Prevalence of human cryptosporidiosis in the Americas: systematic review and meta-analysis

ABSTRACT Cryptosporidiosis is a disease caused by the Cryptosporidium spp parasite. As some species of Cryptosporidium have a wide host spectrum, the characterization of the pathogen at the species or genotype level is of great importance to define the sources of infection for humans and the potential for public health. This study investigated the diversity of the genus Cryptosporidium spp. in humans from all over the American continent and observed whether the method used to search for the parasite influenced the prevalence found in the Americas. This systematic review was carried out using the Pubmed, Science direct, Lilacs, Scielo, and Scopus databases with publications from January 1, 2010, to December 31, 2020. For data synthesis, the PRISMA flowchart was used and for the meta-analysis we used the MetaXL program. Of the selected publications, 57, 9 and 16 belonged to the region of South, Central and North America, respectively. The prevalence found for South, Central, and North America was 7%, 7%, and 8%, respectively, when analyzing publications that used only the microscopy method. When we analyzed the publications that used immunological and molecular methods, we found prevalences of 10%, 9%, and 21% for South, Central, and North America, respectively. The C. hominis subtype IbA10G2 was the most reported in the American continent, followed by subtype IeA11G3T3 and, for C. parvum, subtype IIaA15G2RI was the most reported. In conclusion, Cryptosporidium spp. is present throughout the American continent and its prevalence is higher when immunological and/or molecular methods are used, in addition to direct microscopic examination.

Use of Cerebrospinal Fluid for the Diagnosis of Neuroinvasive Dengue, Zika, and Chikungunya: A 19-year systematic review

Abstract INTRODUCTION: Cerebrospinal fluid analysis contributes to the diagnosis and neuropathogenesis of neuroinvasive arboviruses. Neurological complications caused by dengue, Zika, and chikungunya infections have high clinical relevance because of their high potential to cause death or neurological deficits. We aimed to evaluate the use of cerebrospinal fluid assays for diagnostic support in neurological disorders associated with dengue, chikungunya, and Zika infections. METHODS: A systematic review was carried out by searching the electronic databases LILACS, PubMed, Scopus, and Embase for articles written in English, Portuguese, or Spanish in the last 19 years. Published studies were reviewed using the terms "dengue," "Zika", "chikungunya", alone or in combination with "cerebrospinal fluid" in the period from 2000 to 2019. RESULTS: A total of 98,060 studies were identified; of these, 1.1% (1,041 studies, 58,478 cases) used cerebrospinal fluid assays for neurological investigations. The most frequent neurological disorders included encephalitis (41.4%), congenital syndromes (17%), and microcephaly associated with Zika virus infections (8.9%). Neuroinvasive disorders were confirmed in 8.03% of 58,478 cases by specific cerebrospinal fluid analyses. The main methods used were IgM-specific antibodies (66%) and reverse transcription-polymerase chain reaction (10%). The largest number of scientific papers (29%) originated from Brazil, followed by India (18.4%) and the United States (14.4%). CONCLUSIONS: Although cerebrospinal fluid analysis is of great importance for increasing neurological diagnostic accuracy and contributes to the early diagnosis of neuroinvasive dengue, chikungunya, and Zika infections, it is underused in routine laboratory investigations worldwide.

Cerebrospinal fluid challenges for the diagnosis of herpes simplex infection in the central nervous system / Desafios do exame do líquido cefalorraquidiano para o diagnóstico de infecção por herpes simplex no sistema nervoso central

Abstract Herpes simplex virus (HSV) is a cause of a severe disease of the central nervous system (CNS) in humans. The demonstration of specific antibodies in the cerebrospinal fluid (CSF) may contribute to the retrospective neurological diagnosis. However, the commercial immunological tests for HSV infection are for use in serum samples. Objective: The aim of the present study was to adapt a commercial kit anti-HSV IgG used for serum samples to be performed with a CSF sample. Methods: Forty CSF specimens from 38 patients with suspected CNS HSV infection were serially diluted for detecting anti-HSV IgG by enzyme immunoassay (EIA). The same samples were also analyzed with the polymerase chain reaction (PCR). Results: The sensitivity of EIA test for HSV was 5% (dilution 1:40) and 65% (dilution 1:2) in CSF, and HSV DNA PCR was 15%. The combined analysis of EIA (dilution 1:2) and PCR increased the sensitivity up to 72.5%. The inflammatory CSF was associated with positive HSV PCR. Conclusions: We demonstrated the importance to adapt serological anti-HSV IgG EIA test for CSF assays to increase the accuracy of the analysis, considering the low concentration of specific antibodies in CSF.

