Endogenous development of Cystoisospora belli in intestinal and biliary epithelium of humans.

Cystoisospora (Isospora) belli is a coccidian parasite of humans. It can cause serious digestive disorders involving infection of intestines, biliary tract and gallbladder, especially in those with depressed immunity. It has a direct fecal-oral transmission cycle. After ingestion of sporulated oocysts, the parasite multiplies asexually and sexually within host epithelial cells, resulting in unsporulated oocysts that are excreted in feces. The details of asexual and sexual stages are not known and certain inclusions in epithelial cells in biopsy samples have been erroneously identified recently as C. belli. Here, we provide details of developmental stages of C. belli in two patients, in duodenal biopsy of one and biliary epithelium of the other. Immature and mature asexual stages (schizonts/meronts) were seen in epithelial cells. The merozoites were seen singly, in pairs and in groups in single parasitophorous vacuole (pv) in host cytoplasm. Immature and mature meronts were seen together in the same pv; up to eight nuclei were seen in meronts that retained elongated crescent shape; round multinucleated schizonts, seen in other coccidians, were not found. Meronts were up to 25 µm long and contained up to ten merozoites that were 8-11 µm long. The merozoites and meronts contained PAS-positive granules. Microgamonts (male) contained up to 30 nuclei that were arranged at the periphery and had condensed chromatin; 1-3 PAS-positive, eosinophilic, residual bodies were left when microgametes were formed. The microgametes were 4 µm long and PAS-negative. All stages of macrogamonts, including oocysts were PAS-positive. The detailed description of the life cycle stages of C. belli reported here should facilitate in histopathologic diagnosis of this parasite.

Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient.

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.

Opportunistic parasites among immunosuppressed children in Minia District, Egypt.

A total of 450 stool samples were collected from inpatient and outpatient clinics of Pediatric Department, Minia University Hospital, Minia District, Egypt. Two groups of patients were studied, including 200 immunosuppressed and 250 immunocompetent children. Stool samples were subjected to wet saline and iodine mounts. A concentration technique (formol-ether sedimentation method) was carried out for stool samples diagnosed negative by wet saline and iodine mounts. Samples were stained by 2 different methods; acid fast stain (modified Ziehl-Neelsen stain) and Giemsa stain. Total 188 cases (94%) were diagnosed positive for parasitic infections among immunosuppressed children, whereas 150 cases (60%) were positive in immunocompetent children (P<0.0001). The most common protozoan infection in immunosuppressed group was Cryptosporidium parvum (60.2%), followed by Blastocystis hominis (12.1%), Isospora belli (9.7%), and Cyclospora caytenensis (7.8%). On the other hand, Entamoeba histolytica (24.6%) and Giardia lamblia (17.6%) were more common than other protozoans in immunocompetent children.

Prevalence of Opportunistic Intestinal Parasitic Infections Among HIV/AIDS Patients Before and After Commencement of Antiretroviral Treatment at Felege Hiwot Referral Hospital: A Follow-up Study.

BACKGROUND: Coccidian parasites are opportunistic intestinal parasites that cause diarrhea in immunocompromised individuals. Although the impacts of coccidian infection are significant among HIV/AIDS infected cases, proper diagnosis and management of coccidian infection is limited in sub-Saharan Africa including Ethiopia. OBJECTIVE: The aim of this study was to determine the prevalence of coccidian parasitic infections among HIV/AIDS cases before and after commencement of antiretroviral treatment. METHODS: An institution-based longitudinal study was conducted among 304 randomly selected HIV/AIDS cases from February to July 2018 before and after commencement of antiretroviral therapy. A structured questionnaire was used to collect sociodemographic and associated factors data. Stool and blood samples were collected before and three months after treatment. Coccidian detection and CD4+ count were conducted via modified acid fast stain technique and fluorescence-activated cell scanning, respectively. Data were entered and analyzed using SPSS version 20. Descriptive statistics were used to compute coccidian prevalence. Logistic regression was used to compute possible association between associated factors and coccidian parasitic infection. Variables with P<0.05 were considered to be statistically significant. RESULTS: Among 304 HIV/AIDS cases, prevalence of coccidian parasitic infection before and after antiretroviral treatment was 23.4% and 8.9%, respectively. Prevalence of Cryptosporidium spp. (19.7%) and Isospora belli (4.3%) before antiretroviral treatment were higher than Cryptosporidium spp. (7.9%) and Isospora belli (1.0%) after treatment. Drinking unprotected water (AOR: 7.41; 95%CI: 1.64-33.45), poor knowledge of HIV/AIDS and coccidian parasite (AOR: 4.19; 95%CI: 1.69-10.40), and CD4+ count below 200 cells/mm3 (AOR: 62.49; 95%CI: 25.32-154.21) were significantly associated with coccidian infection. CONCLUSION: Prevalence of coccidian parasites among HIV/AIDS cases decreases after antiretroviral treatment. Drinking unsafe water, limited knowledge of HIV/AIDS and coccidian parasite and low CD4+ cell count are factors associated with coccidian infection. Therefore, proper detection and treatment of coccidian parasites among HIV/AIDS cases should be prioritized.

