Agholi Mahmoud, Hatam Gholam Reza, Motazedian Mohammad Hossein
Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
AIDS Res Hum Retroviruses. 2013 Jan;29(1):35-41. doi: 10.1089/AID.2012.0119. Epub 2012 Sep 11.
Human immunodeficiency virus (HIV) infection has altered both the epidemiology and outcome of enteric opportunistic parasitic infections. This study was done to determine the prevalence and species/genotypes of intestinal coccidian and microsporidial infections among HIV/AIDS patients with diarrhea and/or a history of diarrhea alternately with an asymptomatic interval, and their association with CD4 T cell count. This cross-sectional study was done from May 2010 to May 2011 in Shiraz University of Medical Sciences, South of Iran. A blood sample was obtained from HIV-positive patients for a CD4 T cell count upon enrollment. Sociodemographic data and a history of diarrhea were collected by interviewing 356 consecutive participants (273 males and 83 females). Whenever possible more than a fecal sample was collected from all the participants and examined for parasites using direct, physiological saline solution ethyl acetate, an acid-fast trichrome stain, nested polymerase chain reaction, and sequencing techniques for the detection, confirmation, and genotyping of Cryptosporidium spp., Cyclospora cayetanensis, Isospora belli, and intestinal microsporidia (Enterocytozoon bieneusi). The most common opportunistic and nonopportunistic pathogens were Cryptosporidium spp. (C. parvum and C. andersoni), E. bieneusi, Giardia lamblia, Sarcocystis spp., and Blastocystis homonis affecting 34, 8, 23, 1, and 14 patients, respectively. C. cayetanensis, I. belli, Enterobius vermicularis, and Hymenolepis nana were observed in few patients. A CD4 count <200 cells/μl was significantly associated with the presence of opportunistic parasites and diarrhea (p<0.05). Opportunistic intestinal parasites should be suspected in any HIV/AIDS patient with chronic diarrhea. Tropical epidemic nonopportunistic enteric parasitic infections among such patients should not be neglected in Iran.
人类免疫缺陷病毒（HIV）感染改变了肠道机会性寄生虫感染的流行病学特征和结局。本研究旨在确定腹泻和/或有腹泻病史且有无症状间歇期的HIV/AIDS患者肠道球虫和微孢子虫感染的患病率、种类/基因型，以及它们与CD4 T细胞计数的关系。这项横断面研究于2010年5月至2011年5月在伊朗南部设拉子医科大学进行。入组时从HIV阳性患者采集血样进行CD4 T细胞计数。通过对356名连续参与者（273名男性和83名女性）进行访谈收集社会人口学数据和腹泻病史。尽可能从所有参与者收集多份粪便样本，采用直接涂片、生理盐水-乙酸乙酯法、抗酸三色染色、巢式聚合酶链反应以及测序技术检测、确认和鉴定隐孢子虫属、卡耶塔环孢子虫、贝氏等孢球虫和肠道微孢子虫（比氏肠胞微孢子虫），以检查寄生虫。最常见的机会性和非机会性病原体分别为隐孢子虫属（微小隐孢子虫和安氏隐孢子虫）、比氏肠胞微孢子虫、蓝氏贾第鞭毛虫、肉孢子虫属和人芽囊原虫，分别感染了34例、8例、23例、1例和14例患者。在少数患者中观察到卡耶塔环孢子虫、贝氏等孢球虫、蠕形住肠线虫和微小膜壳绦虫。CD4计数<200个细胞/μl与机会性寄生虫的存在和腹泻显著相关（p<0.05）。任何患有慢性腹泻的HIV/AIDS患者都应怀疑有机会性肠道寄生虫感染。在伊朗，此类患者中的热带流行性非机会性肠道寄生虫感染不应被忽视。
