Fujikawa Hirotoshi, Miyakawa Hiroshi, Iguchi Kanae, Nishizawa Mika, Moro Kunihiko, Nagai Kozo, Ishibashi Miyuki
Fourth Department of Internal Medicine, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki 213-8507, Japan.
J Gastroenterol. 2002;37(10):840-3. doi: 10.1007/s005350200138.
Cryptosporidium parvum infection has been recognized as one of the pathogens causing severe and persistent diarrhea in immunodeficient patients, such as those with AIDS, worldwide. However, in Japan, the frequency of this infection has been rare, except for environmental contamination through the water supply. In this communication, we describe a Japanese patient with AIDS presenting with intestinal Cryptosporidiosis as an initial manifestation.
The oocysts of Cryptosporidium parvum in his stool were detected by the Ziehl-Neelsen method and electron microscopy. The antigen-specificity was proved by immunostaining, using a fluorescein isothiocyanate (FITC)-labeled monoclonal antibody and enzyme-linked immunosorbent assay (ELISA), using Cryptosporidium-specific antibody.
A 28-year-old Japanese homosexual man was admitted to our hospital because of severe watery diarrhea of 1-week duration. Numerous oocysts of Cryptosporidium parvum were observed in his stool. Cryptosporidium parvum antigen was detected in stool samples. Serological examinations revealed that anti-HIV-1 antibody was positive, and HIV RNA was positive at a high level. He was diagnosed as having AIDS associated with intestinal Cryptosporidiosis. The circulating CD4+ T-cell count was 152/microl. His diarrhea was not alleviated by administration of loperamide and an ordinary antibiotic agent, but ultimately resolved by the administration of the macrolide antibiotic agent, clarithromycin.
We emphasize that the presence of Cryptosporidium parvum infection should be kept in mind in searching for pathogens causative of severe diarrhea in AIDS patients.
微小隐孢子虫感染已被公认为是全球免疫缺陷患者（如艾滋病患者）中导致严重持续性腹泻的病原体之一。然而，在日本，除了通过供水造成环境污染外，这种感染的发生率一直很低。在本报告中，我们描述了一名以肠道隐孢子虫病为首发表现的日本艾滋病患者。
通过齐-尼氏法和电子显微镜检测其粪便中的微小隐孢子虫卵囊。使用异硫氰酸荧光素（FITC）标记的单克隆抗体进行免疫染色，以及使用隐孢子虫特异性抗体进行酶联免疫吸附测定（ELISA）来证明抗原特异性。
一名28岁的日本同性恋男子因持续1周的严重水样腹泻入院。在他的粪便中观察到大量微小隐孢子虫卵囊。粪便样本中检测到微小隐孢子虫抗原。血清学检查显示抗HIV-1抗体呈阳性，HIV RNA呈高水平阳性。他被诊断为患有与肠道隐孢子虫病相关的艾滋病。循环CD4 + T细胞计数为152/微升。给予洛哌丁胺和普通抗生素未能缓解他的腹泻，但最终通过给予大环内酯类抗生素克拉霉素得以缓解。
我们强调，在寻找艾滋病患者严重腹泻的病原体时，应考虑到微小隐孢子虫感染的存在。
