Morphological changes in the digestive system of 322 necropsies of patients with acquired immune deficiency syndrome: comparison of findings pre- and post-HAART (Highly Active Antiretroviral Therapy)

ABSTRACT Involvement of the digestive system in AIDS pathologies or injuries is frequent. Aiming at comparing the frequency, the importance that these lesions have for death and the survival time in patients using or not using HAART, we studied 322 necropsies classified as follows: Group A - without antiretroviral drugs (185 cases); B - one or two antiretroviral drugs or HAART for less than six months (83 cases); C - HAART for six months or longer (54 cases). In the overall analysis of the digestive system, changes were present in 73.6% of cases. The most frequent was Candida infection (22.7%), followed by cytomegalovirus (19.2%), Histoplasma capsulatum (6.5%), mycobacteria (5.6%), and Toxoplasma gondii (4.3%). T. gondii infection was more frequent in group A compared with group C, and cytomegalovirus (CMV) was more frequent in group A compared with groups B and C (p < 0.05); 2.2% of the deaths were due to gastrointestinal bleeding. Regarding the segments, only in the large intestine, and only cytomegalovirus, were more frequent in group A compared with group C. We conclude that digestive system infections are still frequent, even with the use of HAART. However, the average survival time in group C was more than three times greater than the one in group A and nearly double that of group B, demonstrating the clear benefit of this therapy.

Influencia de la enfermedad periodontal en la evaluación de los trastornos funcionales digestivos / The influence of periodontal disease in the evaluation of functional digestive disorders

Introducción: existe evidencia de una asociación entre las alteraciones de la flora bacteriana intestinal y el síndromde intestino irritable (SII). Dichas alteraciones pueden ser medidas en forma indirecta mediante el test de hidrógeno en aire espirado con lactulosa (THAEL). La flora bacteriana puede verse también alterada en sujetos con enfermedad periodontal (EP). Objetivo: evaluar la influencia de la EP sobre los resultados del THAEL. Materiales y métodos: se incluyeron pacientes con diagnóstico de SII, alo que se les realizó un THAEL. Se evaluó la presencia de EP según la clasificación de la American Dental Association. Se compararon los resultados del THAEL, medidos como área bajo la curva de concentración de hidrógeno/tiempo (ABC) entre aquellos con y sin EP. Resultados: fueron incluidos 51 pacientes, en su mayoría mujeres. El grupo con EP presentó mayor edad. Encontramos un valor basal de hidrógeno significativamente mayor en aquellos con EP que en el grupo sin EP [4 (2-6) vs 1 (1-3.5), p=0.04], pero con el valor de ABC similar entre ambos grupos [2232 (162-5184) vs 2088 (216-6071), p=0.5]. Conclusión: la salud bucal parece ser relevante en el estudio de las alteraciones de la flora bacteriana intestinal, llevando a cambios en los resultados del THAEL.

In vivo assessment of possible probiotic properties of Zymomonas mobilis in a Wistar rat model

In recent years the incorporation of probiotic bacteria into foods has received increasing scientific interest for health promotion and disease prevention. The safety and probiotic properties of Zymomonas mobilis CP4 (UFPEDA-202) was studied in a Wistar rat model fed the 10(9) colony forming units (cfu)/mL-1 of the assayed strain for 30 days. No abnormal clinical signs were noted in the group receiving viable cells of Z. mobilis and water (control) during the period of the experiment. There were no significant difference (p > 0.05) in feed intake and weight gain among mice fed the Z. mobilis in comparison to the control group. No bacteria were found in blood, liver and spleen of any animals. Mice receiving Z. mobilis showed significantly differences (p < 0.05) in total and differential leucocytes count, excepting for neutrophils, after the experimental period. Otherwise, it was not found in control group. Histological examination showed that feeding mice with Z. mobilis caused no signs of adverse effects on gut, liver and spleen. From these results, Z. mobilis CP4 (UFEPEDA-202) is likely to be nonpathogenic and safe for consumption, and could have a slight modulating effect on immunological performance in mice.

