Accurate detection of Zika virus IgG using a novel immune complex binding ELISA.

OBJECTIVES: Accurate serological assays are urgently needed to support public health responses to Zika virus (ZIKV) infection with its potential to cause foetal damage during pregnancy. Current flavivirus serology for ZIKV infections lacks specificity due to cross-reacting antibodies from closely related other flaviviruses. In this study, we evaluated novel serological tests for accurate ZIKV IgG detection. METHODS: Our ELISAs are based on immune complex binding. The high specificity is achieved by the simultaneous incubation of labelled ZIKV antigen and unlabelled flavivirus homolog protein competitors. Two assays were validated with a panel of 406 human samples from PCR-confirmed ZIKV patients collected in Brazil (n = 154), healthy blood donors and other infections from Brazil, Europe, Canada and Colombia (n = 252). RESULTS: The highest specificity (100% [252/252, 95% confidence interval (CI) 98.5-100.0]) was shown by the ZIKV ED3 ICB ELISA using the ED3 antigen of the ZIKV envelope. A similar test using the NS1 antigen (ZIKV NS1 ICB ELISA) was slightly less specific (92.1% [232/252, 95% CI 88.0-95.1]). The commercial Euroimmun ZIKV ELISA had a specificity of only 82.1% (207/252, 95% CI 76.8-86.7). Sensitivity was high (93-100%) from day 12 after onset of symptoms in all three tests. Seroprevalence of ZIKV IgG was analysed in 87 samples from Laos (Asia) confirming that the ED3 ELISA showed specific reactions in other populations. CONCLUSIONS: The novel ED3 ICB ELISA will be useful for ZIKV-specific IgG detection for seroepidemiological studies and serological diagnosis for case management in travellers and in countries where other flavivirus infections are co-circulating.

Synthetic Organotellurium Compounds Sensitize Drug-Resistant Candida albicans Clinical Isolates to Fluconazole.

Invasive Candida albicans infections are a serious health threat for immunocompromised individuals. Fluconazole is most commonly used to treat these infections, but resistance due to the overexpression of multidrug efflux pumps is of grave concern. This study evaluated the ability of five synthetic organotellurium compounds to reverse the fluconazole resistance of C. albicans clinical isolates. Compounds 1 to 4, at <10 µg/ml, ameliorated the fluconazole resistance of Saccharomyces cerevisiae strains overexpressing the major C. albicans multidrug efflux pumps Cdr1p and Mdr1p, whereas compound 5 only sensitized Mdr1p-overexpressing strains to fluconazole. Compounds 1 to 4 also inhibited efflux of the fluorescent substrate rhodamine 6G and the ATPase activity of Cdr1p, whereas all five of compounds 1 to 5 inhibited Nile red efflux by Mdr1p. Interestingly, all five compounds demonstrated synergy with fluconazole against efflux pump-overexpressing fluconazole-resistant C. albicans clinical isolates, isolate 95-142 overexpressing CDR1 and CDR2, isolate 96-25 overexpressing MDR1 and ERG11, and isolate 12-99 overexpressing CDR1, CDR2, MDR1, and ERG11 Overall, organotellurium compounds 1 and 2 were the most promising fluconazole chemosensitizers of fluconazole-resistant C. albicans isolates. Our data suggest that these novel organotellurium compounds inhibit pump efflux by two very important and distinct families of fungal multidrug efflux pumps: the ATP-binding cassette transporter Cdr1p and the major facilitator superfamily transporter Mdr1p.

Pharmacotherapy follow-up: Role in active malaria surveillance in a travel medicine centre outside the transmission area in Brazil.

