve por objetivo descrever a freqüência das espécies de micobactérias não tuberculosas (MNT) identificadas laboratorialmente a partir do isolamento de sítios não estéreis (escarro) de indivíduos infectados ou não pelo vírus HIV na Baixada Santista (SP), período de 2000 a 2005. MÉTODOS: Foi realizada análise retrospectiva dos resultados de baciloscopia e cultura, disponíveis nos registros do laboratório regional de tuberculose, Instituto Adolfo Lutz-Santos. RESULTADOS: Analisou-se 194 cepas de MNT correspondentes a 125 indivíduos, sendo 73 (58,4 por cento) HIV negativos e 52 (41,6 por cento) HIV positivos. Foram identificadas 13 diferentes espécies: Mycobacterium kansasii; complexo M. avium; M. fortuitum; M. peregrinum; M. gordonae; M. terrae; M. nonchromogenicum; M. intracellulare; M. flavescens; M. bohemicum; M. chelonae; M. shimoidei; e M. lentiflavum. Em 19,2 por cento dos casos obteve-se diagnóstico bacteriológico confirmado pelo isolamento da mesma espécie em no mínimo duas amostras consecutivas. CONCLUSÕES: Os resultados mostram a importância da realização sistemática da identificação de MNT na rotina laboratorial e sua integração com a clínica, podendo contribuir na caracterização da doença e ações de efetivo controle, como nas populações co-infectadas tuberculose e HIV.

OBJECTIVE: The present study aims at describing the frequency of nontuberculous mycobacteria (NTM) species identified through laboratory testing of samples collected from non-sterile sites (sputum), as well as its frequency in HIV-infected and non-HIV-infected individuals in the Baixada Santista region of the state of São Paulo, Brazil, in the period from 2000 to 2005. METHODS: Retrospective analysis of sputum smear microscopy results and culture was conducted based on the records on file at the Instituto Adolfo Lutz-Santos, the regional tuberculosis laboratory. RESULTS: We analyzed 194 NTM strains isolated from 125 individuals, of whom 73 (58.4 percent) were HIV-negative and 52 (41.6 percent) were HIV-positive. Thirteen different species were identified: Mycobacterium kansasii; M. avium complex; M. fortuitum; M. peregrinum; M. gordonae; M. terrae; M. nonchromogenicum; M. intracellulare; M. flavescens; M. bohemicum; M. chelonae; M. shimoidei; and M. lentiflavum. In 19.2 percent of the cases, the bacteriological diagnosis was confirmed by isolation of the same species in at least two consecutive samples. CONCLUSIONS: Our results show the importance of including systematic identification of NTM in the laboratory routine, and that its integration into the clinical routine could improve the characterization of the disease, thereby informing the planning of effective control measures in specific populations, such as individuals presenting tuberculosis/HIV co-infection.

Estudo de colonização por Candida sp. na cavidade oral de indivíduos soropositivos e soronegativos para HIV-1 no Noroeste Paulista, Brasil / Candida sp. in the oral cavities of HIV-1 serum positive and serum negative individuals from the Northeastern São Paulo State region, Brazil

Este estudo avaliou Candida sp. isolada da mucosa orofaríngea e sua sensibilidade antifúngica em 52 portadores do HIV/Aids, residentes na Região Noroeste Paulista e respectivos controles. Para tanto, foram utilizados testes clássicos, o “kit” API20IDAUX e a disco difusão para: anfotericina B, fluconazol, itraconazol e cetoconazol. O isolamento de Candida sp. foi maior (p < 0,05) em pacientes e controles, sendo o índice de colonização/infecção superior entre usuários de próteses dentárias, em ambos os grupos (p < 0,05). A freqüência de espécies “não-albicans” não diferiu (21%) nesses grupos. Todas as cepas obtidas foram sensíveis a anfotericina B, enquanto uma cepa de C. albicans foi resistente a todos os azóis. Treze por cento das cepas foram resistentes ao fluconazol, em ambos os grupos. Nossos resultados mostram que o grupo HIV/Aids é mais colonizado por Candida sp. que os soronegativos para este vírus, sem mudança na proporção Candida albicans/“não-albicans” ou no perfil de resistência aos azóis.

