Intestinal microsporidiosis in HIV-positive patients with chronic unexplained diarrhea in Rio de Janeiro, Brazil: diagnosis, clinical presentation and follow-up.
After the diagnosis of two cases of microsporidial intestinal infection in 1992, in Rio de Janeiro, we have started looking for this parasite in HIV-infected patients with chronic unexplained diarrhea. We have studied 13 patients from Hospital Evandro Chagas, IOC-FIOCRUZ. Fecal specimens from these patients were examined for the presence of Cryptosporidia and Microsporidia, in addition to routine examination. Spores of Microsporidia were found in the stools of 6 (46.1%) of the 13 patients studied, with 2 histological jejunal confirmations. The Microsporidia-infected patients presented chronic diarrhea with about 6 loose to watery bowel movements a day. Five infected patients were treated with Metronidazole (1.5 g/day). They initially showed a good clinical response, but they never stopped eliminating spores. After about the 4th week of therapy, their diarrhea returned. Two patients utilized Albendazole (400 mg/day-4 weeks) with a similar initial improvement and recurrence of the diarrhea. Intestinal Microsporidiosis seems to be a marker of advanced stages of AIDS, since 5 of our 6 infected patients were dead after a 6 month period of follow-up. The present study indicates that intestinal microsporidiosis may be a burgeoning problem in HIV-infected patients with chronic diarrhea in Brazil, which deserves further investigation.
Brasil
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Laboratórios de Parasitologia e de Patologia, Hospital Evandro Chagas, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Brazil.
Sodré
F C
FC
Cuzzi-Maya
T
T
Gutierrez
M C
MC
Mattos
H
H
Moura
H
H
D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001938:Brazil; D002908:Chronic Disease; D003967:Diarrhea / Q000209:etiology*; D005243:Feces / Q000469:parasitology; D005260:Female; D005500:Follow-Up Studies; D019053:HIV Enteropathy / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007583:Jejunum / Q000469:parasitology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D016881:Microsporidiosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence
D000981:Antiprotozoal Agents; D008795:Metronidazole; D015766:Albendazole