WHAT IS KNOWN AND OBJECTIVE: Malaria is a potentially severe disease, widespread in tropical and subtropical areas. Apart from parasite drug resistance, which receives the largest share of attention, several factors directly influence the response to antimalarial treatment such as incorrect doses, adverse drug events, lack of adherence to treatment, drug quality and drug-drug interactions. Pharmacotherapy follow-up can be used to monitor and improve the effectiveness of treatment, prevent drug-related problems and ensure patient safety. The aim of this study was to describe the results of the implementation of pharmacotherapy follow-up of patients with malaria seen at a reference centre for malaria diagnosis and treatment (CPD-Mal) located in the city of Rio de Janeiro, an area without malaria transmission. METHODS: A descriptive study was conducted from January 2009 to September 2013 at the Instituto Nacional de Infectologia Evandro Chagas (INI) of the Fundação Oswaldo Cruz (Fiocruz). All malaria patients enrolled in the study were treated according to the Brazilian Malaria Therapy Guidelines. Data collected during pharmacotherapy follow-up were recorded in a standardized form. The variables included were age, gender, comorbidities, antimalarials and concomitant medications used, adverse drug reactions (ADR), clinical and parasitological cure times, and treatment outcomes classified as success, recurrence (recrudescence or relapse); and lost to follow-up. The ADR were classified by severity (DAIDS-NIH), organ system affected (WHO-ART) and likelihood to be caused by drugs (Naranjo scale). RESULTS AND DISCUSSION: One hundred thirteen cases of malaria were included. Patients were aged between 13 and 66 years and the majority of them (75.2%) were male. Ninety-four ADR were observed, most classified as mild (85.1%), related to disorders of the gastrointestinal system (63.8%), such as nausea and vomiting, and assessed as "possibly" caused by the antimalarial drugs (91.5%). The majority of clinical (90.9%) and parasitological (87.1%) cure occurred less than 72 hours after treatment initiation. Pharmacotherapy follow-up of malaria treatment by surveillance activities is therefore important regarding information about treatment outcomes as well as patient safety, resulting in better patient care and reducing the chance of relapses. The results underscore its use as a tool for monitoring adherence and drug resistance outside an endemic area. WHAT IS NEW AND CONCLUSION: Pharmacotherapy follow-up should be considered a useful malaria surveillance tool that can be developed by reference centres for comprehensive health care assistance and monitoring of therapeutic resistance.

Occult hepatitis B virus infection: clinical implications in tuberculosis treatment.

Occult hepatitis B virus infection (OBI) is characterized by the absence of HBsAg and persistence of the virus genome (HBV-DNA) in liver tissue and/or blood. OBI has been reported in several clinical contexts. However, the clinical significance of OBI in tuberculosis (TB) treatment is unknown. We investigated the OBI prevalence and its impact on the risk of drug-induced liver injury (DILI) during TB treatment. This was a prospective cohort study with one hundred patients who were treated for TB from 2008 to 2015. Laboratory, clinical and demographic data of TB patients were extracted from medical records. Based on HBV-DNA testing of serum samples, an OBI prevalence of 12% was established; almost half of these patients had both anti-HBc and anti-HBs serological markers. Low CD4+ cell counts have been shown to be a risk factor for OBI among TB patients co-infected with HIV (P=.036). High DILI incidence was observed in this study. A multivariable Cox proportional hazard model was conducted and identified OBI (HR 2.98, 95% CI 1.30-6.86) as the strongest predictor for DILI when adjusted to CD4+ cell count (HR 0.38, 95% CI 0.17-0.90), ALT before TB treatment (HR 1.37, 95% CI 0.81-2.32) and TB extrapulmonary clinical form (HR 2.91, 95% CI 1.75-7.21). The main aim of this study was to highlight DILI as a clinical outcome during treatment of TB patients with OBI. Therefore, HBV-DNA testing should be considered routinely in monitoring DILI, and also in other clinical implications associated with OBI, reduce morbidity and mortality.

A cluster of Rickettsia rickettsii infection at an animal shelter in an urban area of Brazil.

Rickettsia rickettsii infection is being increasingly recognized as an important cause of fatal acute illness in Brazil, where this tick-borne disease is designated Brazilian spotted fever (BSF). In this study we report five fatal cases of BSF in employees of an animal shelter in an urban area in the municipality of Rio de Janeiro in southeast Brazil after a natural disaster on 11 January 2011. Four of the cases occurred from 27 January to 11 April 2011, while the fifth fatal case was identified in April 2012. Three cases were confirmed by molecular analysis and two by epidemiological linkage. An investigation of BSF was performed in the animal shelter, and blood samples were collected from 115 employees and 117 randomly selected dogs. The presence of high levels (1024-4096) of antibodies against spotted fever group rickettsiae was found in three (2·6%) employees and 114 (97·5%) dogs. These findings emphasize the need to consider BSF as a possible cause of undifferentiated febrile illness, especially dengue and leptospirosis, in patients occupationally exposed to dogs heavily infested by ticks, mainly working at kennels and animal shelters that have inadequate space for the animals housed and frequently providing an environment conducive to exposure to pathogens such as R. rickettsii.