Resumo O vírus herpes simples (HSV) é um dos agentes causadores de uma doença grave no sistema nervoso central (SNC) em humanos. A detecção de anticorpos específicos no líquido cefalorraquidiano (LCR) pode contribuir para o diagnóstico neurológico retrospectivo. Entretanto, os testes imunológicos comerciais são para uso em amostras de soro. Objetivo: Adaptar um kit comercial sorológico anti-HSV IgG para ser utilizado no de LCR. Metodos: Quarenta amostras de LCR de 38 pacientes com suspeita de infecção por HSV no SNC foram diluídas pesquisa de anticorpos anti-HSV IgG pelo método imunoenzimático (EIA). Além disso, as mesmas amostras também foram analisadas por reação em cadeia da polimerase (PCR). Resultados: A sensibilidade do teste EIA para o HSV consistiu em 5% (diluição 1:40) e 65% (diluição 1:2) no LCR, e o PCR do DNA do HSV, 15%. A análise combinada de EIA (diluição 1:2) e PCR aumentou a sensibilidade para 72,5%. Houve associação entre presença do LCR inflamatório e PCR positiva para HSV. Conclusões: Demonstramos a importância na adaptação previa do teste sorológico anti-HSV IgG EIA para ensaios do no LCR, a fim de aumentar a acuracia da análise, considerando a baixa concentração de anticorpos específicos no LCR.

Dengue infection in the nervous system: lessons learned for Zika and Chikungunya / Infecção por dengue no sistema nervoso: lições para Zika e Chikungunya

ABSTRACT Dengue, Zika and Chikungunya are emerging arboviruses and important causes of acute febrile disease in tropical areas. Although dengue does not represent a new condition, a geographic expansion over time has occurred with the appearance of severe neurological complications. Neglect has allowed the propagation of the vector (Aedes spp), which is also responsible for the transmission of other infections such as Zika and Chikungunya throughout the world. The increased number of infected individuals has contributed to the rise of neurological manifestations including encephalitis, myelitis, meningitis, Guillain-Barré syndrome and congenital malformations such as microcephaly. In this narrative review, we characterize the impact of the geographic expansion of the vector on the appearance of neurological complications, and highlight the lack of highly accurate laboratory tests for nervous system infections. This represents a challenge for public health in the world, considering the high number of travelers and people living in endemic areas.

RESUMO Dengue, Zika e Chikungunya são arbovírus emergentes e importante causa de doença febril aguda em áreas tropicais. Embora a dengue não represente uma doença nova, houve uma expansão geográfica ao longo do tempo, com o aparecimento de complicações neurológicas graves. A negligência desta situação permitiu a propagação do vetor (Aedes spp) em todo o mundo, que também é responsável pela transmissão de outras infecções pelos vírus Zika e Chikungunya. O grande número de casos infectados contribui para o aumento de manifestações neurológicas incluindo encefalite, mielite, meningite, síndrome de Guillain-Barré e má formações congênitas, como microcefalia. Nesta revisão narrativa, destaca-se o impacto da expansão geográfica do vetor no aparecimento de complicações neurológicas e a falta de testes laboratoriais de elevada acurácia para o diagnóstico da infecção neurológica. Estes aspectos representam desafio para a saúde pública mundial, considerando o grande número de indivíduos que moram ou viajam para áreas endêmicas.

