RESUMO
A 49-year-old renal transplant recipient was admitted to our hospital due to abundant liquid diarrhea and dehydration. Parasitological investigations, including genotyping, led to the diagnosis of intestinal microsporidiosis due to a new and highly divergent internal transcribed spacer (ITS) genotype of Enterocytozoon bieneusi. The potential route of transmission through horse stools is discussed.
Assuntos
Diarreia/microbiologia , Enterocytozoon/classificação , Enterocytozoon/isolamento & purificação , Transplante de Rim/efeitos adversos , Microsporidiose/microbiologia , Transplante , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Diarreia/diagnóstico , Enterocytozoon/genética , Genótipo , Humanos , Masculino , Microsporidiose/diagnóstico , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , Análise de Sequência de DNARESUMO
We assessed the performance of the ARCHITECT Toxo IgG, IgM, and IgG Avidity assays against corresponding assays on AxSYM and Vidas using 730 sera from pregnant women. The ARCHITECT Toxo IgG and IgM assays showed a relative sensitivity of 97.5% and 89.9% and a relative specificity of 99.1% and 99.8%, respectively. If IgM sensitivity is calculated only for sera drawn less than 4 months after infection, the relative sensitivity rises to 98.1%. Correlation between the ARCHITECT and Vidas Avidity assays was 0.87 (n = 103). Testing 86 IgG-positive specimens from recent infection (<4 months), we never obtained high avidity results, but 2 specimens were in the gray zone, whereas sera from past infections (>4 months) exhibited high avidity results in 72.5% (137/189) of cases. The method can be used reliably to exclude recent infections in sera with concurrently positive results for IgM and IgG (IgG, >3 IU/mL).
Assuntos
Anticorpos Antiprotozoários/imunologia , Imunoensaio/métodos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Complicações Parasitárias na Gravidez/diagnóstico , Toxoplasma/isolamento & purificação , Toxoplasmose/diagnóstico , Anticorpos Antiprotozoários/sangue , Afinidade de Anticorpos , Automação Laboratorial/métodos , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Gravidez , Complicações Parasitárias na Gravidez/sangue , Complicações Parasitárias na Gravidez/imunologia , Complicações Parasitárias na Gravidez/parasitologia , Valores de Referência , Sensibilidade e Especificidade , Toxoplasma/imunologia , Toxoplasmose/imunologiaRESUMO
Microsporidiosis cases due to Enterocytozoon bieneusi and Encephalitozoon intestinalis are emerging opportunistic infections associated with a wide range of clinical syndromes in humans. The aim of this study was to specify microsporidial epidemiology in two different geographical areas. From November 2004 to August 2005, 228 and 42 stool samples were collected in Niamey, Niger, and Hanoi, Vietnam, respectively. Screening for microsporidia was performed using UV-light microscopy. Detection was confirmed by molecular biology using two methods specific for E. bieneusi and E. intestinalis. All samples positive for E. bieneusi were subjected to genotyping. In this study, we found high prevalences of microsporidiosis among human immunodeficiency virus-infected patients, 10.5% and 9.5%, respectively, in Niamey and Hanoi. These levels of prevalence are similar to those recorded in European countries before highly active antiretroviral therapy was introduced. In the samples positive for E. bieneusi, we found seven distinct genotypes, including two genotypes not previously described. The E. bieneusi genotype distributions in the two geographical areas suggest different routes of infection transmission, person-to-person in Niger and zoonotic in Vietnam.