Dealing with initial inconclusive serological results for chronic Chagas disease in clinical practice.

Most guidelines for Chagas disease recommend the performance of two serological tests in order to detect it. However, inconclusive results may arise from this strategy. The aim was to describe whether serological follow-up together with the patient's clinical characteristics could clarify the outcome of patients with initial inconclusive test results. In this retrospective case series, all results of Chagas disease serological tests and outpatient visits recorded from 2004 to 2008 were screened for inclusion. The inclusion criterion was clinical suspicion of chronic Chagas disease and the exclusion criteria were previous diagnosis of Chagas disease, suspicion of acute Chagas disease, and serological tests with no corresponding medical evaluation. A total of 1,732 patients were analyzed. Chronic Chagas disease prevalence was 21.1%. After the initial set of serological tests, 2.9% of patients had inconclusive test results. Most of these patients had definite diagnosis after clinical follow-up and the repetition of serological tests in a new blood sample. Loss to follow-up while partaking in the diagnostic investigation reached 17.7%. The prevalence of initial inconclusive serological tests for chronic Chagas disease is low. Clinical evaluations and follow-up clarify the definite diagnosis. Noncompliance to follow-up is a frequent problem. Strategies to reduce inconclusive results and noncompliance are discussed.

The roles of GSTM1 and GSTT1 null genotypes and other predictors in anti-tuberculosis drug-induced liver injury.

WHAT IS KNOWN AND OBJECTIVE: Anti-tuberculosis drugs (ATD), although highly effective, often cause liver injury. Glutathione S-transferases (GST) play a crucial protective role in the detoxifying mechanisms of drugs. Several studies have investigated the genetic null variants of GSTM1 and GSTT1 as possible risk factors for ATD-induced liver injury; however, those findings are inconsistent. We investigated GSTM1 and GSTT1 null genotypes in Brazilian patients with tuberculosis (TB), adjusting for other possible predictors of ATD-induced liver injury. METHODS: This was a prospective cohort study with patients who were treated for TB from 2006 to 2011. GSTM1 and GSTT1 gene deletions were analysed from genomic DNA by polymerase chain reaction (PCR). Demographic, clinical and laboratory data were extracted from medical records and possible predictors of liver injury were evaluated. RESULTS AND DISCUSSION: This study enrolled 177 patients. Anti-tuberculosis drugs-induced liver injury incidence was 33.3%. Hepatitis B infection (HBV) and increased alanine aminotransferase (ALT) baseline were significant predictors. Neither GSTM1 nor GSTT1 null genotypes were associated with ATD-induced liver injury; nevertheless, the comparison among four different liver toxicity grades showed that GSTM1 non-null genotype was significant more frequent among the higher grades of liver toxicity. WHAT IS NEW AND CONCLUSION: GSTM1 and GSTT1 null genotypes do not seem to play important roles in ATD-induced liver injury in Brazilians. However, there was evidence that GSTM1 polymorphisms were possibly related to the intensity of toxicity. Active HBV and initial high ALT could predict ATD-induced liver injury.

Interobserver agreement on signs and symptoms of patients with acute febrile illness.

