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PubMed1991

Parasitic diseases. Diseases associated with acquired immunodeficiency syndrome.

There are several protozoan infections that cause relatively benign illness in normal individuals but result in severe disease manifestations in patients with AIDS. These diseases include Pneumocystis carinii pneumonia, CNS toxoplasmosis, cryptosporidiosis, and isosporiasis. Pneumocystis carinii pneumonia (PCP) caused by Pneumocystis carinii, is the most common opportunistic infection in AIDS. It is seen in more than 80% of individuals with this syndrome. Although historically classified as a protozoan, this organism shares many biochemical characteristics with fungi. The onset of PCP may be insidious, and cough and dyspnea are the most common presenting symptoms. Auscultation of the lungs is often unremarkable, but diffuse infiltrates are commonly seen on chest radiographs. The diagnosis of PCP can be confirmed by identifying the organism on specimens obtained by sputum induction or bronchoalveolar lavage. Trimethaprim-sulfamethoxazole is the treatment of choice but is unfortunately associated with leukopenia and rash in many individuals. Both trimethaprim-sulfamethoxazole and aerosolized pentamidine are used prophylactically in patients at high risk for initial or relapsing infection. The appropriate use of these agents has resulted in improved survival for AIDS patients with PCP. Toxoplasmosis, due to Toxoplasma gondii, affects the central nervous system in patients with AIDS. Headache is a common presenting symptom, and both seizures and paresis can occur. A diagnosis of toxoplasmosis is strongly suspected in symptomatic individuals with ringed mass lesions noted on head CT. Patients with this condition are treated with a combination of sulfadiazine, pyrimethamine, and folinic acid. Cryptosporidiosis and isosporiasis are coccidian protozoan diseases that can result in severe, acute, and chronic diarrhea in immunocompromised individuals. Cryptosporidiosis is the more common of the two and is caused by an unknown species of the genus crytosporidium. Isosporiasis is due to infection with Isospora belli. Dehydration and weight loss are a common result of infection with either agent. A definitive diagnosis can be made by examining an acid fast stain of a diarrheal stool specimen and demonstrating oocysts that are specific for each of these organisms. Fluid replacement and general supportive care are essential in the treatment of both of these diseases. Spiramycin is an unproven treatment modality that is often used in patients with cryptosporidiosis. Isosporiasis responds to initial therapy with trimethaprim-sulfamethoxazole, followed by prophylaxis with pyrimethamine. The adoption of safe sexual practices that minimize fecal-oral contamination should decrease the future prevalence of these diseases and other enteric parasitic infections.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[The association of cryptosporidiosis and isosporosis in a patient with acquired immunodeficiency syndrome (AIDS)].

We describe one case of AIDS patient who have excreted simultaneously oocysts of Isospora belli and Cryptosporidium species for ten months. These parasites were noticed with qualitative and quantitative changes. Different treatments were successless about these parasites. This double infestation in tropical AIDS patients appear to have a conspicuously frequency.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[AIDS and gastrointestinal tract: a summary for gastroenterologists and surgeons].

The majority of patients with Aids suffer from diarrhea and weight loss, as well as opportunistic infection and tumors of the gastrointestinal tract; endoscopy is frequently necessary. Often, but not always, it is possible to identify an opportunistic tumor or infection which explains the patient's signs and symptoms. In other cases, HIV may itself be pathogenic. The most important opportunistic pathogens are Candida albicans (stomatitis and esophagitis), cytomegalovirus and herpes simplex virus (esophagus, stomach, biliary system, colon), cryptosporidium (small intestine, biliary system), Isospora belli (small intestine), salmonella, shigella, and campylobacter (small and large intestine, septicemia), and Mycobacterium avium intracellulare (liver, spleen, intestinal submucosa, and bacteremia). Involvement of the gastrointestinal tract is frequent in Kaposi's sarcoma, though it is often asymptomatic. In contrast, gastrointestinal lymphomas are aggressive and rapidly progressive tumors.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Role of cryptosporidiosis in diarrhea among hospitalized adults in Bamako].

