The relevance of laboratory diagnosis of human cryptosporidiosis and other coccidia

Garlipp, C.R.; Bottini, P.V.; Teixeira, A.T.L.S.

doi:10.1590/S0036-46651995000500014

Abstracts

Human infection by Cryptosporidium spp and other coccidia are due to opportunist non-host specific microorganisms. In HIV seropositive patients, the gastrointestinal symptoms accompanying such infections may be serious and prolonged and may include nausea, low-grade fever, abdominal cramps, anorexia and watery diarrhoea. We studied 188 stool samples from 111 patients (84 men and 27 women) with diarrhoea. A modified Ziehl-Nielsen technique for the detection of Cryptosporidium spp and Isospora belli was employed. The mean age of the patients was 31 years. Cryptosporidium spp was seen in 18% (n=20) of the patients, 90% (n=18) of whom were HIV seropositive. Isospora belli was recorded only from HIV seropositive patients (5.4% of all the patients studied and 6.5% of those who were HIV seropositive). These data confirm the good results obtained with this technique for the identification of Cryptosporidium spp and other coccidia and also reaffirm the clinical importance of correctly diagnosing the cause of diarrhoea, particularly in HIV seropositive patients.

Crytosporidium spp; Isospora belli; Diarrhoea; AIDS; Staining

Infecção humana por Cryptosporidium spp e outros coccideos deve-se a microrganismos oportunistas hospedeiros não-específicos e, em pacientes HIV positivos, os sintomas gastro-intestinais podem ser sérios e prolongados incluindo náuseas, febre baixa, dores abdominais, anorexia e diarréia aquosa. Estudamos 188 amostras de fezes provenientes de 111 pacientes (84 homens e 27 mulheres, com idade média de 31 anos) com diarréia, atendidos no Hospital das Clínicas da Universidade Estadual de Campinas. Para detecção de Cryptosporidium spp e lsospora belli empregou-se a técnica de Ziehl-Nielsen modificada. Oitenta e três porcento dos pacientes (n=92) eram HIV positivos. Cryptosporidium spp foi observado em 18% de todos os pacientes, sendo que destes, noventa porcento eram HIV positivos, lsospora belli foi evidenciada somente em pacientes HIV positivos, com uma freqüência de 5.4% de todos os pacientes e de 6.5% considerando-se apenas os pacientes HIV positivos. Este estudo confirma os bons resultados obtidos com a técnica empregada para identificação de Cryptosporidium spp e outros coccideos, além de ressaltar a importância da investigação etiológica apropriada em casos de diarréia prolongada, especialmente em pacientes imunossuprimidos.

CLINICAL AND LABORATORIAL STUDIES

The relevance of laboratory diagnosis of human cryptosporidiosis and other coccidia

Importância do diagnóstico laboratorial da criptosporidiose humana e outras coccidioses

C.R. Garlipp; P.V. Bottini; A.T.L.S. Teixeira

Department of Clinical Pathology, Medical School, State University of Campinas, Campinas, SP, Brazil

^{Correspondence to} Correspondence to: Célia R. Garlipp, PhD Departamento de Patologia Clinica, UNICAMP Cidade Universitária Zeferino Vaz, C.P. 6111 13083-970, Campinas, S.P., Brasil

SUMMARY

Human infection by Cryptosporidium spp and other coccidia are due to opportunist non-host specific microorganisms. In HIV seropositive patients, the gastrointestinal symptoms accompanying such infections may be serious and prolonged and may include nausea, low-grade fever, abdominal cramps, anorexia and watery diarrhoea. We studied 188 stool samples from 111 patients (84 men and 27 women) with diarrhoea. A modified Ziehl-Nielsen technique for the detection of Cryptosporidium spp and Isospora belli was employed. The mean age of the patients was 31 years. Cryptosporidium spp was seen in 18% (n=20) of the patients, 90% (n=18) of whom were HIV seropositive. Isospora belli was recorded only from HIV seropositive patients (5.4% of all the patients studied and 6.5% of those who were HIV seropositive). These data confirm the good results obtained with this technique for the identification of Cryptosporidium spp and other coccidia and also reaffirm the clinical importance of correctly diagnosing the cause of diarrhoea, particularly in HIV seropositive patients.

Keywords:Crytosporidium spp; Isospora belli; Diarrhoea; AIDS; Staining.

RESUMO

Infecção humana por Cryptosporidium spp e outros coccideos deve-se a microrganismos oportunistas hospedeiros não-específicos e, em pacientes HIV positivos, os sintomas gastro-intestinais podem ser sérios e prolongados incluindo náuseas, febre baixa, dores abdominais, anorexia e diarréia aquosa. Estudamos 188 amostras de fezes provenientes de 111 pacientes (84 homens e 27 mulheres, com idade média de 31 anos) com diarréia, atendidos no Hospital das Clínicas da Universidade Estadual de Campinas. Para detecção de Cryptosporidium spp e lsospora belli empregou-se a técnica de Ziehl-Nielsen modificada. Oitenta e três porcento dos pacientes (n=92) eram HIV positivos. Cryptosporidium spp foi observado em 18% de todos os pacientes, sendo que destes, noventa porcento eram HIV positivos, lsospora belli foi evidenciada somente em pacientes HIV positivos, com uma freqüência de 5.4% de todos os pacientes e de 6.5% considerando-se apenas os pacientes HIV positivos. Este estudo confirma os bons resultados obtidos com a técnica empregada para identificação de Cryptosporidium spp e outros coccideos, além de ressaltar a importância da investigação etiológica apropriada em casos de diarréia prolongada, especialmente em pacientes imunossuprimidos.

