马拉维 HIV 感染儿童肠道原生动物的多重实时 PCR 检测：肠内原虫宾氏巴贝斯虫很常见，与胃肠道症状相关，并可能延迟 BMI（营养状况）恢复。
Multiplex Real-time PCR Detection of Intestinal Protozoa in HIV-infected Children in Malawi: Enterocytozoon Bieneusi Is Common and Associated With Gastrointestinal Complaints and May Delay BMI (Nutritional Status) Recovery.
机构信息
From the Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Department of Paediatrics.
出版信息
Pediatr Infect Dis J. 2018 Sep;37(9):910-915. doi: 10.1097/INF.0000000000001924.
BACKGROUND
Intestinal protozoa are common opportunistic infections in HIV patients. Longitudinal studies on either the clinical relevance or the effect of immune reconstitution by antiretroviral therapy on intestinal protozoan infections in children are lacking however. This study investigates prevalence and clinical relevance of intestinal protozoa in HIV-infected Malawian children before and during their first year of antiretroviral treatment (ART).
METHODS
Stool samples collected at enrolment and during follow-up were tested for nonopportunistic (Giardia lamblia, Dientamoeba fragilis, Entamoeba histolytica) and opportunistic protozoa (Enterocytozoon bieneusi, Encephalitozoon spp., Cryptosporidium spp. and Cystoisospora belli) using multiplex real-time polymerase chain reaction. Associations between infections and clinical symptoms were evaluated using univariate methods.
RESULTS
Nonopportunistic and opportunistic protozoa were detected in 40% (14/35) and 46% (16/35) of children at baseline, respectively. E. bieneusi was the most prevalent protozoa (37%, 13/35) and associated with gastrointestinal complaints (43% in positive (10/13) versus 18% (4/22) in E. bieneusi-negative children, P = 0.001. Body mass index recovery during 12 months of ART was more commonly delayed in E. bieneusi-positive children (+0.29 +standard deviation 0.83) than E. bieneusi-negative children (+1.03 +standard deviation 1.25; P = 0.05). E. bieneusi was not detected after 12 months of ART.
CONCLUSIONS
E. bieneusi was the most prevalent opportunistic intestinal protozoa, present in over a third of study participants before initiation of ART. Although all children cleared E. bieneusi after 12 months of ART, E. bieneusi was associated with gastrointestinal complaints and may delay body mass index recovery. Trials to assess effect of treatment of E. bieneusi on nutritional status should be considered in HIV-infected African children.
背景
肠道原虫是 HIV 患者常见的机会性感染。然而，目前缺乏关于抗逆转录病毒治疗（ART）对儿童肠道原虫感染的临床相关性或对免疫重建影响的纵向研究。本研究调查了马拉维 HIV 感染儿童在开始接受抗逆转录病毒治疗（ART）前和第一年期间肠道原虫的流行情况和临床相关性。
方法
在入组时和随访期间采集粪便样本，采用多重实时聚合酶链反应检测非机会性（蓝氏贾第鞭毛虫、脆弱双核阿米巴、溶组织内阿米巴）和机会性原虫（肠上皮细胞内原生动物、脑炎原虫属、隐孢子虫和贝氏等孢球虫）。使用单变量方法评估感染与临床症状之间的关系。
结果
基线时，分别有 40%（14/35）和 46%（16/35）的儿童检测到非机会性和机会性原虫。肠道上皮细胞内原生动物是最常见的原虫（37%，13/35），与胃肠道症状相关（阳性者 43%（10/13），阴性者 18%（4/22），P=0.001）。在 12 个月的 ART 期间，肠道上皮细胞内原生动物阳性儿童的体重指数恢复更常见延迟（+0.29，标准偏差 0.83），而肠道上皮细胞内原生动物阴性儿童则更常见加速（+1.03，标准偏差 1.25；P=0.05）。在 ART 治疗 12 个月后未检测到肠道上皮细胞内原生动物。
结论
肠道上皮细胞内原生动物是最常见的机会性肠道原虫，在开始 ART 前，超过三分之一的研究参与者存在该原虫。尽管所有儿童在 12 个月的 ART 后均清除了肠道上皮细胞内原生动物，但肠道上皮细胞内原生动物与胃肠道症状相关，可能会延迟体重指数恢复。应考虑在感染 HIV 的非洲儿童中开展评估治疗肠道上皮细胞内原生动物对营养状况影响的试验。
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