Ramos-Soriano A G, Saavedra J M, Wu T C, Livingston R A, Henderson R A, Perman J A, Yolken R H
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287-4933, USA.
Mol Cell Probes. 1996 Apr;10(2):67-73. doi: 10.1006/mcpr.1996.0010.
Infants and young children with HIV infection commonly suffer from gastrointestinal manifestations of their disease. Many HIV infected children have evidence of persistent diarrhoea, malabsorption, malnutrition or growth failure. The aetiology and pathogenesis of gastrointestinal dysfunction in HIV infected children have not been well defined. We performed immunocytochemical analyses on intestinal tissue from 19 HIV-infected children with gastrointestinal dysfunction or growth failure. None of these 19 children had microbial pathogens identified in faecal samples using standard microbiological methods. Intestinal tissues were obtained from the children by biopsy and were examined for antigens from Pneumocystis carinii, cytomegalovirus (CMV) and herpes simplex virus (HSV) using the avidin-biotin-complex immunohistochemical technique and monoclonal or monospecific antibodies. We detected at least one of these pathogens in samples from eight (42%) of 19 HIV infected children. P. carinii was the most prevalent pathogen, found in five of the eight HIV infected children. All of the children with intestinal pneumocystis infection were receiving prophylaxis directed at the prevention of pulmonary disease with this organism and none of them were undergoing active pulmonary infection. We also identified CMV antigens in intestinal tissues from four children and HSV antigens in intestinal tissues from one child. Two children were infected with more than one pathogen. On the other hand, none of these pathogens were found in the tissues obtained from 10 HIV-uninfected patients who had intestinal tissues obtained for chronic non-infectious diarrheal and inflammatory diseases (P < 0.01, Fisher's exact test). Our findings indicate that some children with HIV infection and gastrointestinal dysfunction may be infected with opportunistic pathogens despite negative analyses employing standard microbiological methods. Our study also indicates that HIV infected children can undergo intestinal infection with P. carinii despite the administration of standard immunoprophylactic regimens directed at the prevention of infection with this organism.
感染人类免疫缺陷病毒（HIV）的婴幼儿通常会出现该疾病的胃肠道表现。许多感染HIV的儿童有持续性腹泻、吸收不良、营养不良或生长发育迟缓的迹象。HIV感染儿童胃肠道功能障碍的病因和发病机制尚未完全明确。我们对19名患有胃肠道功能障碍或生长发育迟缓的HIV感染儿童的肠道组织进行了免疫细胞化学分析。使用标准微生物学方法，在这19名儿童的粪便样本中均未检测到微生物病原体。通过活检获取儿童的肠道组织，并使用抗生物素蛋白-生物素复合物免疫组织化学技术以及单克隆或单特异性抗体，检测卡氏肺孢子虫、巨细胞病毒（CMV）和单纯疱疹病毒（HSV）的抗原。我们在19名HIV感染儿童中的8名（42%）样本中检测到至少一种这些病原体。卡氏肺孢子虫是最常见的病原体，在8名HIV感染儿童中的5名中被发现。所有肠道感染肺孢子虫的儿童都在接受针对预防该病原体引起的肺部疾病的预防治疗，且他们均未发生活动性肺部感染。我们还在4名儿童的肠道组织中鉴定出CMV抗原，在1名儿童的肠道组织中鉴定出HSV抗原。两名儿童感染了不止一种病原体。另一方面，在10名因慢性非感染性腹泻和炎症性疾病获取肠道组织的未感染HIV的患者的组织中未发现这些病原体（P<0.01，Fisher精确检验）。我们的研究结果表明，一些感染HIV且有胃肠道功能障碍的儿童，尽管采用标准微生物学方法分析结果为阴性，但仍可能感染机会性病原体。我们的研究还表明，尽管给予了针对预防该病原体感染的标准免疫预防方案，但HIV感染儿童仍可能发生肠道卡氏肺孢子虫感染。
