Ordinary and opportunistic enteropathogens associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatus.
Ordinary and opportunistic enteropathogens associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatus.
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DOI：
10.1016/s1201-9712(01)90069-4
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发表时间：
2001-01-01
期刊：
影响因子：
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通讯作者：
Aidara-Kane, A
中科院分区：
文献类型：
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作者：
Gassama, A;Sow, P S;Aidara-Kane, A
目的：了解与人类免疫缺陷病毒(HIV)血清学有关的腹泻相关细菌、寄生虫、真菌和轮状病毒的主要类型和流行情况，为临床医生进行病例管理提供指导。方法：通过病例对照研究确定了病例的病原体：HIV感染的腹泻患者(HIV+D+)和HIV血清阴性的腹泻患者(HIV D+)；对照组为HIV感染的无腹泻患者(HIV+D)和血清阴性对照(HID D)。用常规方法鉴定常见肠道病原菌。采用聚合酶链式反应(PCR)、Hep-2细胞黏附模式鉴定、Sereny试验、GM1-ELISA法和哺乳小鼠试验对不同致病型的大肠杆菌进行鉴定。条件寄生虫：隐孢子虫和微孢子虫分别用Kinyoun法和Weber三色染色鉴定。用市售乳胶凝集试剂盒鉴定轮状病毒。结果：594例患者中，HIV+D+158例，HIV2D+121例，HIV+D 160例，HIV D 155例。腹泻的主要病因因患者的HIV血清状况不同而不同。在免疫功能正常的成人中，引起腹泻的主要原因是志贺氏菌(12.4%)、溶组织内阿米巴(10.7%)、肠炎沙门氏菌(6.6%)和贾第虫(4.9%)。在免疫功能低下的宿主中，常见的病原菌有肠聚集性大肠埃希菌(19.6%)、微孢子虫(9.4%)、隐孢子虫(8.2%)、轮状病毒(8.2%)、志贺氏菌(7.6%)、白色念珠菌(7.6%)、组织溶解杆菌(5.1%)、肠球菌(4.4%)和贝氏等孢子菌(4.4%)。此外，人芽囊原虫必须被视为一种机会性寄生虫，因为它只在艾滋病毒感染患者中发现，成人腹泻患者的发病率较高(艾滋病毒+D+患者为2.5%；艾滋病毒+D患者为0.6%)。蛔虫和鞭虫的无症状携带率较高，部分病例出现多重感染。在低CD4细胞数(范围为79 250个/毫升)患者中，常检出真菌隐孢子虫和微孢子虫。与HIV血清状态无关，腹泻患者的CD4计数较低，这表明腹泻是一种虚弱的疾病，有效的腹泻治疗可以防止免疫抑制。分离的肠源性菌株对塞内加尔治疗腹泻的大多数抗生素(氨苄西林、四环素、复方新诺明)表现出高度耐药性，对丁胺卡星、庆大霉素和诺氟沙星敏感。结论：这些流行病学数据表明，应更新达喀尔地区HIV感染期间腹泻的治疗指南。
OBJECTIVES: A survey was conducted in Dakar, Senegal, to identify major types and prevalences of bacteria, parasites, fungi, and Rotaviruses associated with diarrhea in relation to human immunodeficiency virus (HIV) serostatus with the goal to provide guidance to physicians for case management.METHODS: Etiologic agents were identified in a case control study: cases were HIV-infected patients with diarrhea (HIV+ D+) and HIV seronegative patients with diarrhea (HIV D+); controls were HIV-infected patients without diarrhea (HIV+ D ) and seronegative controls without diarrhea (HID D ). Ordinary enteric pathogens were identified by conventional methods. Different Escherichia coli pathotypes were characterized by polymerase chain reaction (PCR), identification of HEp-2 cell adherence pattern, Sereny test, GM1-ELISA, and the suckling mouse assay. Opportunistic parasites, such as Cryptosporidium and Microsporidium, were identified by the Kinyoun method and trichromic stain of Weber, respectively. Rotaviruses were identified with a commercial latex agglutination kit. Antimicrobial susceptibility testing was carried out by the disk diffusion method.RESULTS: Among the 594 patients examined, 158 were HIV+ D+, 121 were HIV2 D+, 160 were HIV+ D , and 155 were HIV D . The main etiologies of diarrhea were different according to HIV serostatus of patients. In immunocompetent adults the main causes of diarrhea were Shigella sp (12.4%), Entamoeba histolytica(10.7%), Salmonella enterica (6.6%), and Giardia (4.9%). In the immunocompromised host the more frequent pathogens were enteroaggregative E. coli (19.6%), Microsporidium (9.4%), Cryptosporidium sp (8.2%), Rotavirus (8.2%), Shigella sp (7.6%), Candida albicans (7.6%), E. histolytica (5.1%), S. enterica (4.4%), and Isospora belli (4.4%). Also, Blastocystis hominis has to be considered as an opportunistic parasite, because it was identified only in HIV-infected patients, with higher prevalence in adults with diarrhea (2.5% in HIV+ D+ patients; 0.6% in HIV+ D patients). High level of asymptomatic carriage of Ascaris lumbricoides and Trichuris trichiura and some cases of multiple infections were observed. Fungi, Cryptosporidium sp and Microsporidium sp, were often identified in patients with low CD4 counts (range, 79 250 cells/mL). Independently from HIV-serostatus, CD4 count was lower in diarrheic persons, suggesting that diarrhea is a debilitating illness and that effective management of diarrhea can prevent immunosuppression. Isolated enteropathogenic strains displayed high resistance to most antibiotics used in Senegal for treating diarrhea (ampicillin, tetracycline, cotrimoxazole); they were susceptible to amikacin, gentamicin, and norfloxacin.CONCLUSION: These epidemiologic data suggest that guidelines for the management of diarrhea during HIV infection in Dakar should be updated.