Etiologies of infectious diarrhoeas in hospitalised adults have been studied during one year; research of cryptosporidium and isospora oocysts is being made with Henriksen-Pohlenz and Kato methods. Diarrhoea is associated with a positive HIV serology in 40% cases. Cryptosporidium spp is found in 38% of cases. In 91% cases of cryptosporidiosis HIV serology is positive. Cryptosporidiosis is the main cause of AIDS diarrhoeas in Mali. 3 cases of isosporiasis are associated with cryptosporidiosis in AIDS patients. Emaciation and dehydration are the main signs of severity. Diarrhoea's profusion, its chronicity and inefficiency of the treatments explain the heavy death rate of cryptosporidiosis among seropositive patients, which reaches 40% during the first two weeks of hospitalisation.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Role of the microbiology laboratory in the diagnosis of opportunistic infections in persons infected with human immunodeficiency virus.

Patients with defects in the immune system caused by infection with human immunodeficiency virus are predisposed to a variety of opportunistic infections, many of which can be diagnosed by conventional or special microbiological procedures. This article reviews the laboratory diagnosis of bloodstream, lower respiratory tract, gastrointestinal tract, and central nervous system infections in persons infected with human immunodeficiency virus. Laboratories serving health care facilities in which a large number of patients with human immunodeficiency virus infection are cared for should consider enhancing the detection of the specific pathogens affecting these patients by the use of special procedures, including blood culture methods for mycobacteria and fungi, examination of induced sputum for Pneumocystis carinii, and modified acid-fast stains on feces to identify Cryptosporidium and Isospora belli.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[AIDS manifestations in the gastrointestinal tract].

More than 50% of HIV-infected patients develop gastrointestinal symptoms. The HIV-induced damage of the mucosa-associated immune system (reduction of CD4-positive cells in the lamina propria) leads to an increased risk of opportunistic infections (Candida, Herpes simplex virus, Cytomegalovirus, Cryptosporidia, Isospora belli, Strongyloides stercoralis, Mycobacteria) and the development of malignant tumors (Kaposi's sarcoma, malignant lymphoma). 70% of patients with gastrointestinal Kaposi's sarcoma succumb to opportunistic infections within two years. Furthermore, HIV infection promotes the persistence of hepatitis B virus. Although the risk for health care professionals to acquire HIV infection in hospital is minimal, cases of hospital acquired infection are well documented. Therefore when performing endoscopic examinations on HIV-infected patients protective measures such as the wearing of a cap, eye and mouth protection, gloves and a gown must not be neglected. Endoscopes must be disinfected in accordance to standardized procedures.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Coccidian parasites (Apicomplexa: Eimeriidae) from insectivores. VII. Six new species from the hairy-tailed mole, Parascalops breweri.

Sixteen hairy-tailed moles, Parascalops breweri, collected from the northeastern U.S.A. were examined for coccidian oocysts; all were infected with multiple species of coccidia and 3 genera were represented. Two cyclosporans, 2 eimerians, and 2 isosporans are described as new species. Sporulated oocysts of Cyclospora ashtabulensis n. sp. are subspheroid to ellipsoid, 18 X 14 (14-23 X 11-19) microns, and sporocysts are ovoid, 12 X 7 (8-14 X 5-9) microns; C. ashtabulensis was found in 7 of 16 (44%) moles. Sporulated oocysts of Cyclospora parascalopi n. sp. are spheroid, 17 X 14 (13-20 X 11-20) microns, and sporocysts are ovoid, 11 X 7 (8-14 X 5-8) microns; C. parascalopi was found in 8 of 16 (50%) moles. Sporulated oocysts of Eimeria aethiospora n. sp. are subspheroid to ellipsoid, 19 X 13 (15-24 X 10-16) microns, and sporocysts are ovoid, 11 X 6 (8-13 X 4-7) microns; E. aethiospora was found in 4 of 16 (25%) moles. Sporulated oocysts of Eimeria titthus n. sp. are subspheroid, 16 X 14 (13-19 X 11-17) microns, and sporocysts are ellipsoid, 11 X 6 (9-13 X 4-7) microns; E. titthus was found in 4 of 16 (25%) moles. Sporulated oocysts of Isospora ashtabulensis n. sp. are ellipsoid, 20 X 14 (16-24 X 10-18) microns, and sporocysts are ovoid, 10 X 7 (7-14 X 5-10) microns; I. ashtabulensis was found in 5 of 16 (31%) moles.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Infectious diarrhea in African acquired immunodepression syndrome (AIDS). Apropos of 100 patients studied in Bujumbura (Burundi)].