Molecular detection of Cystoisospora belli by single-run polymerase chain reaction in stool samples.

INTRODUCTION: Cystoisospora belli (C. belli) is the only pathogenic species of the Cystoisospora genus responsible for severe diarrhea in immunocompromised patients. Most common microscopic method of diagnosis is less sensitive due to intermittent shedding of oocysts. We developed a new single-run polymerase chain reaction (PCR)-based diagnostic assay for C. belli. METHODS: A new single-run PCR-based diagnostic assay was standardized for the detection of C. belli. Diagnostic reproducibility and repeatability of the PCR assay were evaluated. A cross-sectional analytical study was done on a total of 354 stool samples collected from 331 immunocompromised patients with diarrhea. All the stool samples were tested for the presence of oocysts of C. belli and were also tested by our new PCR assay for C. belli. Three of the representative PCR products were confirmed by sequencing. Fisher's exact test was used to compare the two proportions. RESULTS: Microscopy detected C. belli in 11/354 (3.1%) of stool samples, and the new PCR-based assay detected C. belli in 16/354 (4.5%). The new single-run PCR-based assay detected C. belli in all the stool samples which were tested positive by microscopy and additionally detected C. belli in five stool samples. The developed PCR assay detected statistically significant proportion of C. belli (p < 0.001) as compared to microscopy. The 795 base pair PCR product from one microscopy positive stool sample and two microscopy negative stool samples were confirmed by sequencing. CONCLUSION: Our newly developed single-run PCR-based detection assay for C. belli is robust and reproducible. It may be used for molecular diagnosis of cystoisosporiasis especially in transplant, pediatrics, and human immunodeficiency virus (HIV) positive patients.

[Abundance Dynamic of Oocysts in the Groundwater of Mbankomo, a Sub-urban Area Yaounde: Physico-chemical Factors and Health Risk]. / Dynamique d'abondance des charges oocystiques dans les eaux souterraines de Mbankomo, une zone périurbaine de Yaoundé : physicochimie et risque sanitaire.

To determine the dynamics of dissemination of the different forms of enteric sporozoa in the groundwater of Mbankomo, a study was carried out from August 2018 to July 2019. The physico-chemical analyzes were carried out both in the field and in the hydrobiology and environment laboratory of the University of Yaoundé I. The observation of protozoan oocysts was carried out after application of the Ziehl-Neelsen staining. Physico-chemical analysis showed slightly acidic water (6.32 ± 0.43 UC), with high turbidity (31.30 ± 23.56 mg/l). Biological analysis indicated the presence of protozoan oocysts with an average density of 42 ± 69 oocysts/l of Cryptosporidium spp., 17 ± 34 oocysts/l of Cyclospora cayetanensis, 9 ± 19 oocysts/l of Isospora belli and 6 ± 11 oocysts/l of Sarcocystis spp. The highest concentrations of oocysts were recorded during the rainy season. Statistical tests showed a positive correlation between the densities of oocysts with suspended matters (P < 0.05).

