Daurita Darci de Paiva

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%) 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.

Aspectos epidemiológicos, sociais e sanitários de uma área no Rio Negro, estado do Amazonas, com especial referência às parasitoses intestinais e à infecção chagásica

Um estudo seccional foi realizado na populacao residente em um de cada quatro domicilios habitados na cidade de Barcelos (no norte do Estado do Amazonas, na margem direita do Rio Negro, a 490km de Manaus por via fluvial), visando a avaliar as condicoes sociais, sanitarias e os indicadores especificos para as parasitoses intestinais e para infeccao chagasica. No inquerito, foram aplicados dois questionarios, um domiciliar para avaliar os aspectos sociais e sanitarios, e outro individual, para a avaliacao das condicoes sociais e epidemiologicas da populacao. Uma amostra por conglomerado familiar de 171 domicilios foi estudada. De cada um dos 658 habitantes, foi requisitada uma amostra de fezes para exame parasitologico pelas tecnicas de sedimentacao de Lutz e de Baermann-Moraes-Coutinho, modificado por Willcox & Coura (1989, 1991) e coletada uma amostra de sangue em papel de filtro para a reacao de imunofluorescencia para anticorpos anti-T. cruzi pelo metodo de Fife & Muschel modificado por Camargo (1966) e Souza & Camargo (1966) e Petana & Willcox (1975). O exame de fezes mostrou 69,4% das amostras com um ou mais parasitos. O Ascaris lumbricoides foi predominante, com 51% de positividade, e o Entamoeba histolytica, embora com exame nao especifico, foi positivo em 19,7%. Surpreendentemente, 20,1% das 658 amostras de sangue foram reativas para anticorpos anti-T. cruzi na diluicao de 1:20, e 13,7%, na diluicao de 1:40. Houve forte correlacao entre esses resultados e o nivel de contato da populacao humana com triatomineos silvestres, conhecidos localmente como piolho-da-piacava, e conseguimos isolar por xenodiagnostico uma cepa de T. cruzi de um paciente (no 209-1) com sorologia positiva para infeccao chagasica, natural da area e que havia trabalhado na agricultura, transportando piacava, e que conhecia muito bem o piolho-da-piacava.

Dirofilaríase pulmonar humana no Estado do Rio de Janeiro, Brasil: relato de um caso

We report a case of human pulmonary dirofilariasis in a female patient 45-years-old, derived from Rio de Janeiro, Brazil. The chest radiologic finding consisted of single pulmonary nodule located on the left lower lobe that simulated lung tumor. Human pulmonary dirofilariasis might be investigated in nodules that are not malignants and require conclusive diagnosis.

A 3-year follow-up of a brazilian AIDS patient with protracted diarrhea caused by Enterocytozoon bieneusi

Enterocytozoon bieneusi is the most prevalent microsporidian parasite that causes gastrointestinal infection in persons with AIDS. Microsporidia are increasingly recognized as important opportunistic pathogens all over the world but in Brazil only few cases have been reported due either to the non awareness of the clinical presentation of the disease or to difficulties in the laboratory diagnosis. We report a 3-year follow-up of a Brazilian HIV-positive patient in whom microsporidial spores were detected in stools and were identified as E. bieneusi using electron microscopy and PCR. The patient presented with chronic diarrhea, CD4 T-lymphocytes count below 100/mm3 and microsporidial spores were consistently detected in stools. Albendazole was given to the patient in several occasions with transient relief of the diarrhea, which reappeared as soon as the drug was discontinued. Nevertheless, a diarrhea-free period with weight gain up to 18 Kg occurred when a combination of nucleoside and protease inhibitors was initiated as part of the antiviral treatment.