血液透析患者中隐孢子虫属及其他具有致病潜力的肠道寄生虫的存在情况：一项开放性对照研究。
Presence of Cryptosporidium spp and other enteroparasites with pathogenic potential in hemodialysis patients: an open controlled study.
作者信息
Adami Yara Leite, Gama Nycole Abreu, Cunha Flavia de Souza, Peralta Regina Helena Saramago, Lugon Jocemir Ronaldo
机构信息
Universidade Federal Fluminense, Departmento de Patologia, Faculdade de Medicina, Niterói, RJ, Brazil.
Universidade Federal Fluminense, Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Niterói, RJ, Brazil.
出版信息
J Bras Nefrol. 2025 Jan-Mar;47(1):e20240015. doi: 10.1590/2175-8239-JBN-2024-0015en.
INTRODUCTION
The World Health Organization (WHO) points out that infection by enteroparasites can affect ~3.5 billion people around the world. Hemodialysis (HD) patients may be more susceptible to infections by opportunistic pathogens due to impaired immune function. We evaluated enteroparasite infection in a sample of HD-patients from two dialysis centers and in a control group.
METHODS
Fecal samples were processed using the Hoffmann-Pons-Janner, Ritchie, Willis, and Rugai techniques. Patients with kidney failure from two dialysis centers undergoing HD for more than 3 months were included. The control group consisted of relatives of the patients without overt CKD. The TaqMan PCR and multiplex real-time PCR were carried out for detection of Cryptosporidium spp. and C. parvum and to differentiate the Entamoeba (E.) histolytica/E. dispar complex, respectively.
RESULTS
A total of 97 HD patients and 42 controls were enrolled in the study. Fifty (51.5%) fecal samples from the HD group were positive for enteroparasites, as were 26 (61.9%) from the control group (P = 0.260). S. stercoralis was the single helminth detected and was only present in HD-patients. Coproscopy detected seven positive samples for the E. histolytica/E. dispar complex, three from HD patients and four from controls: by PCR, all samples were positive for the non-pathogenic E. dispar. Safranin-stained fecal smear slides were all negative for Cryptosporidium spp. However, by PCR, amplification for Crypstosporidium spp. was seen in six samples, all from the HD patients. Two of the species were classified as C. hominis by PCR-RFLP.
CONCLUSIONS
Enteroparasite infection as detected by traditional techniques were not more prevalent in HD patients, but S. stercoralis was only found in these patients. It is noteworthy that Cryptosporidium spp. infection, also affecting only HD patients, could only be detected by molecular biology techniques.
引言
世界卫生组织（WHO）指出，肠道寄生虫感染可影响全球约35亿人。血液透析（HD）患者由于免疫功能受损，可能更容易受到机会性病原体的感染。我们评估了来自两个透析中心的HD患者样本和一个对照组中的肠道寄生虫感染情况。
方法
粪便样本采用霍夫曼 - 庞斯 - 詹纳、里奇、威利斯和鲁盖技术进行处理。纳入了来自两个透析中心接受HD治疗超过3个月的肾衰竭患者。对照组由无明显慢性肾脏病（CKD）的患者亲属组成。进行TaqMan PCR和多重实时PCR分别检测隐孢子虫属和微小隐孢子虫，并区分溶组织内阿米巴/迪斯帕内阿米巴复合体。
结果
本研究共纳入97例HD患者和42例对照。HD组50份（51.5%）粪便样本肠道寄生虫检测呈阳性，对照组26份（61.9%）呈阳性（P = 0.260）。粪类圆线虫是检测到的唯一一种蠕虫，仅存在于HD患者中。粪便检查检测到7份溶组织内阿米巴/迪斯帕内阿米巴复合体阳性样本，3份来自HD患者，4份来自对照：通过PCR检测，所有样本均为非致病性迪斯帕内阿米巴阳性。番红染色的粪便涂片载玻片隐孢子虫属均为阴性。然而，通过PCR检测，在6份样本中发现了隐孢子虫属的扩增，所有样本均来自HD患者。其中两个物种通过PCR - RFLP被分类为人隐孢子虫。
结论
传统技术检测到的肠道寄生虫感染在HD患者中并不更普遍，但粪类圆线虫仅在这些患者中被发现。值得注意的是，同样仅影响HD患者的隐孢子虫属感染只能通过分子生物学技术检测到。
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