The authors carried out a prospective survey on 100 cases of AIDS in order to find out the different etiologies of infections diarrhoea in terms of frequency and diagnosis behaviour. 84 out of 100 patients got diarrhoea. All 100 patients had their stools examined, 78 underwent high digestive fibroscopy with irrigation and aspiration of duodenal liquid (IADL), 40 duodenal biopsies. 98 infecting agents were revealed in stool exams, 50 in IADL, 7 at the occasion of histopathological exam of duodenal biopsies. All together, stool exams and IADL gave evidence that Isospora belli and Cryptosporidium are the opportunistic infecting agents most often revealed (16.2 and 13.1 p.c., respectively). The role of yeasts in diarrhoea is not evident, but esophageal candidosis is the most frequent opportunistic digestive infection (48 p.c.). Anguillula is the only intestinal worm appearing to play a role: the role of bacteria and viruses cannot be evaluated precisely, but histopathological study revealed neither an atypical mycobacteriosis nor a virus disease (herpes, cytomegalovirus). If diagnosis appears to be still difficult in 1989 when confronted with AIDS and diarrhoea, it seems highly advisable to examine the stools, to perform high digestive fibroscopy with IADL and biopsies. On the other hand, indications for colonoscopy appear to be restricted.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The pathology of AIDS.

The acquired immunodeficiency syndrome (AIDS) is a devastating new disease caused by the human immunodeficiency virus (HIV). This retrovirus causes profound immunoincompetence in its infected hosts, who are thereafter susceptible to develop myriad severe and relapsing protozoal, fungal, bacterial, viral, and arthropodal opportunistic infections, as well as unusual malignancies. The more than 50,000 patients who have developed AIDS in the United States have produced a sudden unexpected deluge of diagnostic dilemmas that are stressing laboratories of pathology everywhere. This paper describes the gross and microscopic pathology of the numerous complications in patients infected by HIV: (a) the prodromal AIDS-related complex with persistent generalized lymphadenopathy, (b) lymphoid infiltration of salivary gland and lung, including the complex of lymphoid interstitial pneumonitis-pulmonary lymphoid hyperplasia, (c) extranodal non-Hodgkin's lymphomas, (d) multifocal mucocutaneous and visceral Kaposi's sarcoma, (e) small cell undifferentiated (oat cell) carcinomas, (f) protozoal infections caused by Pneumocystis carinii, Toxoplasma gondii, Acanthamoeba, Cryptosporidium species (sp.), and Isospora belli, (g) the causes of chronic enteritis, (h) mycotic infections caused by Candida sp., Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, and Sporothrix schenckii, (i) bacterial infections caused by Mycobacterium avium-intracellulare, M. tuberculosis, M. kansasii, Nocardia sp., Listeria monocytogenes, Legionella sp., Treponema pallidum, and others, (j) viral infections caused by cytomegalovirus, herpes simplex and zoster, polyomavirus (progressive multifocal leukoencephalopathy), hepatitis B, molluscum contagiosum, and papillomavirus, (k) oral hairy leukoplakia, (l) subacute encephalopathy, and (m) Norwegian scabies.

AIDS-Related Complex↗
PubMedDate not supplied

Treatment of infectious complications of acquired immunodeficiency syndrome.

The infectious complications of the acquired immunodeficiency syndrome (AIDS) are discussed, and the conventional and nonconventional therapies used for these infections are reviewed. The infections most commonly encountered in patients with AIDS are Pneumocystis carinii pneumonia (58%), Candida esophagitis (31%), toxoplasmosis (21%), cytomegalovirus infections (15%), and herpes-simplex virus infections (12%). Pneumocystis carinii pneumonia is the most common life-threatening process in these patients. Trimethoprim-sulfamethoxazole (TMP-SMZ) is considered the drug of choice for its treatment. Oral candidiasis often indicates the progression to AIDS in the high-risk populations of homosexual or bisexual men, intravenous drug abusers, and individuals with hemophilia. Nystatin suspension is commonly used to treat oral candidiasis, while Candida esophagitis demands systemic therapy with ketoconazole. Toxoplasmosis most commonly manifests itself in patients with AIDS as a cerebral mass lesion. The recommended therapy includes sulfadiazine and pyrimethamine. AIDS patients frequently experience protozoal invasion of the intestinal tract with Giardia lamblia, Isospora belli, and Cryptosporidium muris. Various drugs have been tried for these infections, including quinacrine hydrochloride, metronidazole, TMP-SMZ, and spiramycin. Cytomegalovirus (CMV) infections commonly involve the lungs, gastrointestinal tract, eyes, brain, and nervous system. Attempts to treat these disseminated CMV infections with antiviral agents, including acyclovir, have not been successful. However, acyclovir has been found beneficial in the treatment of herpes-simplex virus infections. Multiple infectious complications may occur in patients with AIDS as a result of the cellular-immune deficiency associated with this disease. Until more research is done with AIDS patients, therapy must be based on the data available from the treatment of these infections in immunosuppressed patients without AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Cryptosporidiosis and isosporiasis in patients with AIDS.

