十堰地区恶性肿瘤患者隐孢子虫感染情况调查

目的调查十堰地区恶性肿瘤患者的隐孢子虫感染情况及流行特点,为恶性肿瘤患者隐孢子虫感染的防治提供依据。方法采集十堰市太和医院217例恶性肿瘤患者粪便,采用金胺酚＋改良抗酸染色法检查隐孢子虫卵囊。结果 217例肿瘤患者隐孢子虫感染率为48.85%,男性患者与女性患者隐孢子虫感染率分别为49.58%和47.96%,差异无统计学意义（P〉0.05）;化疗、放疗、化疗＋放疗患者隐孢子虫感染率分别为38.46%、37.88%和69.86%,差异有统计学意义（P〈0.01）;不同类别的肿瘤患者的隐孢子虫感染率分别是：呼吸系统为37.50%、消化系统为60.78%、乳腺为38.89%、其他（包括脑瘤、肾上腺瘤、甲状腺瘤等）为40.00%,差异有统计学意义（P〈0.01）。结论恶性肿瘤患者易发生隐孢子虫感染,可能与其机体的免疫功能下降有关。     

衡阳地区HIV/AIDS患者合并肠道寄生虫感染现状分析

目的:了解衡阳地区HIV/AIDS患者合并肠道寄生虫感染状况及流行病学特征。方法:随机抽样衡阳地区HIV/AIDS患者开展流行病学调查,并收集其粪便检测肠道寄生虫。结果:152例HIV/AIDS患者的粪便标本中有61例合并肠道寄生虫感染,感染率为40.13%。隐孢子虫、人芽囊原虫、蓝氏贾第鞭毛虫、微孢子虫、阿米巴原虫感染率分别为13.16%、9.87%、9.21%、5.26%、2.63%,五种肠道寄生虫感染率差异有统计学意义(P0.05)。城市与农村HIV/AIDS患者肠道寄生虫感染率分别为30.12%和52.17%,差异有统计学意义(P0.05);卫生习惯好坏的HIV/AIDS患者肠道寄生虫感染率分别为33.68%和50.88%,差异有统计学意义(P0.05);HIV感染者和AIDS患者肠道寄生虫感染率分别为25.0%和52.38%,差异有统计学意义(P0.05);不同CD4+T淋巴细胞计数水平(cells/μl),HIV/AIDS患者肠道寄生虫感染率有差异,200为64.81%,200~499为48.84%,≥500为9.09%,差异有统计学意义(P0.05)。结论:HIV/AIDS患者合并肠道寄生虫感染率与寄生虫的种类、卫生习惯、病程、居住环境及CD4+T淋巴细胞数量有关,而与年龄、性别、受教育程度及经济收入无关;HIV/AIDS患者肠道寄生虫检测应列入常规检测项目。     

郑州市某医院儿童肠道寄生虫感染情况调查

目的了解郑州地区儿童肠道寄生虫感染情况,为制定肠道寄生虫病防治措施提供参考依据。方法采用卢戈氏碘液染色法、饱和蔗糖溶液漂浮法和改良抗酸染色法对儿童新鲜粪便样品进行检查。结果共调查1996份粪便样品,肠道寄生虫总感染率为1.5%,发现蓝氏贾第鞭毛虫、环孢子虫、隐孢子虫、阿米巴原虫和粪类圆线虫5种肠道寄生虫,其感染率分别为0.6%、0.5%、0.1%、0.3%和0.1%。不同性别、不同季节儿童肠道寄生虫感染情况差异无统计学意义（P〉0.05）。蓝氏贾第鞭毛虫和阿米巴原虫主要发现于春季和冬季,隐孢子虫和环孢子虫仅发现于夏季和秋季。结论郑州地区儿童土源性肠道寄生虫感染率显著下降,以机会性原虫感染为主,应进一步加强健康卫生教育。     