Genetic diversity of Cryptosporidium identified in clinical samples from cities in Brazil and Argentina

The identification and characterisation of Cryptosporidiumgenotypes and subtypes are fundamental to the study of cryptosporidiosis epidemiology, aiding in prevention and control strategies. The objective was to determine the genetic diversity ofCryptosporidium in samples obtained from hospitals of Rio de Janeiro, Brazil, and Buenos Aires, Argentina. Samples were analysed by microscopy and TaqMan polymerase chain reaction (PCR) assays forCryptosporidium detection, genotyped by nested-PCR-restriction fragment length polymorphism (RFLP) analysis of the 18S rRNA gene and subtyped by DNA sequencing of the gp60 gene. Among the 89 samples from Rio de Janeiro, Cryptosporidium spp were detected in 26 by microscopy/TaqMan PCR. In samples from Buenos Aires,Cryptosporidium was diagnosed in 15 patients of the 132 studied. The TaqMan PCR and the nested-PCR-RFLP detected Cryptosporidium parvum, Cryptosporidium hominis, and co-infections of both species. In Brazilian samples, the subtypes IbA10G2 and IIcA5G3 were observed. The subtypes found in Argentinean samples were IbA10G2, IaA10G1R4, IaA11G1R4, and IeA11G3T3, and mixed subtypes of Ia and IIa families were detected in the co-infections. C. hominis was the species more frequently detected, and subtype family Ib was reported in both countries. Subtype diversity was higher in Buenos Aires than in Rio de Janeiro and two new subtypes were described for the first time.

Frequency of amoebiasis and other intestinal parasitoses in a settlement in Ilheus City, State of Bahia, Brazil

Introduction: This study evaluated the frequency of intestinal parasites, emphasizing the identification and differentiation of Entamoeba spp. Methods: Multiplex polymerase chain reaction (PCR), coproantigen tests and morphometric analysis were performed for Entamoeba spp. differentiation. Results: The overall frequency of intestinal parasites was 65%. Entamoeba histolytica was detected by the coproantigen test, and the PCR showed that Entamoeba dispar predominated in the population. In contrast, morphometric analysis was important for identifying Entamoeba hartmanni. Conclusions: It is possible to identify the causative agent of amoebiasis and to differentiate this agent from other species by combining techniques. .

A conventional polymerase chain reaction-based method for the diagnosis of human schistosomiasis in stool samples from individuals in a low-endemicity area

The aim of this study was to evaluate the efficacy of a polymerase chain reaction (PCR)-based method to detect Schistosoma mansoni DNA in stool samples from individuals living in a low-endemicity area in Brazil. Of the 125 initial stool samples, 80 were ELISA reactive and eggs were identified in 19 of the samples by parasitological examination. For the PCR evaluations, 56 stool samples were selected and divided into five groups. Groups I-IV were scored negative for S. mansoni eggs by parasitological examination. Groups I and II were ELISA reactive, whereas Groups III and IV were ELISA nonreactive. Groups II and III were positive for other intestinal parasites. PCR testing scored eight samples as positive from these four groups. Group V represented the S. mansoni -positive group and it included ELISA-reactive samples that were scored positive for S. mansoni by one or more parasitological examinations (6/19 were positive by Kato-Katz method, 9/17 by saline gradient and 10/13 by Helmintex®). PCR scored 13 of these 19 samples as positive for S. mansoni . We conclude that while none of these methods yielded 100% sensitivity, a combination of techniques should be effective for improving the detection of S. mansoni infection in low-endemicity areas.

Detection and differentiation of Cryptosporidium by real-time polymerase chain reaction in stool samples from patients in Rio de Janeiro, Brazil

This study reports the first genetic characterisation of Cryptosporidium isolates in Brazil using real-time polymerase chain reaction (RT-PCR). A total of 1,197 faecal specimens from children and 10 specimens from human immunodeficiency virus-infected patients were collected between 1999-2010 and screened using microscopy. Forty-eight Cryptosporidium oocyst-positive isolates were identified and analysed using a generic TaqMan assay targeting the 18S rRNA to detect Cryptosporidium species and two other TaqMan assays to identify Cryptosporidium hominis and Cryptosporidium parvum. The 18S rRNA assay detected Cryptosporidium species in all 48 of the stool specimens. The C. parvum TaqMan assay correctly identified five/48 stool samples, while 37/48 stool specimens were correctly amplified in the C. hominis TaqMan assay. The results obtained in this study support previous findings showing that C. hominis infections are more prevalent than C. parvum infections in Brazil and they demonstrate that the TaqMan RT-PCR procedure is a simple, fast and valuable tool for the detection and differentiation of Cryptosporidium species.