PURPOSE: To assess the interobserver agreement on clinical history and physical examination when using a semi-structured questionnaire to evaluate patients with an acute febrile illness (AFI). METHODS: A cross-sectional study was conducted with outpatients aged 12 years and over, presenting with an AFI defined as fever up to 7 days and no evident focus of infection. Clinical data were collected independently by two physicians using a semi-structured questionnaire. Interobserver agreement was estimated using kappa coefficients with a 95% confidence interval (CI). RESULTS: A total of 140 patients (age range 13-73 years; 56.4% females) were enrolled. All symptoms showed weighted kappa values significantly greater than 0.6, indicating an at least substantial agreement. As most physical signs were infrequent and of mild intensity, they were recoded and analyzed as absent/present. Of the signs with prevalence ≥15%, exanthema, pallor, lymph node enlargement, and eye congestion showed agreements significantly greater than 0.6, while kappa confidence limits for pharyngeal erythema and dehydration included values classified as regular. CONCLUSIONS: High agreement was observed for most of the clinical data assessed, and symptom grading was feasible. Some physical findings were rare and their inclusion in a structured form may not be justified in this setting. The questionnaire application showed good reliability for the most frequent signs and symptoms and may prove to be useful at gathering data for surveillance and research at sentinel sites.

Epidemiology of acute febrile illness in Latin America.

BACKGROUND: The causes of acute febrile illness (AFI) in Latin America are diverse and their complexity increases as the proportion of fever due to malaria decreases, as malaria control measures and new pathogens emerge in the region. In this context, it is important to shed light on the gaps in the epidemiological characteristics and the geographic range for many AFI aetiologies. OBJECTIVES: To review studies on community-acquired fever aetiology other than malaria in Latin America, and to highlight knowledge gaps and challenges needing further investigation. SOURCES: PubMed from 2012 to April 2018. CONTENT: We found 17 eligible studies describing 13 539 patients. The median number of pathogens tested per individual was 3.5 (range 2-17). A causative pathogen could be determined for 6661 (49.2%) individuals. The most frequently reported pathogen during the study periods was dengue virus (DENV) (14 studies), followed by chikungunya virus (nine studies) and Zika virus (seven studies). Among the studies reporting concurrent infections, 296 individuals (2.2%) were found to have co-infections. In-hospital mortality was reported in eight (47%) studies, ranging between 0% and 18%. IMPLICATIONS: DENV fever is the febrile illness most frequently reported, reflecting its importance, while chikungunya and zika viruses present increasing trends since their emergence in the region. Studies with systematic and harmonized approaches for detection of multiple pathogens are needed and would probably reveal a higher burden of neglected pathogens such as Rickettsia spp. and arenaviruses. The lack of point-of-care tests and harmonized approach limits the care provided by health professionals and the efficacy of surveillance for AFI in the region.

Autoestima e risco para depressão em idosos residentes em instituições de longa permanência / Self-esteem and risk for depression in elderly residents of long stay institutions

Objetivo: mensurar a autoestima e o risco para depressão em idosos residentes em Instituição de Longa Permanência. Métodos: estudo exploratório descritivo com abordagem quantitativa, com 25 idosos residentes em uma Instituição de Longa Permanência, por meio da aplicação de questionário sociodemográfico e escala de autoestima de Rosenberg e de depressão abreviada de Zung. Resultados: prevaleceram idosos com idade superior a 70 anos, sexo feminino, viúvos, que possuíam filhos e visitados mensalmente por familiares. Constatou-se que 52% estavam com autoestima baixa e 48% estavam em risco para depressão. Dentre os sintomas depressivos destacaram-se a dificuldade em tomar decisões, pouca esperança acerca do futuro, sentimento de inutilidade e fracasso, e insatisfação de vida. Conclusões: idosos residentes de instituições de longa permanência são vulneráveis à baixa autoestima e depressão. As escalas são ferramentas que contribuem para detecção e monitoramento desses agravos. Permitem desenvolver ações para a melhoria da qualidade de vida e saúde mental.