人乳头瘤病毒核酸定量检测的流行病学特点

目的为了解本地区HPV感染的流行病学特点。方法 FQ-PCR对本院皮肤性病科及妇产科可疑患者1337例(男404例,女933例)同时检测HPV6/11 DNA和HPV16/18 DNA。结果 1337例患者HPV6/11和HPV16/18感染率分别为20.34%和14.36%(χ2=16.69,P=4.40E-5),其中男性分别为20.05%和13.37%(χ2=6.48,P=0.011),女性分别为20.47%和14.79%(χ2=10.37,P=0.0013);两组病毒载量分别为5.46±1.71和5.20±1.40(t=1.76,P=0.078),男性分别为5.40±1.65和4.94±1.48(t=1.64,P=0.10),女性分别为5.49±1.73和5.30±1.36(t=1.07,P=0.29)。近九年间,两组病毒感染率及病毒载量无统计学变化。年龄均以21～35岁为主要人群,各年龄段两组病毒感染率及载量也无统计学差异。阳性患者HPV6/11病毒载量以5.00-7.99为多见,而HPV16/18病毒载量以4.00-6.99多见。结论 HPV6/11感染率高于HPV16/18,两组病毒载量无统计学差异,男性和女性感染率和病毒载量也存在相似特征;阳性患者年龄以21～35岁为主;HPV 6/11以急性感染率多见,HPV16/18以慢性感染率多见;近九年间HPV感染状况较稳定,无明显变化趋势。     

西安地区人芽囊原虫感染状况调查

目的了解西安市人芽囊原虫的感染状况。方法采集西安市社区居民、中学生、动物饲养人员、腹泻病人共781名受检者粪便标本,采用生理盐水直接涂片法及碘液染色法,典型形态使用数码显微镜摄像。结果健康人群和腹泻人群人芽囊原虫的感染率分别为1.99%（11/554）和7.05%（16/227）,差异具有统计学意义（χ2=12.367,P〈0.05）;社区居民、中学生、动物饲养人员的感染率分别为2.20%（6/273）、1.20%（3/250）、6.45%（2/31）,差异无统计学意义（χ2=4.033,P〉0.05）;粘液脓血便人群的感染率为12.16%（9/74）,其他腹泻人群（水样便、糊便及脂肪泻）为7%（7/153）,两者差异有统计学意义（χ2=4.382,P〈0.05）。各年龄组间感染率差异有统计学意义（χ2=18.632,P〈0.05）。观察到空泡型、颗粒型和包囊型虫体,可见出芽生殖、二分裂生殖和复分裂繁殖三种繁殖方式。结论人芽囊原虫在不同年龄、不同健康状况（健康和腹泻）及不同腹泻性状人群中的分布存在差异。空泡型、颗粒型多见,多以二分裂、出芽生殖方式繁殖。     

中小学生乙型肝炎病毒感染现状及其基因型分布特征研究

目的了解深圳地区中小学生乙型肝炎病毒(HBV)感染现状及基因型分布情况,为HBV患者合理用药提供依据。方法选取2016年3月～2017年9月在深圳地区就读的中小学生4217名,采用酶联免疫吸附法(ELISA)检测学生血清中HBV表面抗原(HBVHBsAg),对HBsAg为阳性的学生,采用PCR法检测HBVDNA,对HBVDNA阳性标本采用PCR测序法对HBV基因型进行分析,并对结果进行统计分析。结果 4217名中小学HBV-HBsAgELISA法阳性率为6.28%(265/4217),其中男生为6.69%(137/2047),女生为5.90%(128/2170),男生略高于女生,但差异无统计学意义(χ~2=1.492,P0.05),经PCR-DNA定量复检阳性230例,阳性符合率为86.79%(230/265),其中初中生阳性率为5.62%(124/2206),小学生为5.27%(106/2011),两者差异无统计学意义(χ~2=0.835,P0.05)。HBVDNA阳性标本中B基因型检出率为61.30%(141/230),明显高于C基因型的24.35%(56/230),差异有统计学意义(χ~2=6.755,P0.05),混合感染以B+C为主,感染率为12.17%(28/230);初中生和小学生HBV各基因型分布之间差异均无统计学意义(χ~2=0.573～1.132,P0.05),男生和女生之间差异也均无统计学意义(χ~2=0.759～1.496,P0.05)。结论深圳地区中小学生有一定的HBV感染率,B基因型为本区HBV感染的主要基因型,其次为C基因型,混合感染以B+C混合基因型为主。因此,加强HBV基因型分析对HBV合理用药具有重要的意义。     