Genital schistosomiasis mansoni concomitant to genital tumor in areas of low endemicity: challenging diagnosis

Genital infection by Schistosoma mansoni is usually misdiagnosed in individuals who reside in, or travel to endemic areas. We describe two cases of genital tumor associated with S. mansoni infection manifested by methrorragy. Surgical specimens revealed leiomyomas in both cases associated with S. mansoni. In one of them, granulomas were found in the ovary and in the other they were found in the uterine tube. Although none presented intestinal/hepatic disease, fecal egg excretion was detected in one. Both had elevated pretreatment antibody reactivity to S. mansoni antigen, but follow-up showed different outcomes. Schistosomiasis should be considered as a diagnosis in individuals with methrorragy residing in or having traveled to endemic areas. Since diagnosis follows genital amputation, and cure control is troublesome, improvement of diagnostic tools and follow-up markers are important priorities to decrease schistosomiasis morbidity.

Persistence of viable cysts in neurocysticercosis: a serial imaging study / Persistência de cistos viáveis na neurocisticercose: um estudo seriado de imagem

Introduction: Cysticercosis is an endemic disease in developing countries and is the most common parasitic infection of the central nervous system. The diagnosis is difficult and imaging may contribute to the confirmation. Objective: To report the evolution of brain lesions and the clinical response of a patient with a definitive diagnosis of neurocysticercosis (NCC). Methods: We analyzed six computed tomography (CT) and three magnetic resonance imaging (MRI) exams, performed in a period of six years. Results: The serial imaging study revealed the involution of nine viable cysts and two degenerating cysts out of 39 lesions. It occurred after six years of disease and four courses of treatment with Albendazole. The other 28 lesions were calcified. Clinically, there was reduction in frequency of seizures after treatment with Albendazole and the onset of regular use of anticonvulsants (six per year to 1.8 per year). Conclusion: This case illustrates an instance of partial NCC efficacy to antiparasitic therapy, and demonstrates the role of serial imaging studies in the monitoring the evolution of NCC lesions and in characterizing the diversity of lesion appearance over time.

Introdução: A cisticercose é uma doença endêmica nos países em desenvolvimento. Representa a infecção parasitária mais comum dosistema nervoso central. O diagnóstico é difícil e o exame de imagem pode contribuir para a confirmação. Objetivo: Relatar a evolução das lesõesencefálicas, assim como avaliar a resposta clínica de um paciente com um diagnóstico definitivo do NCC. Métodos: Foram analisadas seistomografias computadorizadas (TC) e três ressonâncias magnéticas (RM) realizadas durante o período de seis anos. Resultados: O estudode imagem seriada revelou a involução de nove cistos viáveis e dois cistos em degeneração de 39 lesões. Isso ocorreu após seis anos de evolução da doença e quatro cursos de tratamento com albendazol. As outras 28 lesões encontravam-se calcificadas e aumentaram para 36 em número. Clinicamente, houve redução na frequência das crises após o tratamento com albendazol e do início do uso regular de anticonvulsivantes (seis por ano para 1,8 por ano). Conclusão: O caso demonstra a importância dos estudos da imagem seriada no acompanhamento das lesões da neurocisticercose (NCC), considerando a possibilidade de resistência medicamentosa e a necessidade da repetição do tratamento.

Oligosymptomatic dengue infection: a potential cause of Guillain Barré syndrome / Dengue oligossintomática: causa potencial de síndrome de Guillain Barré

BACKGROUND: Dengue infection may cause neurological manifestations such as encephalitis, myelitis, mononeuropathies, acute disseminated encephalomyelitis, and Guillain Barré syndrome (GBS). In endemic regions, the infection course can be oligosymptomatic making difficult the diagnosis of the neurological picture associated with dengue infection. OBJECTIVE: To report dengue infection and GBS association, even in oligosymptomatic cases of this infection. METHOD: During the dengue epidemic in Rio de Janeiro city we looked for GBS cases, testing IgM antibodies for dengue and dengue polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) and serum. RESULTS: We report seven cases (46.6 percent), presenting dengue positive IgM in serum but with poor or without clinical symptoms of the previous infection. Two of them had also positive IgM antibodies in CSF. CONCLUSION: These data show that search for dengue infection should be a routine in GBS cases living in endemic areas.

