Idris Nikmah Salamia, Dwipoerwantoro Pramita Gayatri, Kurniawan Agnes, Said Mardjanis
Department of Child Health, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
J Infect Dev Ctries. 2010 Jun 3;4(5):309-17. doi: 10.3855/jidc.275.
Parasitic gastrointestinal infections have been variably reported among immunocompromised adults while data on children have been limited. This prospective cross-sectional study aimed to assess the clinical profile of intestinal parasitic infections among immunocompromised children with diarrhoea and their treatment response.
Two freshly voided stool samples taken for two consecutive days were examined by direct and formalin-ether concentrated smears. Modified Ziehl-Neelsen staining was used to detect Cryptosporidium, Isospora belli, and Cyclospora cayetanensis. Blastocystis hominis was identified using in vitro culture. Subjects positive for stool parasite(s) received standard therapy according to the aetiology and were evaluated afterward.
Forty-two subjects from Jakarta, Indonesia were included in this study, mostly aged one to five years (78%) and HIV infected (52%). Parasites were found in 24/42 (57%) subjects in which B. hominis comprised the largest proportion (23/24 = 96%). Cryptosporidium was identified in two subjects who were HIV infected with CD4 percentages of < 15%. No helminth infestations were found. Parasites were most frequently found in preschool age children (16/23), in those with recurrent or watery diarrhoea (23/24 and 14/18, respectively), and in HIV subjects not receiving antiretrovirals (16/22). Of 13 subjects evaluated for response to a 10-day metronidazole course for B. hominis infection, seven achieved clinical remission and nine had their parasites eradicated.
The prevalence of intestinal parasitic infection in immunocompromised children with persistent and/or recurrent diarrhoea is moderately high and dominated by B. hominis infection. Clinical remission and parasite eradication can be achieved in B. hominis infection treated with metronidazole.
免疫功能低下的成年人中，寄生性胃肠道感染的报告情况各不相同，而关于儿童的数据有限。这项前瞻性横断面研究旨在评估腹泻的免疫功能低下儿童肠道寄生虫感染的临床特征及其治疗反应。
连续两天采集的两份新鲜粪便样本通过直接涂片和福尔马林 - 乙醚浓缩涂片进行检查。采用改良齐尔 - 尼尔森染色法检测隐孢子虫、贝氏等孢球虫和卡耶塔环孢子球虫。人芽囊原虫通过体外培养进行鉴定。粪便寄生虫检测呈阳性的受试者根据病因接受标准治疗，随后进行评估。
本研究纳入了42名来自印度尼西亚雅加达的受试者，大多年龄在1至5岁（78%）且感染了HIV（52%）。42名受试者中有24名（57%）检测出寄生虫，其中人芽囊原虫占比最大（23/24 = 96%）。两名CD4百分比<15%的HIV感染受试者中检测出隐孢子虫。未发现蠕虫感染。寄生虫最常见于学龄前儿童（16/23）、反复或水样腹泻的儿童（分别为23/24和14/18）以及未接受抗逆转录病毒治疗的HIV受试者（16/22）。在13名接受针对人芽囊原虫感染的10天甲硝唑疗程治疗反应评估的受试者中，7名实现了临床缓解，9名受试者的寄生虫被根除。
持续性和/或反复性腹泻的免疫功能低下儿童肠道寄生虫感染患病率中等偏高，且以人芽囊原虫感染为主。甲硝唑治疗人芽囊原虫感染可实现临床缓解和寄生虫根除。