中国南方妇女AhR和ARNT基因多态性与子宫内膜异位症的相关性

目的 探讨中国南方汉族妇女芳香烃受体(arylhydrocarbon receptor,AhR)基因和芳香烃受体核转位子(arylhydroarbon nuclear translocator,ARNT)基因多态性与子宫内膜异位症的相关性.方法 收集经手术证实的431例子宫内膜异位症患者和499名对照人群外周血,采用高分辨率熔解曲线技术检测AhR及ARNT基因多态性.结果 病例组和对照组妇女AhR 1661G/A位点AA、AG、GG基因型频率分别为9.7%、44.6%、45.7%和12.0%、41.9%、46.1%,两组的基因频率差异无统计学意义(χ2=0.234,P=0.629);A和G等位基因频率为32.0%、68.0%和33.0%、67.0%,两组差异无统计学意义(χ2=0.189,P=0.664).病例组和对照组妇女ARNT 567G/C位点GG、GC、CC基因频率分别为13.5%、47.8%、38.7%和15.6%、51.7%、32.7%,两组差异无统计学意义(χ2=0.194,P=0.659);C、G等位基因频率为62.6%、37.4%和58.5%、41.5%,两组差异无统计学意义(χ2=3.30,P=0.07).2组间AhR1661G/A和ARNT 567G/C联合基因型频率分布差异亦无统计学意义(χ2=11.20,P=0.191).结论 中国南方妇女外周血AhR 1661G/A及ARNT 567G/C基因多态与子宫内膜异位症的发病无明显相关.     

中国南方妇女AhR和ARNT基因多态性与子宫内膜异位症的相关性

目的 探讨中国南方汉族妇女芳香烃受体(arylhydrocarbon receptor,AhR)基因和芳香烃受体核转位子(arylhydroarbon nuclear translocator,ARNT)基因多态性与子宫内膜异位症的相关性.方法 收集经手术证实的431例子宫内膜异位症患者和499名对照人群外周血,采用高分辨率熔解曲线技术检测AhR及ARNT基因多态性.结果 病例组和对照组妇女AhR 1661G/A位点AA、AG、GG基因型频率分别为9.7%、44.6%、45.7%和12.0%、41.9%、46.1%,两组的基因频率差异无统计学意义(χ2=0.234,P=0.629);A和G等位基因频率为32.0%、68.0%和33.0%、67.0%,两组差异无统计学意义(χ2=0.189,P=0.664).病例组和对照组妇女ARNT 567G/C位点GG、GC、CC基因频率分别为13.5%、47.8%、38.7%和15.6%、51.7%、32.7%,两组差异无统计学意义(χ2=0.194,P=0.659);C、G等位基因频率为62.6%、37.4%和58.5%、41.5%,两组差异无统计学意义(χ2=3.30,P=0.07).2组间AhR1661G/A和ARNT 567G/C联合基因型频率分布差异亦无统计学意义(χ2=11.20,P=0.191).结论 中国南方妇女外周血AhR 1661G/A及ARNT 567G/C基因多态与子宫内膜异位症的发病无明显相关.     