Study on fungal flora in the midgut of the larva and adult of the different populations of the malaria vector anopheles stephensi

Many microorganisms in midgut of mosquito challenge with their host and also other pathogens present in midgut. The aim of this study was presence of non-pathogens microorganisms like fungal flora which may be crucial on interaction between vectors and pathogens. Different populations of Anopheles stephensi were reared in insectary and objected to determine fungal flora in their midguts. The midgut paunch of mosquito adults and larvae as well as breading water and larval food samples transferred on Subaru-dextrose agar, in order to detect the environment fungus. Although four fungi, Aspergillus, Rhizopus, Geotrichum and Sacharomyces were found in the food and water, but only Aspiragilus observed in the midgut of larvae. No fungus was found in the midgut of adults. This is the first report on fungal flora in the midgut of the adults and larvae of An. stephensi and possible stadial transmission of fungi from immature stages to adults. The midgut environment of adults is not compatible for survivorship of fungi but the larval midgut may contain few fungi as a host or even pathogen

Aeromonas caviae septicemia in immunocompetent gastrointestinal carriers

Aeromonas caviae strains have been isolated from blood and stool cultures of three immunocompetent patients, residents of Northern India, who presented with community acquired septicemia without any recent history of diarrhea. Cell culture infectivity test performed on Hep-2 cells have shown substantial degree of invasiveness in the isolated strains. This case unleashes a possibility of asymptomatic gastrointestinal carriage of such strains of A. caviae in a very large population of India, as several areas of India have very high rates of Aeromonas induced acute diarrhea/gastroenteritis (up to 13 percent). It needs to be appraised further in India as well as other countries having high rates of Aeromonas induced acute diarrhea/gastroenteritis.

Dolor abdominal, dispepsia y gastritis en pediatría: rol del helicobacter pylori / Abdominal pain, dyspepsia and gastritis in paediatrics: role of the helicobacter pylori

Helicobacter pylori (H. pylori), el patógeno más común del tracto gastrointestinal en seres humanos, es la causa más frecuente de gastritis crónica, está asociado etiológicamente con úlcera gastroduodenal y algunos cánceres gástricos. La creciente acumulación de información ha hecho necesario reevaluar los conceptos de gastritis, dolor abdominal y dispepsia en pediatría, por lo que el objetivo de esta revisión fue actualizar estos conceptos enfatizando la relación de estas relación de estas entidades y discutir la evidencia disponible para promover una buena práctica clínica, al respecto. La asociación entre la infección por H pylori y otras condiciones, como dolor abdominal recurrente y dispepsia no ulcerosa, no ha sido demostrada y es más bien especulativa. El H. pylori es considerado un patógeno, porque, entre otras características, cumple cada uno de los postulados de Koch como causante de gastritis crónica; en efecto, H. pylori juega un rol crítico y necesario en la patogénesis de la gastritis crónica activa. El papel H. pylori como causa de úlcera péptica en adultos ha sido bien establecido. Aunque en niños las evidencias no son tan potentes, sí son altamente sugerentes. aun cuando la mayoría de la población mundial está colonizada por H. pylori, solo una pequeña proporción tendrá manifestaciones clínicas producidas por la infección. Aproximadamente el 10 por ciento de ellos desarrollará úlcera péptica a lo largo de su vida, y las personas infectadas tendrán un incremento de 2 a 6 veces en el riesgo de desarrollar cáncer y lifoma tipo MALT (tejido linfoide asociado a mucosas) comparado con población no infectada

Probióticos: microorganismos de la dieta al servicio de la salud / Probiotics: microorganisms of the diet working for health

Los probióticos son microorganismos, bacterias o levaduras, que después de haber sido ingeridos por el individuo pueden transitar vivos a lo largo del tubo digestivo y ejercer acciones específicas, beneficiosas para su salud. Las bacterias lácticas, en particular, se han usados empíricamente desde hace siglos en forma de yogurt, kefir o leche cultivada, para prevenir o/y curar numerosas patologías gastrointestinales, por lo cual están asociadas, en la opinión pública, con la imagen de "alimentos sanos". Durante la última década, se han efectuado numerosos estudios tanto clínicos como básicos, con el fin de comprobar el real impacto de los probióticos sobre la salud. En la actualidad está plenamente confirmado que la ingestión de lactobacilos mejora la tolerancia a la lactosa en los individuos hipolactásicos, y que limita la colonización del intestino por patógenos, lo cual se puede traducir a nivel clínico por un menor riesgo de desarrollar diarrea. Otros estudios sugieren un papel para los probióticos en la estimulación del sistema inmune del individuo, en la reducción de actividades enzimáticas implicadas en el desarrollo de lesiones malignas a nivel colónico y posiblemente en la disminución de la colesterolemia. A pesar de los numerosos resultados ya obtenidos, es necesario seguir explorando las propiedades funcionales de los probióticos, a fin de optimizar su uso tanto en el campo nutricional como terapéutico

