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.

Microsporidiosis in a Brazilian University Hospital: case report

This is the report on a patient with chronic diarrhea caused by microsporidia. He is married, infected with HIV and has low CD4 cell count. The diagnosis was established through stool parasite search using concentration methods and Gram - chromotrope staining technique. Ileum biopsy was also performed in this case. The etiological diagnosis may be established in a clinical laboratory, by chromotrope staining technique in routine microscopic examination of stool specimens.

Este é o relato de caso de doente com diarréia crônica causada por Microsporidia. O doente era homem, casado, infectado com HIV e tinha baixa taxa de linfócitos CD4+. O diagnóstico foi feito em exame de fezes utilizando métodos de concentração e técnica de coloração de Gram-Chromotrope. Biópsia de íleo também foi realizada neste caso. O diagnóstico etiológico pode ser feito em laboratório clínico, por técnicas de coloração baseada em cromotrope na rotina da observação microscópica direta.

A Case of Pulmonary Microsporidiasis in an Acute Myeloblastic Leukemia (AML) -M3 Patient

Reported here is a case of microsporidiasis that occurred in an acute myeloblastic leukemia (AML) -M3 patient who underwent chemotherapy. Fever, cough, expectorate and dyspnea were observed during the therapy. Since this case was considered as adult respiratory distress syndrome due to the chest X-ray and arterial blood gas findings, the male patient was bounded to a mechanical ventilator. As coagulation tests showed compatible findings with disseminate intravascular coagulation (DIC), it was thought to be a case of sepsis originating from the lungs and DIC. Pseudomonas aeruginosa and Staphylococcus aureus were found in the sputum of the patient. Although he was given combined antibiotic therapy, there was no reduction in the fever. A bronchoalveolar lavage (BAL) sample was taken and Microsporidia sp. was found upon staining with Giemsa. The patient died due to sepsis and DIC just before receiving therapy for microsporidiasis. Pulmonary infection with Microsporidia, although classically occurring in patients with HIV infection, may occur rarely in leukemia patients, especially if previously treated with systemic immune suppression. This case reinforces the need to consider Microsporidia as a possible pathogen in immunocompromised patients with pulmonary infections.

Intestinal microsporidiosis in HIV-infected children with diarrhea.

Intestinal microsporidiosis is a common opportunistic disease associated with diarrhea in adult AIDS patients in Thailand; the data regarding this infection in children are scarce. The present study was designed to investigate the prevalence and clinical features of intestinal microsporidiosis in hospitalized HIV-infected and uninfected (free of HIV) children with diarrhea. Of the 95 HIV-infected children and 87 uninfected children, 24 (25.3%) and 13 (14.9%) respectively were diagnosed with intestinal microsporidiosis. Species identification of microsporidia spores, by transmission electron microscopy, demonstrated Enterocytozoon bieneusi in 5 cases. Cryptosporidium parvum was a common coinfective parasite; pneumonia was the most frequent concurrent disease found in children with intestinal microsporidiosis. Malnutrition was commoner in the HIV-infected group (79.2% vs 23.1%; p = 0.003). This study indicates that intestinal microsporidiosis is an important disease in both HIV-infected and uninfected Thai children with diarrhea.

Intestinal microsporidiosis in HIV-infected children with acute and chronic diarrhea.

A prospective study of intestinal microsporidiosis in HIV-positive children was conducted at the Queen Sirikit National Institute of Child Health and Phramongkutklao Hospital, Bangkok, Thailand. Hospitalized HIV-positive children with and without diarrhea were enrolled in this study. Microsporidial spores identified by calcofluor fluorescent and gram-chromotrope stain were confirmed by electron microscopy. As well as Cryptosporidium parvum, Microsporidia was the most common protozoa found in the present study, each was 7.1%. Microsporidia was significantly more common in those who had diarrhea. Intestinal microsporidiosis was found in HIV-positive children with both acute and chronic diarrhea. This study emphasizes the importance of Microsporidia in HIV-infected children. Early detection of microsporidia could be of benefit for the patients, since the infection is treatable.

Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil

The objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5 percent) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS

Identificación de Enterocytozoon bieneusi en un paciente con colangitis esclerosante y SIDA / Identification of Enterocytozoon bieneusi in a patient with sclerosing cholangitis and AIDS

Enterocytozoon bieneusi es el microsporidio que más comúnmente ha sido identificado en pacientes con SIDA. En este trabajo, se describen las manifestaciones clínicas de un paciente con diarrea crónica, pancreatitis y colangitis esclerosante asociada con SIDA. Los estudios por imágenes, con ultrasonografía y colangiopancreatografia retrógrada endoscópica, revelaron alteraciones en la vía biliar intra-y extrahepática, idénticas a las observadas en colangitis esclerosante. Se detectó Enterocytozoon bieneusi en duodeno y duodeno peripapilar por microscopia óptica y se confirmó por la reación en cadena de la polimerasa (PCR) utilizando primers específicos en muestras incluidas en parafina. La infección con microsporidios se debería sospechar en nuestro país en pacientes con inmunodeficiencia severa y colangitis esclerosante asociada con SIDA.

Actualizaciones sobre microsporidiosis en el hombre / Update on microsporidiosis in man

The importance of microsporidium as an opportunistic agent in immunocompromised and AIDS patients is reviewed. Five strains of the agent have been described: Encephalitozoon, Enterocytozoon, Nosema, Pleistophora and Septata. The clinical presentation may be as 1) Generalized infections with multisystemic involvement, specially of the central nervous system; 2) Intestinal, that is the most important and frequent localization in man, and that may cause death in AIDS patients; 3) Ocular, that affects cornea, conjunctiva and may extend to paranasal sinuses; 4) Liver and biliary tract infection with granulomatous lesions, hepatic necrosis or sclerosing colangitis and 5) Muscular, affecting skeletal muscle. The diagnosis is difficult and is established finding spores in the affected tissues with light or electron microscopy. Lately, the diagnosis of intestinal microsporidiosis is made looking for faecal spores. The resistant wall of spores hampers treatment. However, good results are obtained with albendazole in intestinal microsporidiosis

Diarrea por microsporidia en un enfermo con SIDA / Diarrhea due to microsporidia in a patient with AIDS

Se presenta el caso de un varón de 26 años de edad con síndrome de inmunodeficiencia adquirida, que refiere tener hasta siete deposiciones líquidas por día de 2 meses de evolución. El estudio microbioiógico de materia fecal descartó la presencia de los enteropatógenos más frecuentes, incluyendo Cryptosporidíum parvum. Con una coloración de Ziehl-Neelsen prolongada (7 minutos de fucsina fenicada en lugar de 3 minutos) se observaron formas que sugirieron la presencia de microsporidias, las cuales fueron confirmadas por la coloración tricrómica modificada y por Ia técnica fluorescente con calcofluor, observándose una morfología semejante a la descrita para Enterocytozoon bieneusi. Mediante la técnica de ELISA se detectaron anticuerpos séricos dirigidos contra 4 especies diferentes de microsporidias en títulos significativos (> 1/800). Los sintomas desaparecieron luego del tratamiento con 400 mg de albendazol, dos veces por día, durante 4 semanas. Sin embargo, en el examen de las heces pos-tratamiento se observó la presencia de las esporas de microsporidias. Hasta donde sabemos, este es el primer caso de microsporidiosis descrito en Argentina.