Lamps L W, Bronner M P, Vnencak-Jones C L, Tham K T, Mertz H R, Scott M A
Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5310, USA.
Am J Clin Pathol. 1998 Apr;109(4):404-10. doi: 10.1093/ajcp/109.4.404.
With improving therapeutic protocols, confirmation of microsporidiosis has become increasingly important. We designed a study to determine the best screening method(s) for microsporidian detection in biopsy specimens. Forty-two small intestinal biopsy specimens from 31 immunocompromised patients (68% AIDS) were stained (hematoxylin-eosin [H & E], modified trichrome, Warthin-Starry, and Brown-Brenn) and polarized. Polymerase chain reaction and Southern blot assays were performed on all positive cases. Microsporida were detected in nine cases (21%) by modified trichrome (all patients with AIDS). Of these, seven were Brown-Brenn positive, and five Warthin-Starry positive. Two cases polarized on H & E and three on special stains. Four of nine positive cases were confirmed by molecular studies. We found polarization to be the least sensitive screening method. The modified trichrome was the most sensitive when screening for microsporidiosis in paraffin-embedded biopsy specimens. Furthermore, combining Brown-Brenn or Warthin-Starry with the trichrome stain helps exclude false-positive results due to granular artifacts (eg, eosinophils, Paneth cells).
随着治疗方案的改进，微孢子虫病的确诊变得越来越重要。我们设计了一项研究，以确定活检标本中微孢子虫检测的最佳筛查方法。对31例免疫功能低下患者（68%为艾滋病患者）的42份小肠活检标本进行染色（苏木精-伊红染色[H&E]、改良三色染色、Warthin-Starry染色和Brown-Brenn染色）并进行偏振光观察。对所有阳性病例进行聚合酶链反应和Southern印迹分析。通过改良三色染色在9例（21%）病例中检测到微孢子虫（所有患者均为艾滋病患者）。其中，7例Brown-Brenn染色阳性，5例Warthin-Starry染色阳性。2例在H&E染色下呈偏振光阳性，3例在特殊染色下呈偏振光阳性。9例阳性病例中有4例通过分子研究得到确诊。我们发现偏振光观察是最不敏感的筛查方法。在石蜡包埋的活检标本中筛查微孢子虫病时，改良三色染色是最敏感的。此外，将Brown-Brenn染色或Warthin-Starry染色与三色染色相结合有助于排除由于颗粒状伪像（如嗜酸性粒细胞、潘氏细胞）导致的假阳性结果。