Monoassociation with Lactobacillus acidophilus UFV-H2b20 stimulates the immune defense mechanisms of germfree mice

Probiotics are formulations containing live microorganisms or microbial stimulants that have some beneficial influence on the maintenance of a balanced intestinal microbiota and on the resistance to infections. The search for probiotics to be used in prevention or treatment of enteric infections, as an alternative to antibiotic therapy, has gained significant impulse in the last few years. Several studies have demonstrated the beneficial effects of lactic acid bacteria in controlling infection by intestinal pathogens and in boosting the host's nonspecific immune response. Here, we studied the use of Lactobacillus acidophilus UFV-H2b20, a lactic acid bacterium isolated from a human newborn from Viçosa, Minas Gerais, Brazil, as a probiotic. A suspension containing 108 cells of Lactobacillus acidophilus UFV-H2b20 was inoculated into groups of at least five conventional and germfree Swiss mice to determine its capacity to stimulate the host mononuclear phagocytic activity. We demonstrate that this strain can survive the stressing conditions of the intestinal tract in vivo. Moreover, the monoassociation of germfree mice with this strain for seven days improved the host's macrophage phagocytic capacity, as demonstrated by the clearance of a Gram-negative bacterium inoculated intravenously. Monoassociated mice showed an undetectable number of circulating E. coli, while 0.1 percent of the original inoculum was still present in germfree animals. Mice treated with viable or heat-killed Lactobacillus acidophilus UFV-H2b20 presented similarly improved clearance capacity when compared with germfree controls. In addition, monoassociated mice had twice the amount of Kupffer cells, which are responsible for the clearance of circulating bacteria, compared to germfree controls. These results suggest that the L. acidophilus strain used here stimulates a nonspecific immune response and is a strong candidate to be used as a probiotic

Azo reductase activity of microbial population from gastrointestinal tract segments of various animals species.

Azo reductase activity of microbial population of stomach, small intestine, caecum and large intestine of different animals was investigated. There was low activity in stomach flora of wistar rat and 3 strains of mice. Flora of proximal portion of small intestine in different species revealed that carnivorous animals exhibited maximum activity followed by grazing animals. Maximum activity in middle portion of small intestine was noted in dog (98.2%), while minimum was observed in guinea pig (23.3%). Majority of test animals revealed maximum floral azo reductase activity (58-98%) in caecum. Activity in proximal portion of large intestine was highest in dog while pigeon and guinea pig had least activity (23.3-27.1%). Appreciable microbial activity in distal end of large intestine was noted in sheep and goat. In all the 15 animal species investigated caecum showed maximum activity followed by pre and post caecal segments while stomach possessed the least. The results suggest that inter-species differences exist in microbial reductive activity which may be due to variation in composition and distribution of GI tract microflora and thus can influence toxicological implication of various dyes.

Microorganisms of the digestive tract of Brazilian termites (Isoptera, Termitidae)

The hundgut microbiota of the termites Armitermes euamignathus, Cornitermes cumulans and Anoplotermes sp. was examined using transmission electron microscopy. A great variety of bacterial forms were detected and they comprise bacillus, spirochetes and coccus. Negatively stained preparations of the hindgut content showed more than six different bacterial morphotypes including bacteria devoid of flagellum and flagellate. The number of flagella and their distribution in the bacterial surface is also variable.

Enterotoxicity, haemolytic activity and antibiotic susceptibility of Aeromonas eucrenophila strains isolated from water and infected fish.