中国西北与东北地区2010—2011年成人颈椎骨折的流行病学对比分析

目的 对比分析中国西北与东北地区成人颈椎骨折的流行病学特征。方法 收集西北地区和东北地区14家医院2010—2011年诊治的成人创伤性颈椎骨折病例资料,排除病理性、陈旧性骨折和二次骨折。西北地区10家医院患者资料定义为西北组,东北地区4家医院患者资料定义为东北组,对比分析两组患者的性别、年龄、各年龄段骨折例数及骨折AO分型等资料。结果 共收集成人颈椎骨折771例,其中西北组509例,男296例(58.15%),女213例(41.85%);东北组262例,男151例(57.63%),女111例(42.37%);两组性别差异无统计学意义(χ²=0.019,P＞0.05)。西北组和东北组患者年龄分别为48(20)岁和57(21)岁,差异有统计学意义(Z=6.405,P＜0.01)。西北组41～50岁年龄段患者最多(26.52%,135/509),东北组51～60岁年龄段最多(21.76%,57/262)。西北组中青年(16～60岁)和老年(＞60岁)分别有407例(79.96%)和102例(20.04%),东北组分别为155例(59.16%)和107例(40.84%),两组比较差异有统计学意义(χ²=37.873,P＜0.01)。西北组和东北组51.01节段高发类型均为A型,分别有20例(57.14%,20/35)、13例(46.43%,13/28),差异无统计学意义(χ²=2.966,P＞0.05);51.02节段高发类型均为B型,分别有222例(92.50%,222/240)、71例(75.53%,71/94),差异有统计学意义(χ²=28.989,P＜0.05);下颈椎51.03～51.07节段最常见的骨折类型为A型,分别有187例(79.91%,187/234)、80例(57.14%,80/140),骨折类型构成比差异有统计学意义(χ²=39.919,P＜0.05)。结论 西北、东北两地成人颈椎骨折均男性多于女性,西北地区41～50岁年龄段最多,东北地区51～60岁年龄段最多,51.01节段A型高发,51.02节段B型高发,下颈椎51.03～51.07节段A型高发。     

婴幼儿肺炎支原体感染的相关因素分析

目的了解肺炎支原体感染与性别、年龄及季节的关系,为预防其感染提供科学依据。方法受检者共1111例,按性别分为男性组、女性组;按年龄分为小于3岁组、3-6岁组及6-13岁组;按季节分为春季组、夏季组、秋季组及冬季组,分别比较各组感染状况。结果男性组阳性率为26.22%、女性组为26.92%,两者差别无统计学意义(χ2=0.07,P0.05);小于3岁组阳性率为30.40%、3-6岁组24.13%及6-13岁组19.35%,三者差别有统计学意义(χ2=7.82,0.01P0.025);春季组阳性率为21.32%、夏季组30.22%、秋季组23.18%及冬季组32.41%,四组差别有统计学意义(χ2=11.58,0.005P0.01)。结论在西安地区小儿肺炎支原体感染男女之间无差异,而不同年龄段之间有差异,年龄在3岁以下小儿感染率较高。四季中的肺炎支原体感染率也有差异,以冬季为感染高峰。     

人免疫缺陷病毒感染者/艾滋病患者浅表淋巴结肿大与CD4+T淋巴细胞计数的相关性

目的 探讨人免疫缺陷病毒感染者/艾滋病患者（简称HIV感染者/AIDS患者）浅表淋巴结肿大的病理改变及其与CD4+T淋巴细胞计数的相关性。方法 对1066例HIV感染者/AIDS患者浅表淋巴结肿大的发生情况及其外周血CD4+T淋巴细胞计数进行分析;并对浅表淋巴结肿大患者行淋巴结活检。结果 在1066例HIV感染者/AI...     

Clarithromycin prophylaxis against Cryptosporidium enteritis in patients with AIDS.