INTRODUÇÃO: O vírus da dengue pode determinar várias manifestações neurológicas como: encefalite, mielite, mononeuropatias, encefalomielite disseminada aguda e a síndrome de Guillain Barré (SGB). Em regiões endêmicas a infecção pode ser oligosintomática dificultando o diagnóstico neurológico associado a infecção por dengue. OBJETIVO: Relatar a associação entre SGB e o vírus da dengue, principalmente em formas oligosintomáticas da infecção. MÉTODO: Durante epidemia pelo vírus da dengue na cidade do Rio de Janeiro, casos de SGB foram selecionados e tiveram suas amostras de soro e líquido cefalorraqueano (LCR) testadas para anticorpos dengue IgM e PCR para dengue. RESULTADOS: Descrevemos sete casos (46,6 por cento) com diagnóstico de SGB, apresentando IgM positiva para dengue no soro, porém com poucos ou nenhum sintoma infeccioso prévio. Dois pacientes também apresentavam IgM positiva no LCR. CONCLUSÃO: Estes dados sugerem que a pesquisa para o vírus da dengue deve ser realizada em todos os casos de SGB em áreas endêmicas.

Comparison of multiplex-PCR and antigen detection for differential diagnosis of Entamoeba histolytica

Amebiasis is an infection caused by Entamoeba histolytica. However, differentiation between E. histolytica and Entamoeba dispar, which are morphologically identical species, is essential for treatment decision, precaution of the invasive disease and public health. The purpose of the present study was to evaluate a Multiplex -PCR for detection and differentiation of E. histolytica from E. dispar from fresh stool samples in comparison with the coproantigen commercial ELISA. Microscopic examination of stools using the Coprotest method, detection of stool antigen by enzyme-linked immunosorbent assay kit and a home made Multiplex-PCR, were used for the diagnosis of amoebiasis infection. Analysis of the 127 stools samples by microscopy examination demonstrated that only 27 (21 percent) samples were positive for E. histolytica/E. dispar complex. Among these stool samples, 11 were positive by Multiplex-PCR, with nine presenting the diagnostic fragment characteristic of E. dispar (96 bp) and two presenting diagnostic fragment of E. histolytica (132 bp). Among negative samples detected by microscopic examination, three positive samples for E. dispar and one positive for E. histolytica by Multiplex-PCR was observed. This denotes a low sensibility of microscopic examination when a single stool sample is analyzed. Assay for detection of E. histolytica antigen was concordant with multiplex-PCR in relation to E. histolytica. Statistical analysis comparing the sensibility tests was not done because of the low number of E. histolytica cases. The results demonstrate the importance of the specific techniques use for the differentiation between E. histolytica and E. dispar.

Diagnóstico da estrongiloidíase humana: importância e técnicas / Diagnosis of human strongyloidiasis: needs and techniques

A estrongiloidiase é causada pelo nematóide intestinal Strongyloides stercoralis e ocorre de forma assintomática na maior parte dos indivíduos infectados. Entretanto, é considerada de grande importância por causar hiperinfecção e disseminação em pacientes imunodeprimidos, principalmente durante o uso de corticóides. O diagnóstico definitivo normalmente é feito mediante a detecção de larvas nas fezes, mas torna-se extremamente difícil em razão da baixa quantidade de parasitos, na maioria dos casos, e da reduzida e irregular eliminação de larvas. As técnicas sorológicas, principalmente as imunoenzimáticas, podem ser uma boa alternativa para o diagnóstico da estrongiloidíase. Uma das principais limitações encontradas no desenvolvimento de testes sorológicos mais sensíveis e específicos é a dificuldade em se obter quantidades suficientes de antígenos que permitam seu posterior fracionamento e análise. Sendo assim, são necessários novos estudos que levem ao desenvolvimento de testes sorológicos confiáveis para o diagnóstico da estrongiloidíase, que não dependam de larvas como fonte antigênica.