Dans le but de déterminer la dynamique des formes de dissémination des sporozoaires entéropathogènes présents dans les eaux souterraines de la localité de Mbankomo, une étude a été menée d'août 2018 à juillet 2019. Les analyses physicochimiques se sont déroulées à la fois sur le terrain et au laboratoire d'hydrobiologie et environnement de l'université de Yaoundé-I. L'observation des oocystes de protozoaires s'est faite après coloration de Ziehl-Neelsen modifiée. Les analyses physicochimiques des eaux souterraines ont donné des résultats légèrement acides (6,32 ± 0,43 UC) avec des valeurs élevées en turbidité (31,30 ± 23 ,56 mg/l). Les analyses biologiques présentent les valeurs de densités moyennes de 42 ± 69 oocystes/l pour Cryptosporidium spp., 17 ± 34 oocystes/l pour Cyclospora cayetanensis, 9 ± 19 oocystes/l pour Isospora belli et 6 ± 11 oocystes/l pour Sarcocystis spp. Dans l'ensemble, les densités d'oocystes ont été plus élevées pendant les saisons des pluies. La dynamique d'abondance de ces entéroprotozoaires sporozoaires est significativement et positivement corrélée aux matières en suspension (p < 0,05).

Isosporiasis in HIV/AIDS Patients in Edo State, Nigeria.

BACKGROUND: The role of opportunistic infections in accelerating disease progression in HIV-positive individuals, leading to quick death, is still receiving serious attention. The objective of this study was to determine the prevalence of Isospora belli infections in HIV-positive patients in Edo State, Nigeria between August 2007 and March 2008. METHODS: A total of 268 samples from HIV-positive patients and 20 samples from HIV-negative patients were processed using the modified Ziehl-Neelsen staining technique to microscopically identify the presence of I. belli oocysts. RESULTS: The overall prevalence of the coccidian was 3.1%. Gender and age had no correlation with the prevalence of the parasite (P > 0.05). There was a significant relationship between isosporiasis and CD4+ T cell counts in HIV-positive patients (OR=11.388, 95% CI= 2.797-46.371, P=0.0004). CONCLUSIONS: Routine investigation of I. belli in HIV-positive subjects is advocated in tertiary health institutions.

[Dynamic Abundance of Oocysts in the Mezam Watershed in Bamenda (Northwest Region, Cameroon)]. / Dynamique d'abondance des charges oocystiques dans le bassin versant du Mezam à Bamenda (région du Nord-Ouest, Cameroun).

In order to evaluate the abundance of oocysts in the Mezam watershed in Bamenda, Northwest Region of Cameroon, a study was carried out from January to June 2017. Samples were collected monthly from 13 stations within the watershed. The direct concentration method and the Ziehl-Neelsen technique were employed in the identification of these parasites. The physicochemical analysis showed that the water samples had a neutral pH (7.46±0.46), lowly mineralized (165.61±110.02µS/cm), moderately oxygenated (60.64 ± 17, 25%), present moderate organic pollution (2.85±2.49mg/l KMnO4). KMnO4) and low levels of orthophosphate (1.8±1.88 mg/l PO43-) and nitrates (2.47±5.06 mg/l NO3-). Biological analysis revealed the presence of Cryptosporidium spp. (143.98±203.35 oocysts/l), Isospora belli (88.47 ± 123.19 oocysts/l), Cyclospora cayetanensis (141.31±143.19 oocysts/l) and Sarcocystis hominis (76 ± 111.04 oocysts/l). The highest densities of these parasites were recorded at the Mufueh stream, situated in the periurban area. Meanwhile, the lowest densities were found in the urban area (Formuki, Mankon, Ayaba and Mezam streams). The dry season showed higher densities of oocysts (471.42±216.32 oocysts /l). Statistical analysis revealed a significant correlation (P ≤ 0.05) between the density of the organisms and the physico-chemical parameters such as pH, oxidability, dissolved oxygen and nitrates. Respecting basic hygienic rules as well as treating water before use would reduce the risk of contamination of the population.