Cryptosporidium enteritis (CE) in patients with acquired immunodeficiency syndrome (AIDS) can be a life-threatening opportunistic infection. A retrospective review of 471 charts of patients with AIDS in our clinic, prior to the availability of clarithromycin for the treatment of Mycobacterium avium complex (MAC), revealed that seven patients with CD4 counts < 25/mm3 developed CE. The median survival period from diagnosis to death in these patients was 10.6 days. The incidence of CE in patients with CD4 counts < 50/mm3 treated with clarithromycin prophylaxis for MAC was compared with patients not receiving clarithromycin prophylaxis. Of 136 patients with AIDS, 63 received clarithromycin 500 mg twice daily, and 73 patients not treated with clarithromycin represented the control group. None of the patients who received clarithromycin developed CE compared with four patients who developed CE in the control group. All four patients in the control group who developed CE had CD4 counts < 25/mm3. All patients who received clarithromycin remained stool negative for Cryptosporidium. In a subsequent 2-year follow-up of an additional 217 AIDS patients with CD4 counts < 50/mm3 receiving clarithromycin 500 mg twice daily as MAC prophylaxis, no patient developed CE. These results provide strong evidence supporting the use of clarithromycin as prophylaxis against cryptosporidium enteritis in patients with AIDS.     

Prevalence of intestinal parasitic infections in HIV-infected individuals and their relationship with immune status

Background and Objectives: Intestinal parasitic infection is a common entity in patients infected with human immunodeficiency virus (HIV). These infections may lead to fatal complications in the immuno suppressed individuals. The aim of the present study was to determine the prevalence of intestinal parasitic infections in HIV sero-positive patients and their relationship with the immune status of individuals. Materials and Methods: Fecal samples from 100 HIV sero-positive and an equal number of HIV sero-negative individuals were collected and examined for enteric parasites by direct microscopy. CD4 counts were carried out in only HIV sero-positive patients. Prevalence of intestinal parasites in patients with CD4 count <200 cells/μl, 200-499 cells/μl, and ≥500 cells/μl in HIV-infected patients were compared. Results: Enteric parasites were detected in 59.3% HIV-infected patients with CD4 count <200 cells/μl as compared with 23.5% in patients with CD4 count>200 cells/μl (P < 0.01). Prevalence of coccidian parasites was significantly (P < 0.01) higher (14%) in HIV sero-positive subjects compared with HIV sero-negative subjects (2%). Isospora belli (25%) was the most common parasite with CD4 count <200 cells/μl, followed by Cryptosporidium parvum (12.5%). Prevalence of intestinal parasitic infections was significantly higher in patients with diarrhea, 73.6% than without diarrhea, 25.9%, (P < 0.05). The mean CD4 count of HIV sero-positive patients presenting with diarrhea was significantly (P < 0.01) lower (181.26 ± 135.14) than without diarrhea (352.02 ± 204.03). Conclusion: This study emphasizes the need for routine screening of parasites especially in patients with lower CD4 count so as to decrease the morbidity by ensuring the early treatment of the cases.     

Enhanced levels of CCL19 in patients with advanced acquired immune deficiency syndrome (AIDS)

Based on the ability to recruit lymphocytes and dendritic cells to lymphoid tissue and to promote inflammation, we hypothesized a role for dysregulated CCL19 and CCL21 levels in human immunodeficiency virus (HIV)-infected patients with advanced immunodeficiency, and in particular in those with accompanying Mycobacterium avium complex (MAC) infection. The hypothesis was explored by studies in HIV-infected patients with and without MAC infection, as well as in vitro, examining the ability of proteins from MAC to promote CCL19 and CCL21 responses in peripheral blood mononuclear cells (PBMC) during highly active anti-retroviral therapy (HAART). Our main findings were: (i) raised serum levels of CCL19 in HIV-infected patients with CD4(+) T cell count <50 cells/μl compared with HIV-infected patients with CD4(+) T cell count >500 cells/μl and healthy controls, with particularly high levels in those with MAC infection; (ii) elevated plasma levels of CCL19 predicted a higher mortality in acquired immune deficiency syndrome (AIDS)-patients, independent of ongoing MAC infection; and (iii) marked production of CCL19 in MAC-stimulated peripheral blood mononuclear cells (PBMC) and pronounced disturbances in MAC-induced CCL19 production in PBMC from HIV patients that was partly reversed during HAART. Our findings suggest the involvement of CCL19 in AIDS patients with advanced immunodeficiency, potentially mediating both adaptive and maladaptive responses.     