Perfil dos atendimentos realizados pelo Serviço de Atendimento Móvel de Urgência no município de Colombo (PR) / Profile of care provided by the Mobile Emergency Care service of the city of Colombo-PR

Objetivo: Descrever o perfil dos atendimentos realizados pelo Serviço de Atendimento Móvel de Urgência (SAMU) do município de Colombo (PR). Método: Estudo descritivo de abordagem quantitativa, utilizando as informações contidas nas fichas de atendimentos do SAMU do município de Colombo (PR) para a coleta dos dados no período de dezembro de 2016 a agosto de 2017. Resultados: Foram analisados 2.784 fichas e os resultados mostram predominância do sexo masculino com 1.441 (51,76%), faixa etária de 19-59 anos com 1.531 (54,99%), ocorrências de perfil clínico com 1.715 (61,60%) e, tendo como destino final a UPA do município 1.377 casos (63,75%). Conclusões: O estudo contribui na quantificação de informações de atendimento do SAMU realizados no município de Colombo, a fim de qualificar a organização das demandas de atendimento pela rede de Urgência e Emergência no município

Conhecimento da equipe de enfermagem de setores críticos na realização e interpretação de eletrocardiograma / Knowledge of the nursing team of critical sectors during the performance and interpretation of an electrocardiogram

Estudio exploratorio descriptivo con enfoque cuantitativo, cuyo objetivo fue analizar el conocimiento del equipo de enfermería en sectores críticos mediante la realización e interpretación del electrocardiograma. Los participantes fueron 35 profesionales, incluidas enfermeras y técnicos de enfermería, de sectores críticos de un hospital privado en Curitiba. Para la recopilación de datos, se utilizó un formulario con veinte preguntas de opción múltiple preparadas por el investigador y aplicadas a través de los formularios de Google. El estudio fue estadístico descriptivo, realizado con el software Microsoft Excel. Se concluyó al darse cuenta de que el uso de ECG es esencial en sectores críticos, y que el equipo de enfermería necesita capacitación principalmente en lectura e interpretación de este examen, también se destaca la importancia de la educación continua y la falta literaria sobre este tema dirigido al equipo técnico de enfermería.

Percepção do estudante sobre a influência do ambiente/clima educacional no processo ensino-aprendizagem: uma revisão integrativa / Student's perception of the influence of the educational environment / climate in the teaching-learning process: an integrative review

Trata-se de revisão integrativa que objetivou descrever o conceito de ambiente/clima educacional e identificar a influência do ambiente/clima educacional no processo ensino-aprendizagem sob a percepção do estudante. Ambiente educacional (AE) é todo e qualquer contexto em que se dá o ensino e o aprendizado. Foram selecionados doze artigos relevantes ao tema, nas bases de dados BVS e PubMed, com descritores, educação superior, competência clínica, procedimentos clínicos e aprendizagem. Emergiram três categorias: ambiente educacional e ensino clínico na saúde; percepção do estudante sobre o ambiente educacional e fatores do ambiente educacional que influenciam no processo ensino-aprendizagem. O AE pode afetar as habilidades e o desempenho acadêmico e deve propiciar confiança nas atividades diárias. Conclui-se que o AE tem influência no processo ensino-aprendizagem, fornece informações importantes para os educadores, estimulam a autoconfiança e aspectos afetivos.

Família presente no atendimento da emergência pediátrica: e agora, equipe? / Family present at pediatric emergency care: now what, team?

O atendimento na emergência pediátrica compreende passos importantes no manejo do paciente crítico e pode-se considerar, ou não, a presença da família. O objetivo é analisar a percepção da equipe de saúde multiprofissional, em um pronto atendimento pediátrico, em um município do estado do Paraná, referente à presença da família na emergência pediátrica. O método foi exploratório-descritivo, com abordagem qualitativa. Os dados foram submetidos à análise de conteúdo temática. Os profissionais se mostraram favoráveis à permanência da família, auxiliando na recuperação da criança, proporcionando segurança e tranquilidade. Destacaram que a instabilidade familiar atrapalha o desempenho da equipe. Recomenda-se que instituições hospitalares proporcionem a educação permanente em saúde como forma de capacitação dos profissionais, além de reflexões sobre o processo de trabalho envolvido no acolhimento da família para estruturação de um protocolo interno que padronize as ações.

