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

Abstract

SUMMARYThe 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%) 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.

Etiological agents of diarrhea in patients infected by the human immunodeficiency virus-1: a review

“…Still further elucidation is necessary in order to identify any association between diarrhea, so common in sufferers with this virus and the low TCD4 + cell counts. Hence, the criteria utilized to establish specific treatment should be analyzed including the severity of diarrhea which depends on the immunological state of the patient and of the virulence of the pathogen involved 8,9 . These studies are important tools for interventions in patients with HIV/AIDS, enabling a better understanding of the etiology of diarrhea 13 , as well as favoring the quality of life of these patients.…”

“…In the context of the commonest identified parasites are Giardia lamblia, Entamoeba histolytica, Strongyloides stercoralis, Ascaris lumbricoides and Ancylostoma duodenale 12,26,48,74 . Apart from the classical protozoa, emergent species such as Cryptosporidium parvum, Microsporidia, Cyclospora cayetanensis and Isospora belli have also been frequently mentioned in the literature 9,14,26,74 . A study in India identified different pathogens related to diarrhea in HIV-1 infected patients.…”

Real-Time PCR Method for Detection ofEncephalitozoonintestinalisfrom Stool Specimens

“…However, the symptoms of microsporidiosis have been consistently reported to be chronic diarrhea with liquid stools (10,23). Therefore, only liquid fecal specimens should be tested at this time.…”

“…With crossover points as a measure of relative DNA concentration and therefore extraction yield, spore suspensions at concentrations of 10 7 spores/ml were tested with tissue lysis buffer, lysis binding buffer, and FBS as sample diluents. Tissue lysis buffer permitted more efficient DNA extraction, with a crossover point of 20.6 Ϯ 0.6 cycles (here and below, means and standard deviations are given), than did FBS (26.6 Ϯ 1.2 cycles) or lysis binding buffer (30.3 Ϯ 2.8 cycles).…”

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

“…In the case of E. bieneusi infection, the disease is usually confined to the gastrointestinal tract, though disseminated infection can occur. In HIV patients with E. bieneusi infection, chronic diarrhea associated with wasting syndromes and cachexia are common (32,130). Dissemination to the hepatobilary system with cholangitis (29,226), to the maxillary sinus with invasive sinusitis (131,272), and to the respiratory system with pulmonary infections (28,66) have all been reported for E. bieneusi/HIV coinfections.…”