Ben Abda I, Essid R, Mellouli F, Aoun K, Bejaoui M, Bouratbine A
Laboratoire de parasitologie-mycologie laboratoire de recherche 05SP03, institut Pasteur de Tunis, 13, place Pasteur, 1002 Tunis, Tunisie.
Arch Pediatr. 2011 Sep;18(9):939-44. doi: 10.1016/j.arcped.2011.06.015. Epub 2011 Aug 3.
In Tunisia, Cryptosporidium is frequently identified in diarrheic stools of children and immunocompromised patients. The infection is usually self-limited in immunocompetent populations, but can be severe and life-threatening in immunocompromised individuals. Cryptosporidiosis is well-documented in patients with the human immunodeficiency virus; however, few data are available concerning children with primary immunodeficiencies (PIDs).
A retrospective study was conducted on 5 cryptosporidiosis cases diagnosed in 11 children with PIDs. Cryptosporidium was systematically investigated when patients presented chronic diarrhea. Stool samples were examined for the parasite oocysts by modified Ziehl-Neelsen staining, and DNA was systematically extracted for a nested polymerase chain reaction (PCR). The species were identified by the analysis of restriction patterns. Epidemiological and clinicobiological data were presented for each patient.
All cryptosporidiosis cases presented a CMH class II deficiency syndrome. Chronic diarrhea was associated with failure to thrive in all cases. PCR provided the diagnosis in all patients, while Ziehl-Neelsen staining revealed Cryptosporidium oocysts in only 3 cases. Species identification yielded Cryptosporidium hominis in 2 cases, Cryptosporidium meleagridis in 1 case, and Cryptosporidium parvum in 1 case; a C. hominis/C. meleagridis co-infection was observed in the last case. C. hominis was isolated in children from rural areas, suggesting that the infection could have been contracted in the hospital and thus a probability of nosocomial transmission. One of the C. hominis carriers developed sclerosing cholangitis with a high parasite load.
Cryptosporidiosis with serious clinical symptoms is observed in PID patients, particularly those with CMH class II deficiency syndrome. Early, regular, and repeated screening, improved by PCR, is recommended in this group of patients. The predominance of C. hominis, the anthropophilic species, in children from rural areas should emphasize hygiene measures in care centers where PID cases are treated.
在突尼斯，隐孢子虫常在儿童和免疫功能低下患者的腹泻粪便中被发现。该感染在免疫功能正常人群中通常为自限性，但在免疫功能低下个体中可能严重且危及生命。隐孢子虫病在人类免疫缺陷病毒患者中已有充分记录；然而，关于原发性免疫缺陷（PID）儿童的数据却很少。
对11例PID患儿中诊断出的5例隐孢子虫病病例进行了回顾性研究。当患者出现慢性腹泻时，系统地对隐孢子虫进行调查。粪便样本通过改良齐-尼氏染色检查寄生虫卵囊，并系统提取DNA用于巢式聚合酶链反应（PCR）。通过限制性图谱分析鉴定物种。呈现了每位患者的流行病学和临床生物学数据。
所有隐孢子虫病病例均表现为Ⅱ类主要组织相容性复合体（CMH）缺陷综合征。所有病例中慢性腹泻均与发育不良相关。PCR在所有患者中都做出了诊断，而齐-尼氏染色仅在3例中发现了隐孢子虫卵囊。物种鉴定结果为2例为人隐孢子虫，1例为火鸡隐孢子虫，1例为微小隐孢子虫；最后1例观察到了人隐孢子虫/火鸡隐孢子虫混合感染。人隐孢子虫在农村地区儿童中被分离出来，这表明感染可能是在医院感染的，因此存在医院内传播的可能性。其中1名人隐孢子虫携带者出现了寄生虫载量高的硬化性胆管炎。
在PID患者中观察到有严重临床症状的隐孢子虫病，尤其是那些患有Ⅱ类CMH缺陷综合征的患者。建议对该组患者进行早期、定期和重复筛查，并通过PCR加以改进。在治疗PID病例的护理中心，农村地区儿童中人隐孢子虫（嗜人种类）占优势应强调卫生措施。