A high HIV DNA level in PBMCs at antiretroviral treatment interruption predicts a shorter time to treatment resumption,independently of the CD4 nadir

This study aimed to evaluate the safety of antiretroviral treatment interruption (TI) in HIV‐infected patients who started treatment based on earlier guidelines, and to identify baseline factors predictive of the time to reach fixed criteria for treatment resumption. Prospective, open‐label, multicenter trial. Patients were eligible if they had a CD4 cell count >350/mm³ and plasma HIV RNA <50,000 copies/ml when they first started antiretroviral therapy (ART); and if they had a CD4 count >450/mm³ and stable plasma HIV RNA <5,000 copies/ml for at least 6 months prior to enrolment. The criteria for ART resumption were a CD4 cell count <300/mm³ and/or a CDC stage B or C event. 116 patients had received ART for a median of 5.3 years. The median CD4 cell count and plasma HIV RNA values at inclusion were 809/mm³ and 2.6 log copies/ml, respectively. Median HIV DNA load at inclusion was 2.3 log copies/10⁶ peripheral blood mononuclear cells (PBMCs). Thirty‐six months after TI, 63.9% of the patients had not yet reached the criteria for ART resumption, and 55.9% of patients had not resumed ART. In Cox multivariable analysis, a high HIV DNA level at TI, a low CD4 nadir, and pre‐existing AIDS status were the only significant risk factors for reaching the criteria for ART resumption (hazards ratio: 2.15 (1.02–4.53), 4.59 (1.22–17.24), and 5.74 (1.60–20.56), respectively). Patients who started ART with a CD4 cell count above 350/mm³ were able to interrupt treatment for long periods without a high absolute risk of either AIDS or severe non‐AIDS morbidity/mortality. A high PBMC HIV DNA level at TI was a strong predictor for more rapid treatment resumption. J. Med. Virol. 82:1819–1828, 2010. © 2010 Wiley‐Liss, Inc.     

Dynamics of CD4 cell count among HIV-infected individuals in Lagos,Nigeria

Human immunodeficiency virus (HIV) infection leads to progressive loss of CD4 T cells. Antiretroviral therapy has been able to inhibit this process, resulting in significant level of immune recovery and function. Our aim is to investigate the dynamics of CD4 recovery among HIV patients in Lagos, Nigeria. A total of 213 HIV-positive individuals were enrolled between October 2007 and May 2008, and followed up for 9 months based on CD4 count. CD4 analysis was done by flow cytometry at enrollment and after every 3 months. Data were grouped according to age range, antiretroviral treatment (ART), and time between infection and diagnosis. Kaplan–Meier survival analysis was used for data analysis. There was a significant difference in CD4 count between antiretroviral (ART) naïve and ART experienced subjects (P < 0.001). About 50% of the ART experienced population was identified to show poor CD4 reconstitution unable to achieve a CD4 of 500 cells/µl after 9 months of therapy. Time interval between infection and therapy was also identified to contribute to poor CD4 restoration. Further studies need to be done to classify immunological nonresponders among HIV patients in Nigeria. We also recommend introduction of programs that will facilitate early detection of HIV infection.     

Profil clinicobiologique, thérapeutique et évolutif des patients infectés par le VIH hospitalisés au service des maladies infectieuses et tropicales d’Abidjan (Côte d’Ivoire)