Strains of A. eucrenophila isolated from fresh water (2 strains) and infected fish (4 strains) were tested for haemolytic activity and enterotoxicity and any correlation between them. Also, the resistance patterns of A. eucrenophila were tested especially in relation to ampicillin. None of the A. eucrenophila strains caused fluid accumulation in the initial tests, however, they did so only after one to four sequential passages through the gut of a susceptible host. All the strains of A. eucrenophila showed beta-haemolytic activities. Production of beta-haemolysin could be correlated with enterotoxicity. Since all the strains of A. eucrenophila were resistant to ampicillin, media containing this antibiotic may be used for their isolation from diverse sources.

Bacterial overgrowth in the upper gastrointestinal tract in diabetes mellitus

The study was conducted on 70 diabetics [36 males and 34 females] and 10 healthy subjects [9 males and 1 female] as a control group. All were complaining of gastrointestinal symptoms. Abdominal sonography was done. Gastric and duodenal lavage, and gastric biopsies were taken and were cultured for aerobic and anaerobic bacteria, fungi and Helicobacter pylori 70% of diabetics were positive for bacterial overgrowth while only 10% of controls were positive. Significantly higher incidence of bacterial overgrowth was detected in uncontrolled diabetics especially those with abnormal endoscopic findings and those with autonomic neuropathy and in diabetic females. Bacterial overgrowth was not correlated with the age, the duration of diabetes or the type of gastrointestinal symptoms. The most frequent organisms were enterococci [48%], helicobacter pylori [42%] and candida [40%]

Helicobacter pylori prevalence in northeastern Thailand.

Helicobacter pylori is distributed worldwide and has been demonstrated in Thailand. However, no study has been conducted so far in northeastern Thailand. The objective of this study was to find the prevalence of H. pylori in patients undergoing upper gastrointestinal endoscopy in northeastern part of Thailand. One hundred and twenty-six patients undergoing surgery between November 1992 and January 1993 were studied. Biopsies were done at antrum, corpus, and other positive lesions. Diagnostic tests of H. pylori by using CLO test, microbiological tests (Gram stain and culture), and histological examination (hematoxylin and eosin) were carried out. The prevalence of H. pylori by CLO test, Gram stain, culture, and histology were 49.2%, 61.9%, 22.2%, and 45.2% respectively. The overall prevalence of H. pylori by all diagnostic tests was 73.8% (95% confidence interval = 66.1-81.5%). This study revealed a high prevalence rate of H. pylori in patients which should alert clinicians who practice in this geographical area.

Descontaminaçäo intestinal seletiva: por que ainda näo utilizamos na prática clínica? / Selective descontamination of digestive system: why does not still utilize in the clinical practice?

A descontaminaçäo seletiva do trato digestivo com antibióticos näo absorvíveis tem sugerido a ocorrência de diminuiçäo da incidência de infecçäo hospitalar dos pacientes em unidades de terapia intensiva, sendo um procedimento cada vez mais utilizado. Entretanto, tal procedimento ainda näo conseguiu provar o seu valor, sendo objeto de várias críticas. O autor deste trabalho considera esta hipótese atrativa, sugerindo, porém, dever ser utilizada, neste momento, somente em trabalhos clínicos controlados

Infecçöes oportunistas do trato digestivo em pacientes com síndrome da imunodeficiência adquirida / Digestive tract and opportunistic infections in AIDS patients

A Síndrome da Imunodeficiência Adquirida (AIDS) se manifesta através de amplo espectro de lesöes, comprometendo qualquer órgäo ou tecido. Essas lesöes säo causadas por agentes etiológicos raros e se caracterizam por localizaçäo anômala, progressäo rápida com tendência à generalizaçäo, reaçäo celular ineficaz e apresentaçäo histológico atípica. A biópsia do tecido afetado e o seu exame microscópico é um método que vem sendo usado para se conseguir diagnóstico rápido e definitivo. Principalmente as lesöes do trato digestivo säo suscetíveis a este tipo de abordagem. Neste artigo revemos as lesöes que comumente säo observadas no trato gastrointestinal de pacientes aidéticos, ressaltando suas características histológicas e seu diagnóstico diferencial; relatamos também nossos achados em biópsias do trato digestivo alto, onde temos detectado microorganismos oportunistas em mucosa gástrica