Dans le but d'évaluer l'abondance des oocystes des sporozoaires dans le bassin versant du Mezam à Bamenda dans la région du Nord-Ouest du Cameroun, une étude a été menée de janvier à juin 2017. Des échantillonnages ont été effectués sur 13 stations de ces eaux, suivant une fréquence mensuelle de prélèvement. Les oocystes ont été identifiés à l'aide de la méthode directe de concentration et de la technique de Ziehl-Neelsen. Les analyses physico-chimiques montrent que les eaux ont un pH neutre (7,46 ± 0,46), sont faiblement minéralisées (165,61 ± 110,02 µS/cm), moyennement oxygénées (60,64 ± 17, 25 %), ont une pollution organique modérée (2,85 ± 2,49 mg/l de KMnO4) et des faibles teneurs en orthophosphates (1,8 ± 1,88 mg/l de PO43-) et en nitrates (2,47 ± 5,06 mg/l de NO3-). Les analyses biologiques révèlent la présence de Cryptosporidium spp. (143,98 ± 203,35 oocystes/l), de Isospora belli (88,47 ± 123,19 oocystes/l), de Cyclospora cayetanensis (141,31 ± 143,19 oocystes/l) et de Sarcocystis hominis (57,76 ± 111,04 oocystes/l). Les plus fortes densités de ces oocystes sont enregistrées en saison sèche (471,42 ± 216,32 oocystes/l). Les analyses statistiques montrent des corrélations significatives (P ≤ 0,05) entre la densité de ces oocystes et les paramètres physico-chimiques tels que le pH, l'oxydabilité, l'oxygène dissous et les ions nitrates. Le respect des règles d'hygiènes élémentaires et le traitement des eaux avant tout usage réduiraient les risques de contamination de la population.

Ultrastructural aspects of Cystoisospora belli (syn. Isospora belli) in continuous cell lines.

Cystoisospora belli is an opportunistic protozoan that causes human cystoisosporiasis, an infection characterized by diarrhea, steatorrhea, abdominal pain, fever, and weight loss. The lack of animal models susceptible to C. belli, and the difficulty in obtaining clinical samples with fair amounts of oocysts have limited the research pertaining to the basic biology of this parasite. This study aimed to describe the ultrastructure of endogenous stages of C. belli in Monkey Rhesus Kidney Cells (MK2) and Human Ileocecal Adenocarcinoma cells (HCT-8). Zoites of C. belli exhibited typical morphological features of coccidia, which included a trilaminar pellicle, an apical complex formed by a conoid, polar rings, rhoptries, and micronemes, in addition to dense granules and the endoplasmic reticulum. No crystalloid body was observed but various lipid and amylopectin granules were usually present in the cytoplasm of zoites. We observed a tendency of the endoplasmic reticulum of the host cell to be located near the parasitophorous vacuole membrane. Merozoites were formed by endodyogeny and during replication, the apical complex of the mother cell remained intact. The formation of gametes or oocysts was not observed. The ultrastructural findings of C. belli are further evidence of its proximity to Sarcocystidae family members and corroborate their reclassification as Cystoisospora spp.

Isospora belli associated recurrent diarrhea in a child with AIDS.

Persistent diarrhea is a major manifestation of Acquired Immunodeficiency Syndrome (AIDS) which might be more complicated in Human Immunodeficiency Virus (HIV) infected children especially those from developing countries. There are numerous reports showing the emergence of intestinal opportunistic coccidian parasites, mostly Cryptosporidium parvum and Isospora belli in HIV-infected individuals. The prevalence of isosporiasis is probably underestimated in developing countries because routinely not all HIV-infected patients are examined for the presence of this protozoan infection. Here we report a case of HIV-infected isosporiasis presenting with failure to thrive and persistent diarrhea. Since I. belli infection in children responds well to therapy with trimethoprim-sulfamethoxazole, isosporiasis should be considered as a treatable infection in AIDS, if it is detected at proper time.

Prevalence of isosporiasis in relation to CD4 cell counts among HIV-infected patients with diarrhea in Odisha, India.