Influence of the cerebrospinal fluid laboratory parameters in the ELISA test for neurocysticercosis using a total cysticerci antigen

Avaliar se os parâmetros do líquido cefalorraquidiano (LCR) podem influenciar na reatividade da resposta imune específica do LCR na neurocisticercose (NC). Amostras de LCR de 109 pacientes foram analisadas e classificadas em três grupos, de acordo com as manifestações neurológicas e reatividade do teste de Ab-ELISA para NC no LCR. Grupo A, 18 pacientes com enfermidades neurológicas compatíveis com NC e reatividade do teste Ab-ELISA para NC no LCR; grupo B, 50 pacientes com enfermidades neurológicas não compatíveis com NC e reatividade do teste Ab-ELISA para NC no LCR; grupo C, 41 pacientes com enfermidades neurológicas não compatíveis com NC e na ausência de reatividade do teste de Ab-ELISA para NC no LCR. A análise do LCR do grupo A foi compatível com NC. O grupo B apresentou maior freqüência e intensidade da pleocitose, da presença de hemácias no LCR, hiperproteinorraquia, reatividade imune para outros agentes etiológicos em comparação aos grupos A e C (p<0.05). Os dados indicam que o processo inflamatório e os elevados níveis de concentração da proteína no LCR podem influenciar na ocorrência de reações falso positivas de Ab-ELISA para NC. Destacamos a importância da correlação clínico-laboratorial para o diagnóstico de neurocisticercose e o uso de testes laboratoriais confirmatórios.

Estudo soroepidemiológico da cisticercose humana em um município do Estado do Piauí, Região Nordeste do Brasil / Seroepidemiological survey of human cysticercosis in a municipality of Piaui State, Northeast Brazil

Integrando as pesquisas sobre parasitoses na região do entorno do Parque Nacional Serra da Capivara, Piauí, Brasil, realizadas entre 1999 e 2001, o presente estudo tem como objetivo avaliar a situação epidemiológica da cisticercose humana no Município de João Costa, no Nordeste do Brasil. Foram obtidas informações clínico-epidemiológicas e coletadas amostras de sangue para testes sorológicos imunoenzimáticos (ELISA e Western blot), empregando cisticercos de Taenia crassiceps como antígeno. Na primeira etapa, em 1999, foram investigadas 169 pessoas com história confirmada ou suspeita de infecção/doença pelo complexo teníase-cisticercose, e seus familiares. Na análise, 13,6 por cento das pessoas apresentaram soros reagentes para cisticercose pelo método ELISA. Na segunda etapa, em 2001, foram avaliadas 92 amostras de soro de indivíduos reativos para cisticercose detectados no primeiro momento e seus familiares, sendo que 24,0 por cento das amostras de soro foram reagentes para cisticercose pelo ELISA, e 29,0 por cento, pelo WB. Nessa mesma etapa, realizou-se inquérito coprológico em 701 pessoas, incluindo voluntários. A prevalência de parasitoses intestinais foi de 51,0 por cento, tendo sido observada uma maior prevalência de protozoários (95,0 por cento) em relação aos helmintos (5,0 por cento). Os resultados do estudo indicam o caráter endêmico da cisticercose na área, além da elevada freqüência de protozooses intestinais.

Anticuerpos naturales contra proteínas propias y no propias de la membrana eritrocitaria / Natural antibodies against self and non-self red cell membrane proteins

Fue observada la presencia de anticuerpos naturales contra las proteínas de la membrana eritrocitaria en sueros de origen humano y animal. Se demuestran, por medio del "Western blot", las reacciones de sueros de conejos adultos contra el estroma de auto-, alo- y xeno-antígenos (humano y mono rhesus) de las membranas de los hematíes. Los sueros de conejo estaban dirigidos principalmente contra las dos espectrinas (alfa + beta) y la proteína banda 3. No hubo reacción contra estromas de tres monos rhesus. Las comparaciones entre sueros tratados y no tratados con ditiotreitol (DTT) sugieren la presencia de anticuerpos IgG. Los animales fueron clasificados de acuerdo con éstas reacciones, mediante el método de agrupamiento UPGMA. Aunque existe cierta variabilidad, probablemente debida a fenómenos estocásticos, los resultados apuntan a un reconocimiento de estructuras químicas similares entre las proteínas banda 3 y entre las espectrinas de los hematíes de conejo, mono rhesus y humanos. Esta amplia reactividad plantea el tema de cuáles serían los epitopos reconocidos por éstos anticuerpos. El presente trabajo incluye también la descripción del peso molecular de las proteínas de la membrana de los hematíes de conejo