Cuidados paliativos de enfermagem a pacientes com feridas neoplásicas / Palliative nursing care for patients with neoplastic wounds

Objetivo: Descrever as evidências científicas disponíveis na literatura sobre os cuidados paliativos de enfermagem a pacientes com feridas neoplásicas. Métodos: Trata-se de uma revisão integrativa, realizada no LILACS, MEDLINE e BDENF, a partir dos descritores: Oncologia, Cuidados Paliativos, Neoplasias Cutâneas. Resultados: Analisaram-se 8 artigos, organizados nas seguintes categorias: 1) Assistência de enfermagem no controle do odor e exsudato em feridas neoplásicas; 2) Cuidados paliativos de enfermagem no controle da dor e hemorragias em feridas neoplásicas; 3) Atuação assistencial de enfermagem aos impactos psicossociais em pacientes com feridas neoplásicas em tratamento paliativo; 4) A importância da educação permanente dos profissionais de enfermagem que atuam no cuidado paliativo de feridas neoplásicas. Conclusões: A enfermagem atua proporcionando assistência humanizada aos pacientes em cuidados paliativos, a fim de minimizar o desconforto das feridas neoplásicas.

Eu mudo, nós mudamos? Perspectivas sobre o trabalho dos Agentes Comunitários de Saúde / I change, do we change? Perspectives on the work of Community Health Agents

Este artigo visa analisar o processo de trabalho e as perspectivas de mudanças, a fim de proporcionar reflexões sobre a prática cotidiana de 62 Agentes Comunitários de Saúde da cidade de Campo Bom, no Rio Grande do Sul, Brasil. Os dados obtidos foram coletados através de entrevistas individuais e questionários autopreenchidos, e a análise dos conteúdos foi feita a partir da construção do Discurso do Sujeito Coletivo. A maioria dos trabalhadores relata que haveria algo a ser modificado no seu processo de trabalho. Dentre os aspectos a serem modificados e/ou melhorados estão: burocratização do trabalho, reorganização das marcações de consulta, respeito, união das equipes, maior participação dos profissionais de saúde (médicos e enfermeiros) nas visitas domiciliares, equipes incompletas, automatização do processo de trabalho, grande número de famílias cadastradas, reconhecimento, ausência e/ou sucateamento de materiais básicos de trabalho

Tuberculosis in renal transplants in Rio de Janeiro.

Retrospective analysis of 982 renal transplants over 21 years (1981 to 2002) sought to evaluate the prevalence of tuberculosis (TB). This analysis included 74 patients: 30 with a past TB history, who had INH prophylaxis since the beginning of immunosuppression, and 44 who only became TB infected after receiving transplants. The diagnosis of TB was made by a compatible medical situation with bacteriological/histological confirmation, which when not possible, underwent a therapeutic test occur. The average time for the illness to surge was 3 years. The mortality rate was 34.9% (15/44). Patients with hepatitis C were more affected. Among those who used INH prophylaxis only one contracted TB, showing that the drug displayed a protection rate of 96.6% (29/30).

Intestinal microsporidiosis in HIV-positive patients with chronic unexplained diarrhea in Rio de Janeiro, Brazil: diagnosis, clinical presentation and follow-up.

After the diagnosis of two cases of microsporidial intestinal infection in 1992, in Rio de Janeiro, we have started looking for this parasite in HIV-infected patients with chronic unexplained diarrhea. We have studied 13 patients from Hospital Evandro Chagas, IOC-FIOCRUZ. Fecal specimens from these patients were examined for the presence of Cryptosporidia and Microsporidia, in addition to routine examination. Spores of Microsporidia were found in the stools of 6 (46.1%) of the 13 patients studied, with 2 histological jejunal confirmations. The Microsporidia-infected patients presented chronic diarrhea with about 6 loose to watery bowel movements a day. Five infected patients were treated with Metronidazole (1.5 g/day). They initially showed a good clinical response, but they never stopped eliminating spores. After about the 4th week of therapy, their diarrhea returned. Two patients utilized Albendazole (400 mg/day-4 weeks) with a similar initial improvement and recurrence of the diarrhea. Intestinal Microsporidiosis seems to be a marker of advanced stages of AIDS, since 5 of our 6 infected patients were dead after a 6 month period of follow-up. The present study indicates that intestinal microsporidiosis may be a burgeoning problem in HIV-infected patients with chronic diarrhea in Brazil, which deserves further investigation.

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.

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.