BACKGROUND: To determine the prevalence of Isospora belli and its correlation with CD4+ cell counts in HIV-positive patients with diarrhea in this region. MATERIALS AND METHODS: Stool samples from 250 HIV-positive patients, including 200 with diarrhea and 50 without diarrhea included in the study were examined for the presence of enteric parasites under microscopy. Prevalence of the enteric parasites with special reference to I. belli in HIV-positive patients with and without diarrhea were calculated and correlated with their CD4+ cell counts. RESULTS: Enteric parasites were detected in 39% of the HIV patients with diarrhea compared to 30% without diarrhea. I. belli was detected in 22% of the patients with diarrhea and in 4% without diarrhea (P = 0.0019). I. belli was the most common parasite, followed by Entamoeba histolytica/dispar (8%) and Cryptosporidium parvum (5%) in HIV-positive patients with diarrhea. In HIV-positive patients without diarrhea, the most common parasite detected was E. histolytica/dispar (12%) followed by C. parvum (6%) and I. belli (4%). The mean CD4 cell count of HIV-positive patients with diarrhea suffering from isosporiasis was 138.35 ± 70.71. In patients with CD4 cell counts <200/µl, I. belli was seen in 36/123 stool samples and 2/27 stool samples which was statistically significant (P = 0.0157). CONCLUSION: I. belli was the predominant parasite with a prevalence of 22% among HIV-positive patients with diarrhea, majority having CD4 cell count <200/µl. This study highlights the importance of routine screening for coccidian parasites in HIV-positive patients with and without diarrhea especially in those with low CD4 cell counts.

Intestinal protozoans in adults with diarrhea.

BACKGROUND: Diarrhea is one of the most common presenting complaints in human immunodeficiency virus-infected individuals. AIMS: The study was designed to determine the magnitude of opportunistic and nonopportunistic intestinal parasitic infections among diarrheal patients and association between CD4(+) T-cell counts and human immunodeficiency virus (HIV)-infected intestinal parasites. MATERIALS AND METHODS: A cross-sectional study was conducted among 207 enrolled diarrheal patients attending HIV integrated counseling and testing center from January 2012 to December 2012. Stool samples were subjected to special modified Ziehl-Neelsen and chromotrope staining method for detection of opportunistic protozoans. Blood samples were also collected from all study subjects for HIV testing and CD4(+) T-cell counts were estimated by only in HIV-infected patients. RESULTS: Intestinal parasitic pathogens were detected in 46.1% HIV-infected patients and the major pathogens were opportunistic protozoans 32.2% (37/115), most common being Isospora belli 16.5% (19/115) followed by Cryptosporidium parvum 12.2% (14/115). In HIV noninfected diarrheal patients, major pathogens detected were Entamoeba histolytica/Entamoeba dispar 8.7% (8/92) and Ascaris lumbricoides 3.3% (3/92). CONCLUSIONS: The opportunistic intestinal protozoans especially I. belli and C. parvum were most commonly isolated in HIV-infected patients with diarrhea. Majority of the infections occurred in patients when a CD4(+) T-cell counts were less than 200 cells/µl.

Enteric Parasitic Infections in Relation to Diarrhoea in HIV Infected Individuals with CD4 T Cell Counts <1000 Cells/µl in Chennai, India.

AIM: This study was conducted to estimate the prevalence of enteric parasites in HIV patients in Chennai and to correlate with CD4 counts and diarrhoeal status. MATERIAL AND METHODS: Faecal specimens from 100 HIV infected individuals with CD4 < 1000/µl were screened for enteric parasites with wet mounts, modified acid-fast stain for coccidian parasites, modified trichrome stain for Microsporidia, before and after the stool concentration. Agar plate culture for Strongyloides was put up. Chi-square and ANOVA tests were used for statistical analysis. RESULTS: Study group comprised of 38 subjects with acute diarrhoea, 30 with chronic diarrhoea (> 2 weeks) and remaining 32 without diarrhoea. Enteric parasites were detected in 33% of subjects; Isoapora belli (21) being the commonest followed by E.histolyt/Entamoeba dispar (5), Entamoeba coli (2), Cryptosporidium spp (2), Hookworms (2), Strongyloides stercoralis (2), Giardia lamblia (1) and Microsporidium spp (1). There was a significant inverse relation between CD4 counts and duration of diarrhoea. Opportunistic parasites were isolated from the subjects with wide range of CD4 counts and different diarrhoeal status but most commonly from chronic diarrhoea patients. CONCLUSION: The prevalence of intestinal parasitic infections in HIV patients is high in Chennai, India, especially at CD4 <1000/µl, I.belli infection being the commonest. Routine screening of all HIV patients with low CD4 counts for coccidian parasitic infections by using simple stool microscopic techniques can help in early diagnosis and treatment.

