Cryptosporidium spp. en muestras de lavado broncoalveolar de pacientes VIH/sida en un hospital de Guayaquil, Ecuador / Cryptosporidium spp. in bronchoalveolar lavage samples of HIV/AIDS patients in a hospital in Guayaquil, Ecuador

Introducción: Cryptosporidium spp. son parásitos que causan infecciones respiratorias principalmente en pacientes inmunocomprometidos. Objetivo: Detectar Cryptosporidium spp. en el lavado broncoalveolar (BAL) de pacientes VIH positivos y con síndrome respiratorio. Métodos: Se seleccionaron 60 muestras de BAL y se analizaron mediante microscopía óptica con tinción de Ziehl-Neelsen y PCR de punto final; esta última es una técnica eficiente para el diagnóstico de patógenos oportunistas. Se recolectaron datos clínicos y epidemiológicos de cada paciente. Resultados: La prevalencia hallada en este estudio mediante PCR de punto final fue del 5 %. Los signos y síntomas que se presentaron con mayor frecuencia, sobre todo en el grupo etario de 31 a 40 años, fueron fiebre, tos y disnea; sin embargo, no se obtuvieron asociaciones estadísticamente significativas a ninguna de las variables y no se pudo visualizar parásitos mediante la tinción de Ziehl-Neelsen. Conclusión: Cryptosporidium spp. puede causar infecciones pulmonares de difícil reconocimiento clínico, pues se confunde con otras infecciones oportunistas. En el presente estudio no puede establecerse si la detección del ADN parasitario correspondió a una verdadera infección o solamente a colonización, lo que es importante para implementar técnicas con mayor sensibilidad para el diagnóstico. Se debe considerar relevante la prevalencia encontrada en Ecuador, al ser inusualmente alta en comparación con países cercanos como Brasil(AU)

Introduction: Cryptosporidium spp. are parasites that cause respiratory infections mainly in immunocompromised patients. Objective: To detect Cryptosporidium spp. in bronchoalveolar lavage (BAL) of HIV-positive patients with respiratory syndrome. Methods: Sixty samples of BAL were selected and analyzed by optical microscopy with Ziehl-Neelsen staining and end-point PCR. The latter is an efficient technique for the diagnosis of opportunistic pathogens. Clinical and epidemiological data were collected from every patient. Results: In this study, the prevalence by end-point PCR was 5%. The most frequent signs and symptoms, mainly in the age group 31-40 years old, were fever, cough, and dyspnea. However, no significant statistical associations to any variable were obtained, and no parasites were observed with the Ziehl-Neelsen staining technique. Conclusions: Cryptosporidium spp. can cause pulmonary infections that are difficult to identify clinically, since they are confused with other opportunistic diseases. The current study could not establish whether the detection of parasitic DNA corresponded to a real infection or only to colonization, which is important to implement diagnostic techniques with greater sensitivity. The prevalence found in Ecuador should be considered relevant, as it is unusually high in comparison with nearby countries such as Brazil(AU)

[Molecular characterization of Cryptococcus neoformans isolates from HIV patients, Guayaquil, Ecuador].

INTRODUCTION: Neurocryptococcosis is an opportunistic fungal infection that represents a high cost in human lives and for the economy of countries. Its causative agent, the Cryptococcus neoformans/Cryptococcus gattii species complex, has a sexual and an asexual phase, four major serotypes and seven molecular varieties with phenotypic, clinical-epidemiological and antifungal susceptibility differences. OBJECTIVE: To characterize by molecular methods clinical isolates of C. neoformans from Guayaquil, Ecuador. MATERIALS AND METHODS: We determined mating types, serotypes and molecular varieties by PCR and RFLP in 27 yeast isolates previously identified as C. neoformans by conventional methods. The isolates were recovered from cerebrospinal fluid of HIV seropositive patients with neurological syndrome admitted at "Dr. José Daniel Rodríguez Maridueña" Hospital from December, 2013, to January, 2015. RESULTS: We established a wide prevalence of C. neoformans serotype A, MATα and genotype VNI among the studied isolates. CONCLUSIONS: These data are similar to those obtained in other countries and the first identified by molecular characterization in Guayaquil, Ecuador. Therefore, they constitute an important contribution to the knowledge on cryptococcosis in this country.

Caracterización molecular de los aislamientos de Cryptococcus neoformans de pacientes con HIV, Guayaquil, Ecuador / Molecular characterization of Cryptococcus neoformans isolates from HIV patients, Guayaquil, Ecuador

Resumen Introducción. La neurocriptococosis es una infección fúngica oportunista que representa un alto costo en vidas humanas y para la economía de los países. Sus agentes causales, las especies del complejo Cryptococcus neoformans/Cryptococcus gattii, tienen una fase sexuada y otra asexuada, cuatro serotipos principales y siete variedades moleculares con diferencias clínico-epidemiológicas, fenotípicas y de sensibilidad a los antifúngicos. Objetivo. Caracterizar molecularmente los aislamientos clínicos de C. neoformans de Guayaquil, Ecuador. Materiales y métodos. Se determinó el tipo de apareamiento, el serotipo y la variedad molecular mediante reacción en cadena de la polimerasa y análisis del polimorfismo de los fragmentos de restricción de 27 aislamientos levaduriformes previamente identificados como C. neoformans mediante métodos convencionales. Los aislamientos fueron recuperados del líquido cefalorraquídeo de pacientes con síndrome neurológico seropositivos para HIV, internados en el Hospital de Infectología "Dr. José Daniel Rodríguez Maridueña", entre diciembre de 2013 y enero de 2015. Resultados. Se demostró el amplio predominio de C. neoformans del serotipo A, MATα y el genotipo VNI entre los aislamientos estudiados. Conclusiones. Estos datos son similares a los obtenidos en otros países y son los primeros de su tipo en Guayaquil, Ecuador, por lo cual constituyen un aporte importante al conocimiento de la criptococosisen esta ciudad.

Abstract Introduction: Neurocryptococcosis is an opportunistic fungal infection that represents a high cost in human lives and for the economy of countries. Its causative agent, the Cryptococcus neoformans/Cryptococcus gattiispecies complex, has a sexual and an asexual phase, four major serotypes and seven molecular varieties with phenotypic, clinical-epidemiological and antifungal susceptibility differences. Objective: To characterize by molecular methods clinicalisolates of C. neoformans from Guayaquil, Ecuador. Materials and methods: We determined mating types, serotypes and molecular varieties by PCR and RFLP in 27 yeast isolates previously identified as C. neoformans by conventional methods. The isolates were recovered from cerebrospinal fluid of HIV seropositive patients with neurological syndrome admitted at "Dr. José Daniel Rodríguez Maridueña" Hospital from December, 2013, to January, 2015. Results: We established a wide prevalence of C. neoformans serotype A, MATαand genotype VNI among the studied isolates. Conclusions: These data are similar to those obtained in other countries and the first identified by molecular characterization in Guayaquil, Ecuador. Therefore, they constitute an important contribution to the knowledge on cryptococcosis in this country.