Full text available only in PDF format.

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Recebido para publicação em 17/03/1995

Aceito para publicação em 04/07/1995

1. BEAVER, C.P.; JUNG, R.C. & CUPP, E.W. - Clinical Parasitology. 9 ed. Philadelphia, Lea & Febiger, 1984. p. 149-173.
2. BRANDBORG, L.L.; GOLDBERG, S.B & BRIDENBACH, W.F. - Human coccidiosis a possible cause of malabsorption. New Engl. J. Med., 283: 1306-1313, 1970.
3. CENTERS FOR DISEASE CONTROL - Cryptosporidiosis: assessment of chemotherapy of males with acquired immune deficiency syndrome (AIDS). M.M.W.R., 31: 589, 1982.
4. CURRENT, W.L.; REESE, N.C.; ERNST, J.V.; BAILEY, W.S. & HEYMAN, M.B. - Human cryptosporidiosis in immunocompetent and immunodeficient persons. New Engl. J. Med., 308: 1252-1257, 1983.
5. DeHOVITZ, J.A.; PAPE, J.W.; BONCY, M. & JOHNSON Jr., W.D. - Clinical manifestations and therapy of Isospora belli infection in patients with acquired immunodeficiency syndrome. New Engl. J. Med., 315: 87-90, 1986.
6. DIAS, R.M.D.S.; MANGINI, A.C.S.; TORRES, D.M.A.G.V. et al. - Cryptosporidiosis among patients with acquired immunodeficiency syndrome (AIDS) in the county of Săo Paulo, Brazil. Rev. Inst. Med. trop. S. Paulo, 30: 310-312, 1988.
7. FAYER, R. & UNGAR, B.L. - Cryptosporidium spp. and cryptosporidiosis. Microbiol. Rev., 50: 458-483, 1986.
8. GELLIN, B.G. & SOAVE, R. - Coccidian infections in AIDS. Med. Clin. N. Amer., 76: 205-234, 1992.
9. JANOFF, E.N. & BARTH RELLER, L. - Cryptosporidium species, a protean protozoa. J. clin. Microbiol., 25: 967-975, 1987.
10. LASSER, K.H.; LEVIN, K.J. & RYNING, F.W. - Cryptosporidial enteritis in patients with congenital hypogammaglobulinemia. Human Path., 10: 234-240, 1979.
11. LAUGHON, B.E.; DRUCKMAN, D.A. & VERNON, A. - Prevalence of enteric pathogens in homossexual men with and without acquired immunodeficiency syndrome. Gastroentcrology, 94: 984, 1988.
12. NAVIN, T.R. & HARDEN, A.M. - Cryptosporidiosis in patients with AIDS. J. infect. Dis., 155: 150, 1985.
13. NG, E.; MARKELL, E.K.; FLEMING, R.L. & FRIED, M. - Demonstration of Isospora belli by acid - fast stain in a patient with acquired immune deficiency syndrome. J. clin. Microbiol., 20: 384-386, 1984.
14. QUINN, T.C.; MANN, J.M.; CURRAN, J.W. & PIOT, P. - AIDS in Africa: an epidemiologic paradigm. Science, 234: 955-963, 1986.
15. RODRIGUES, J.L.N. - Importância do Cryptosporidium sp. na síndrome diarréica do paciente HIV positivo. Săo Paulo, 1989. (Dissertaçăo de Mestrado - Escola Paulista de Medicina).
16. SAUDA, F.C.; ZAMARIOLI, L.A.; EBNER FILHO, W. & MELLO, L.B. - Prevalence of Cryptosporidium sp. and Isospora belli among AIDS patients attending Santos Reference Center for AIDS, Săo Paulo, Brazil. J. Parasit., 79: 454-456, 1993.
17. SMITH, H.V. - Environmental aspects of Cryptosporidium species: a review. J. roy. Soc. Med., 83: 629-631, 1990.
18. SOAVE, R. & JOHNSON Jr., W.D. - Cryptosporidium and Isospora belli infections. J. infect. Dis., 157: 225-229, 1988.
19. WHITESIDE, M.E.; BARKIN, J.S.; MAY, R.G. et al. - Enteroccoccidiosis among patients with the acquired iimmunodeficiency syndrome. Amer. J. trop. Med. Hyg., 33: 1065-1072, 1984.
20. WUHIB, T.; SILVA, T.M.J.; NEWMAN, R.D. et al. - Cryptosporidial and microsporidial infections in human immunodeficiency virus infected patients in northeastern Brazil. J. infect. Dis., 170: 494-497, 1994.