Enteric spore-forming opportunistic parasites in HIV / AIDS.

Human Immunodeficiency Virus (HIV) infection causes progressive damage to both limbs of the immune system, which results in a plethora of opportunistic infections. Among the various opportunistic infections, gastrointestinal infections are very common in HIV / Acquired Immunodeficiency Syndrome (AIDS). Opportunistic spore-forming protozoal parasites, namely, Cryptosporidium parvum, Isospora belli, Cyclospora cayetanensis, and Microsporidia, play a major role in causing chronic diarrhea, accompanied with weight loss, in patients with HIV / AIDS. The purpose of this review is to discuss the salient microbiological, clinical, and diagnostic aspects of important enteric spore-forming opportunistic parasites in HIV / AIDS.

Infección por Isospora belli en pacientes con infección por VIH: presentación de dos casos y revisión de la literatura / Isospora belli infection in HIV positive patients: report of two cases and literature review

Isosporosis is an infection caused by parasitic protozoa of the genus Isospora, coccidia affecting various different vertebrate species, including humans. It is an uncommon infection in our country and it is not a zoonosis. We present two cases oí Isospora belli infection in HIV positive patients from the Valparaiso region. We discuss the clinical events caused by this agent, its epidemiology, cases published in the local and foreign literature, as well as its treatment and prevention measures.

La isosporosis es una infección parasitaria provocada por protozoos del género Isospora, coccidio que afecta con diversas especies a diferentes vertebrados, entre los que se encuentra el ser humano. Es una infección poco frecuente en nuestro país y no constituye una zoonosis. Se presentan dos casos con infección por Isospora belli en pacientes infectados con el virus de inmunodeficiencia humana procedentes de la Región de Valparaíso. Se analizan las manifestaciones producidas por este agente, la epidemiología de la infección, los casos publicados en la literatura nacional e internacional, así como su tratamiento y las medidas de prevención.

Seasonal profile and level of CD4+ lymphocytes in the occurrence of cryptosporidiosis and cystoisosporidiosis in HIV/AIDS patients in the Triângulo Mineiro region, Brazil

Patients with AIDS are particularly susceptible to infection with intestinal coccidia. In this study the prevalence of infections with Cryptosporidium sp and Cystoisospora belli were evaluated among HIV/AIDS patients in the Triângulo Mineiro region, Brazil. Between July 1993 and June 2003 faecal samples from 359 patients were collected and stained by a modified Ziehl-Neelsen method, resulting in 19.7 percent of positivity for coccidian (8.6 percent with Cryptosporidium sp, 10.3 percent with Cystoisospora belli and 0.8 percent with both coccidian). Patients with diarrhoea and T CD4+ lymphocyte levels < 200 cells/mm3 presented higher frequency of these protozoans, demonstrating the opportunistic profile of these infections and its relationship with the immunological status of the individual. It was not possible to determine the influence of HAART, since only 8.5 percent of the patients positive for coccidian received this therapy regularly. Parasitism by Cryptosporidium sp was more frequent between December and February and thus was characterised by a seasonal pattern of infection, which was not observed with Cystoisospora belli.