Avaliaçäo de testes imunológicos para o diagnóstico da neurocisticercose / Evaluation of immunological tests for the diagnosis of neurocysticercosis

Introduçäo: O diagnóstico da neurocisticercose (NCC) deve ser feito pela associaçäo de técnicas de imagem com métodos Elisa e Western blot (Wb), utilizandoðse como antígeno extrato bruto salino da larva da Taenia solium, o Cysticercus cellulosae e Wb, empregandoðse como antígeno cisticercos da Taenia crassiceps em amostras de soro, para o diagnóstico da NCC. Materiais e métodos: Foram avaliadas amostras de soro de 43 pacientes com diagnóstico de NCC: 21 por clínica, tomografia computadorizada de crânio (TC) e presença de anticorpos anticisticerco no líquido cefalorraquiano (LCR); 22 por clínica e TC e 229 pacientes com diferentes parasitoses. Para as análises desses materiais biológicos foram empregados os métodos Elisa, usandoðse como antígeno C. cellulosae, e Wb, usandoðse como antígeno C. cellulosae e Cysticercus longicollis. Resultado: O método Elisa utilizando C. cellulosae como antígeno apresentou especificidade de 95 por cento e sensibilidade de 71 por cento. O método Wb utilizando C. cellulosae ou C. longicollis como antígeno apresentou sensibilidade de 86 por cento e especificidade de 99 por cento. Conclusões: Os métodos imunológicos no LCR säo importantes para a definiçäo da NCC. Entretanto o método Elisa no soro ainda näo é adequado pela sua baixa sensibilidade, podendo auxiliar no diagnóstico da NCC, possibilitando sugerir a existência de forma transicional da doença, näo demonstrada pela TC

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 percent) 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

Microsporidiose disseminada na AIDS: relato de caso / Pulmonary microsporidiosis in AIDS: report of a case

A microsporidiose é uma infecçäo protozoária que vem emergindo rapidamente, sendo relatada predominantemente em imunossuprimidos graves, como na síndrome da imunodeficiência adquirida (AIDS). Desde o primeiro caso de infecçäo por microsporídio em humanos, relatado em 1956, mais de 400 casos foram publicados. A descriçäo inicial de infecçäo pelo microsporídio em paciente com AIDS ocorreu em 1985. Cinco gêneros têm sido identificados como agentes de microsporidiose em pessoas imunossuprimidas (Enterocytozoon, Encephalitozoon, Septata, Pleistophora e Nosema). A infecçäo do trato respiratório devido ao microsporídio está associada quase exclusivamente à doença disseminada produzida pelos membros dos gêneros Encephalitozoon e Septata. O metronidazol e o albendazol foram recentemente relatados como responsáveis pela melhora clínica dos pacientes. Os autores relatam caso de uma mulher com AIDS e sintomas respiratórios associados à presença de dois patógenos pulmonare: Mycobacterium tuberculosis e Encephalitozoon cuniculi, o qual foi identificado pela reaçäo de cadeia de polimerase (PCR) usando sonda diagnóstica direcionada a pequena subunidade ribossomal RNA.

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

Enterocytozoon bieneusi e o mais comum microsporidio agente de infeccoes gastrointestinais que ocorre predominantemente em pessoas com AIDS. Em todo o mundo os microsporidios sao reconhecidos como importantes patogenos oportunistas, entretanto poucos casos ja foram diagnosticados no Brasil, provavelmente devido ao pouco conhecimento do quadro clinico que os agentes produzem ou a dificuldades no diagnostico laboratorial. No presente trabalho relatamos o caso de um paciente brasileiro HIV-positivo acompanhado durante 3 anos, em que foram detectados esporos de microsporidios nas fezes, identificados como Enterocytozoon bieneusi por microscopia eletronica e PCR. O paciente apresentava diarreia cronica, contagem de linfocitos CD4 abaixo de 100/mm3 e fez uso de albendazol em diferentes ocasioes com melhora transitoria da diarreia, que reaparecia logo que a droga era suspensa...