Barboni Graciela, Candi Marcela, Inés Villacé María, Leonardelli Araceli, Balbaryski Jeanette, Gaddi Eduardo
Division Inmunología Clínica, Hospital General de Niños Dr. Pedro de Elizalde, Buenos Aires, Argentina.
Medicina (B Aires). 2008;68(3):213-8.
Cryptosporydium parvum is an intracellular parasite that infects gastrointestinal epithelium and produces diarrhea that is self-limited in immunocompetent persons but potentially life-threatening in immunocompromised, especially those with the acquired immunodeficiency syndrome (AIDS). C. parvum enteric infection's incidence in a pediatric HIV/AIDS cohort, during a 6 years period, was studied. Clinical and immunologic characteristics of the dual infection were also recorded. Highly active antiretroviral therapy (HAART) was started or continued by all the patients during follow-up. Azithromicyn was used as antiparasitic drug. Cryptosporidiosis incidence was 13.7%; 33 out 240 children showed chronic diarrhea lasting 14 days at least, or recurrent, without dehydration and electrolytic disturbance. Peripheral blood T CD4+ percentage levels of the patients were variable and without relationship with C. parvum presence. Viral load levels in 31 out 33 patients were over cut-off at the enteric episode time. Mild or moderate eosinophilia were recorded in 23% of the patients and other intestinal parasites were present in 11 children. When the number of enteric episodes were compared with the clinical and immunological patient's status, not significant differences were recorded. HAART is the best treatment to improve immune function in HIV patients avoiding potentially fatal complications that accompany acute diarrhea during concomitant infection with C. parvum.
微小隐孢子虫是一种细胞内寄生虫,可感染胃肠道上皮细胞并导致腹泻。在免疫功能正常的人群中,腹泻通常是自限性的,但在免疫功能低下的人群中,尤其是获得性免疫缺陷综合征(AIDS)患者中,可能会危及生命。本研究对一个儿科HIV/AIDS队列在6年期间微小隐孢子虫肠道感染的发病率进行了研究。同时还记录了双重感染的临床和免疫学特征。在随访期间,所有患者均开始或继续接受高效抗逆转录病毒治疗(HAART)。阿奇霉素被用作抗寄生虫药物。隐孢子虫病的发病率为13.7%;240名儿童中有33名出现持续至少14天的慢性腹泻或反复腹泻,且无脱水和电解质紊乱。患者外周血T CD4+百分比水平各不相同,与微小隐孢子虫的感染情况无关。33名患者中有31名在肠道发病时病毒载量水平超过临界值。23%的患者记录到轻度或中度嗜酸性粒细胞增多,11名儿童同时感染了其他肠道寄生虫。当将肠道发病次数与患者的临床和免疫状态进行比较时,未发现显著差异。HAART是改善HIV患者免疫功能的最佳治疗方法,可避免在同时感染微小隐孢子虫时伴随急性腹泻出现的潜在致命并发症。