Correspondence to:

Célia R. Garlipp, PhD

Departamento de Patologia Clinica, UNICAMP

Cidade Universitária Zeferino Vaz, C.P. 6111

13083-970, Campinas, S.P., Brasil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Oct 1995

History

Accepted
04 July 1995
Received
17 Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BEAVER, C.P.; JUNG, R.C. & CUPP, E.W. - Clinical Parasitology. 9 ed. Philadelphia, Lea & Febiger, 1984. p. 149-173.

[2] 2. BRANDBORG, L.L.; GOLDBERG, S.B & BRIDENBACH, W.F. - Human coccidiosis a possible cause of malabsorption. New Engl. J. Med., 283: 1306-1313, 1970.

[3] 3. CENTERS FOR DISEASE CONTROL - Cryptosporidiosis: assessment of chemotherapy of males with acquired immune deficiency syndrome (AIDS). M.M.W.R., 31: 589, 1982.

[4] 4. CURRENT, W.L.; REESE, N.C.; ERNST, J.V.; BAILEY, W.S. & HEYMAN, M.B. - Human cryptosporidiosis in immunocompetent and immunodeficient persons. New Engl. J. Med., 308: 1252-1257, 1983.

[5] 5. DeHOVITZ, J.A.; PAPE, J.W.; BONCY, M. & JOHNSON Jr., W.D. - Clinical manifestations and therapy of Isospora belli infection in patients with acquired immunodeficiency syndrome. New Engl. J. Med., 315: 87-90, 1986.

[6] 6. DIAS, R.M.D.S.; MANGINI, A.C.S.; TORRES, D.M.A.G.V. et al. - Cryptosporidiosis among patients with acquired immunodeficiency syndrome (AIDS) in the county of Săo Paulo, Brazil. Rev. Inst. Med. trop. S. Paulo, 30: 310-312, 1988.

[7] 7. FAYER, R. & UNGAR, B.L. - Cryptosporidium spp. and cryptosporidiosis. Microbiol. Rev., 50: 458-483, 1986.

[8] 8. GELLIN, B.G. & SOAVE, R. - Coccidian infections in AIDS. Med. Clin. N. Amer., 76: 205-234, 1992.

[9] 9. JANOFF, E.N. & BARTH RELLER, L. - Cryptosporidium species, a protean protozoa. J. clin. Microbiol., 25: 967-975, 1987.

[10] 10. LASSER, K.H.; LEVIN, K.J. & RYNING, F.W. - Cryptosporidial enteritis in patients with congenital hypogammaglobulinemia. Human Path., 10: 234-240, 1979.

[11] 11. LAUGHON, B.E.; DRUCKMAN, D.A. & VERNON, A. - Prevalence of enteric pathogens in homossexual men with and without acquired immunodeficiency syndrome. Gastroentcrology, 94: 984, 1988.

[12] 12. NAVIN, T.R. & HARDEN, A.M. - Cryptosporidiosis in patients with AIDS. J. infect. Dis., 155: 150, 1985.

[13] 13. NG, E.; MARKELL, E.K.; FLEMING, R.L. & FRIED, M. - Demonstration of Isospora belli by acid - fast stain in a patient with acquired immune deficiency syndrome. J. clin. Microbiol., 20: 384-386, 1984.

[14] 14. QUINN, T.C.; MANN, J.M.; CURRAN, J.W. & PIOT, P. - AIDS in Africa: an epidemiologic paradigm. Science, 234: 955-963, 1986.

[15] 15. RODRIGUES, J.L.N. - Importância do Cryptosporidium sp. na síndrome diarréica do paciente HIV positivo. Săo Paulo, 1989. (Dissertaçăo de Mestrado - Escola Paulista de Medicina).

[16] 16. SAUDA, F.C.; ZAMARIOLI, L.A.; EBNER FILHO, W. & MELLO, L.B. - Prevalence of Cryptosporidium sp. and Isospora belli among AIDS patients attending Santos Reference Center for AIDS, Săo Paulo, Brazil. J. Parasit., 79: 454-456, 1993.

[17] 17. SMITH, H.V. - Environmental aspects of Cryptosporidium species: a review. J. roy. Soc. Med., 83: 629-631, 1990.

[18] 18. SOAVE, R. & JOHNSON Jr., W.D. - Cryptosporidium and Isospora belli infections. J. infect. Dis., 157: 225-229, 1988.

[19] 19. WHITESIDE, M.E.; BARKIN, J.S.; MAY, R.G. et al. - Enteroccoccidiosis among patients with the acquired iimmunodeficiency syndrome. Amer. J. trop. Med. Hyg., 33: 1065-1072, 1984.

[20] 20. WUHIB, T.; SILVA, T.M.J.; NEWMAN, R.D. et al. - Cryptosporidial and microsporidial infections in human immunodeficiency virus infected patients in northeastern Brazil. J. infect. Dis., 170: 494-497, 1994.