The objective of this study is to describe the clinical, biological, therapeutic and evolving current profile of hospitalized patients with HIV infection in the cohort of the Infectious and Tropical Diseases Unit (ITDU) in the aim to improve their care management. This is a retrospective study, conducted on medical data of hospitalized cases of patients with HIV infection in the ITDU at the teaching hospital of Treichville (Abidjan) from 2006 to 2007. During the two years, 447 patients were included in the study. Their average age was 39 years [18 years-86 years] and sex ratio was 0.69. Of the 447 patients, 35% were unemployed and 67% were new patients who had never undergone antiretroviral therapy (ART). The duration of drug exposure was less than 6 months in 59% of treated patients. The average time to initiate ART was seven weeks. Among naive patients 41.9% were lost to follow up, 35.9% were waiting for treatment and 22.1% waiting for baseline biological test to initiate ART. At the initiation of ART, 79.6% of patients had a CD4 count less than 200/mm³. The reasons of hospitalization defining AIDS were dominated by tuberculosis (34.2%), cerebral toxoplasmosis (17.9%) and neuromeningeal cryptococcosis (8%). The main reasons of hospitalization in classifying non-AIDS were pyelonephritis (6.5%), bacterial pneumonia (5.4%) and undetermined infectious encephalitis (4.9%). Hospital mortality was 24.4%. The leading causes of death were tuberculosis (22.9%), cerebral toxoplasmosis (20.2%), undetermined infectious encephalitis (18.3%) and cryptococcal meningitis (13.7%). The profile of PLHIV in hospital is characterized by profound immunosuppression due to late diagnosis and high mortality associated with severe opportunistic infections and late initiation of ART     

Coinfection with Cryptosporidium, Isospora and S. stercoralis in a patient with AIDS--a case report

A thirty eight year old lady, positive for human immunodeficiency virus (HIV) antibodies, was found to be positive for three different opportunistic parasitic infections. Cryptosporidium, Isospora and S.stercoralis were simultaneously detected from her stool samples. Her CD4 count was 116/cmm. The patient belonged to a slum area with poor sanitation.     

Respiratory cryptosporidiosis in two patients with HIV infection in a tertiary care hospital in Morocco

Respiratory cryptosporidiosis is recognized as a late-stage complication in persons with AIDS. We report two cases of respiratory cryptosporidiosis in patients with HIV infection. The first patient was a 46-year-old person with chronic diarrhea, a two-month history of low-grade fever, progressive dyspnea and productive cough. The search for acid-fast bacillus, Pneumocystis jirovecii, Toxoplasma gondii and Cryptococcus sp. in sputum was negative on several samples. The modified Ziehl has shown oocysts of Cryptosporidium sp. in induced sputum. The patient's death occurred, due to electrolytes disorders. The second patient was a 45-year-old person hospitalized for chronic fluid diarrhea, complicated with weight loss, dry cough, dyspnea stage II and low-grade fever. The patient was HIV-positive with low CD4 count and pancytopenia. Acid-fast oocysts of Cryptosporidium sp. were observed in stool samples and induced sputum. The patient was treated daily with azithromycin 500 mg resulting of disappearance of gastrointestinal and respiratory disorders.     

Apport de la PCR dans la recherche et l’identification des microsporidies intestinales chez les sujets infectés par le VIH

Aim

Intestinal microsporidiosis are among the most frequent opportunistic diseases in immunocompromised subjects. This study aimed to evaluate the contribution of PCR for a better detection and species identification of microsporidia in stool specimens of HIV-infected patients.

Patients and methods

Stool samples obtained from 119 HIV-infected Tunisian subjects were screened for intestinal microsporidiosis by light microscopy using Weber's modified Trichrome stain and by a PCR method using universal primers V1/PMP2 which amplified a common fragment of the small subunit rRNA gene of microsporidia. The obtained PCR products were then sequenced using an ABI PRISM 377 DNA sequencer.

Results

The results showed a better sensitivity of PCR in the detection of microsporidia with an infection rate of 14.3% significantly higher than that of 6.7% obtained by light microscopy (p = 0.03). As previously described, intestinal microsporidiosis was associated with low CD4 cell counts; 23.9% infection rate in patients having CD4 cell count under 200/mm³ against 5.6% in patients with higher CD4 cell count (p = 0.008). The sequencing of 15 out of the 17 positive PCR products has confirmed in all cases the species identified based on the PCR fragment size i.e., 250 pb for Enterocytozoon bieneusi (seven cases) and about 270 pb for Encephalitozoon intestinalis (nine cases); one case revealed a double infection.

Conclusion

PCR proved to be more effective than classical Trichrome stain for the diagnosis of intestinal microsporidiosis. Moreover, the ability of PCR to identify the species involved could also be useful for cases management.