Pacientes com AIDS são particularmente susceptíveis a infecção por coccídios intestinais e nesse estudo foi avaliada a freqüência de Cryptosporidium sp. e Cystoisospora belli entre pacientes HIV/AIDS na região do Triângulo Mineiro, Brasil. No período de julho de 1993 a junho de 2003, amostras de fezes de 359 pacientes foram submetidas à coloração pelo método de Ziehl-Neelsen modificado, sendo detectada a presença de coccídios em 19,7 por cento destas (8,6 por cento de Cryptosporidium sp, 10,3 por cento de Cystoisospora belli e 0,8 por cento de ambos coccídios). Pacientes com diarréia e níveis de linfócitos T CD4+ < 200 células/mm3 apresentaram maior frequência destes protozoários, demonstrando o perfil oportunista destas infecções e a relação com o status imunológico do indivíduo. Não foi possível determinar a influência da HARRT, pois apenas 8,5 por cento dos pacientes positivos para coccídios fazriam uso regular desta terapia. Parasitismo por Cryptosporidium sp foi mais freqüente no período compreendido de dezembro a fevereiro caracterizando padrão sazonal desta infecção, fato não observado com Cystoisospora belli.

Freguência de cryptosporidium sp e Isospora belli em pacientes soropositivos para o HIV na regiäo de Ribeiräo Preto, SP - Brasil / Freguency of cryptosporidium sp and Isospora belli in HIV - seropositive patients in the region of Ribeiräo Preto, SP, Brazil

Entre os patógenos entéricos que acometem os pacientes portadores vírus da imunodeficiência humana (HIV) estäo os protozoários oportunistas Cryptosporidium sp e Isospora belli. O objetivo de estudo é avaliar a frequência de criptosporodiose e isosporíase em pacientes soropositivos para o HIV na região de Ribeirão Preto. Entre julho de 1990 a junho de 1997, foram examinados no Instituto Adolfo Lutz de Ribeirão Preto 3.340 amostras de fezes de 1.833 pacientes sintomáticos ou não, com idade entre 10 meses e 55 anos, atendidos nos Ambulatórios de DST/AIDS do município. A frequência destes protozoários nas amostras de fezes foi 9,3(por cento). Foi observado que 207, 11,3(por cento) dos pacientes estavam parasitados, sendo que cryptosporidium sp foi encontrado em 117, 6,4(por cento) pacientes e Isospora belli em 81, 4,4(por cento). Infecção concomitante por ambos parasitas ocorreu em 09, 05(por cento) dos pacientes. (AU)

Among the enteric pathogens that attack patients with the human immunodeficiency vírus (HIV) are opportunistic protozoans Cryptosporidium spp and Isospora belli . The purpose of this investigation was to establish the frequency of cryptosporidiosis and isosporidiosis in HIV seropositives patients in Ribeir"o Preto region. From July 1990 to June 1997 in Adolfo Lutz Institute ñ Ribeir"o Preto,3340 stool samples were examined from 1833 symptomatic and asymptomatic patients, with ages ranging between 10 months and 55 years, attended in Ribeir"o Preto AIDS Outpatient Departaments. The frequency of these protozoans among all the examined stool samples was 9,3%. We observed 207 (11,3%) patients with these parasites. Cryptosporidium spp was identified in 117 (6,4%) patients, Isospora belli in 81(4,4%) and 09 (0,5%) patients were infected by both parasites. (AU)

Identificação de Cryptosporidium e Isospora belli em pacientes HIV positivo com diarréia / Identification of Creyptosporidium and Isospora belli in patients HIV positive with diarrhoea

Foram analisadas 1.500 amostras de fezes de pacientes HIV positivo adultos de ambos os sexos, internados no hospital São José, no período de agosto de 1997 a fevereiro de 1998. As amostras foram encaminhadas ao laboratório central (LACEN) de saúde pública para realização dos exames. Oocistos de Cryptosporidium sp e Isospora belli fora encontrados em 180 (12%) e 300 (20%) amostras de fezes, respectivamente após prévia concentração do material pela técnica de sedimentação em formol-éter e posterior coloração dos esfregaços pelo carbol-fucsina. Em nenhuma amostra foi observada a presença de Cryptosporidium parvum e Isospora belli em concomitância. Entretanto foram identificados Strongyloides stercoralis, Giardia lamblia, Entamoeba coli e Entaboema histolytica em concomitância com o Cryptosporidium ou Isospora belli. Nesse estudo observamos a presença dos coccidios em apenas 32% dos pacientes HIV positivo com diarréia, sugerindo que esses coccidios não são os únicos agentes patogênicos responsáveis pela diarréia.