Disseminated histoplasmosis in HIV positive patients in Espírito Santo state, Brazil: a clinical-laboratory study of 12 cases (1999-2001)

Twelve cases of histoplasmosis in HIV-infected patients were found in a retrospective analysis at the Hospital Universitário Cassiano Antônio de Moraes of the Universidade Federal do Espírito Santo (HUCAM), Vitória (ES), from June 1999 to May 2001. The frequency of histoplasmosis among HIV-positive patients was 2.1 percent in the infectious diseases division of the hospital during this period. Histoplasmosis compromised mainly males (11/12), 27 to 44 years old, and residents of the metropolitan urban area (10/12). Alcohol abuse and tobacco smoking were described in 10 of the 12 patients. For all patients, this was the first opportunistic infection. Two of the 12 patients died; 10 patients had disseminated disease, one patient had an intestinal presentation and one had disease restricted to the lungs. The most frequent clinical manifestations were weight loss, fever, hepatomegaly and splenomegaly, coughing, abdominal pain, and diarrhea. Six of the 12 patients had skin lesions. Time of symptoms preceding the diagnosis varied from two months to one year. CD4 counts were below 200 cells/mm³ in 9 of 10 patients. Diagnosis was made by histology in two thirds of the patients. The typical adult patient with HIV infection and histoplasmosis in our series was male, had a CD4 count below 200 cells/mm³, had fever, weight loss, cough, abdominal pain and hepatomegaly in the last two months or more, had a high probability of alcohol and tobacco addiction, was having his first opportunistic infection, and had no identifiable environmental exposure risk.

Infección por virus de inmunodeficiencia humana en la mujer / HIV infection in the women

La mujer constituye uno de los puntos más vulnerables en la cadena epidemiológica en la Infección por Virus de Inmunodeficiencia Humana (HIV). Dicha vulnerabilidad está determinada por factores sociopolíticos, económicos y culturales de cada país en particular, lo cual se traduce en un incremento cada vez mayor del número de casos de Infección por VIH en este sexo. Los aspectos más dramáticos de la Infección por VIH en este segmento tan especial de la población susceptible, corresponden a: 1. el mayor número de casos se observa en mujeres jóvenes con vida sexual activa. 2. el Síndrome de Inmunodeficiencia Adquirida (SIDA) es la tercera causa de muerte en mujeres con edad comprendida entre 25 y 44 años, lo cual coloca en situación de orfandad a miles de niños a nivel mundial, con un total actual de 8.2 millones de niños huérfanos por esta causa. 3. aún cuando el porcentaje de mujeres con Infección por VIH que consultan por sintomatología primaria de enfermedad ginecológica es relativamente bajo (aproximadamente 9 por ciento), una evaluación ginecológica exhaustiva, puede demostrar patología ginecológica hasta en un 83 por ciento de los casos. 4. en relación a la transmisión vertical, en algunas regiones del mundo, el hecho de saberse infectada con el HIV no cambia en la mujer la conducta ante la concepción, por lo tanto considerando que más del 86 por ciento de la Infección por VIH en niños es adquirida de madre a hijo, es la mujer uno de los elementos claves de la cadena epidemiológica donde se deben fundamentar programas integrales de prevención y tratamiento antiretroviral efectivo para garantizar de esta forma no solo una mejor calidad de vida a la mujer infectada, sino la posibilidad de disminuir la incidencia de Infección por VIH en los niños

Some characteristics of hospitalized HIV seropositive patients in Myanmar.

Twenty-two hospitalized HIV seropositive patients were studied prospectively between July 1991 and January 1992. The majority of the patients were intravenous drug users (IVDUs). Their age ranged from 20 to 38 years with a male preponderance of 12 to 1. Anemia, lymphopenia and thrombocytopenia were observed in 100%, 36% and 41%, respectively. The common pathogens like malaria parasites, Mycobacterium tuberculosis, Entamoeba histolytica, Streptococcus and Salmonella were isolated/identified rather than opportunistic organisms.

Detection of human immunodeficiency virus type 1 (HIV-1) proviral DNA in breast milk and colostrum of seropositive mothers.

There is increasing evidence of vertical transmission of HIV-1 to infants through breast feeding of milk from HIV-1 infected mothers. It has been postulated that transmission occurs mainly via ingestion of infected cells in breast milk and colostrum. In this study, detection of HIV-1 proviral DNA was used to prove that cells from colostrum and milk do contain HIV. DNA were extracted from these cells of colostrum and milk of 18 seropositive mothers and amplified by nested PCR for HIV-1 gag and pol and 44 per cent were positive mostly by two primers. All ten negative control samples from seronegative mothers were negative. This study demonstrated the infectivity of breast milk and colostrum. Nevertheless, recommendation against breast-feeding should be weighed against poor alternatives in low socioeconomic families.

Comparison of methods for HIV isolation from monocytes and lymphocytes of seropositive asymptomatic hemophiliacs and homosexuals

1. Since monocyte-macrophages have been recognized as HIV targets in addition to CD4+ T-lymphocytes, we have evaluated HIV infection of purified peripheral blood mononuclear cell fractions obtained from 10 seropositive asymptomatic hemophiliacs and compared with that of 10 assymptomatic homosexual patients. 2. HIV was isolated more frequently from the lymphocytes than the monocytes of both groups of patients. 3. HIV preferential replicated in phytohemagglutinin-stimulated lymphocytes compared with growth factor-treated monocytes. Monocytes did not preferentially harbour HIV in either group