Cryptosporidium and Isospora belli are coccidian protozoan parasites that were long recognized as pathogens of animals. They were brought to the attention of the medical community by the advent of AIDS. These parasites are associated with persistent, devastating enteritis in patients with AIDS and self-limited diarrheal illness in the immunocompetent host. Cryptosporidiosis appears to be more common than isosporiasis in both patients with AIDS and those who are not immunosuppressed. Clinically, cryptosporidiosis is indistinguishable from isosporiasis. Watery, noninflammatory diarrhea, abdominal cramping pain, and weight loss are the characteristic symptoms. Diagnosis is made by identification of the acid-fast organisms in stained fecal specimens. There is no known effective therapy for cryptosporidiosis, whereas patients with isosporiasis respond promptly to treatment with trimethoprim-sulfamethoxazole. Patients with AIDS and isosporiasis have a high frequency of recurrent infection and therefore should be maintained on suppressive therapy. Much more needs to be learned about these two fascinating and unique parasites to be able to intervene successfully in the management of infected patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Parasitic diarrhea.

This article reviews the biology, epidemiology, and clinical management of amebiasis, giardiasis, and cryptosporidiosis as well as the less common intestinal protozoa, Dientamoeba fragilis, Isospora belli, Balantidium coli, and Blastocystis hominis.

Diarrhea↗
PubMed1986

[Coccidiosis in suckling calves raised on large farms].

In a large herd of pigs whose piglets suffered from diarrheas coprological examination revealed the great incidence of Isospora suis coccidia in piglets. The first oocysts were found out in seven-day piglets; the highest incidence was observed in twelve-day piglets (65.9%); the time of oocyst elimination (patency) was five to six days. The oocysts appeared in the excrements of piglets two to three days after the diarrhea onset. Individual examinations of piglets demonstrated the correlation between the intensity of clinical signs and the numbers of eliminated oocysts. No oocysts of I. suis were found either in sow excrements or gilt excrements. The I. suis oocysts were diagnosed in the excrements of piglets from first-farrowing sows and in the excrements of piglets from the sows, in the litters of which I. suis had already been demonstrated. Evaluating the therapeutic and preventive effects of the anticoccidic drug amprolium no significant difference was recorded in the I. suis incidence between the medicated group and the control group.

Amprolium↗
PubMed1988

[Study on the presence of Cryptosporidium in Umbria].

Cryptosporidium is an intestinal protozoan parasite belonging to the same family as Isospora and Toxoplasma. Cryptosporidium can cause severe, life-threatening enteritis in immunocompromised patients; he can also cause much less severe diarrhea in immunocompetent humans and in several animal species. Cryptosporidiosis has been diagnosed by identification of characteristic cocysts in fecal smear. In order to detect the small numbers of oocysts excreted, a modified Teleman-Miyagawa concentration technique was used. After, the faecal smears were stained by means of the dimethyl-sulfoxide (DMSO) acid-fast method. During 12 months, 157 specimens of faeces of patients with diarrhoea and 75 stool samples of asymptomatic humans were examined. Cryptosporidium was identified, only, in 2 of 157 stools of patients with diarrhoea. These two patients were less than 2 years of age. Cryptosporidial oocysts not were seen in the faeces of 75 asymptomatic humans and of 35 (only 20 with diarrhoea) immunocompromised patients. Failure to detect the agent in immunosuppressed patients in likely related to poor number of examinated cases. In conclusion, routine laboratory studies to identify Cryptosporidium in the stools of immunocompromised patients seem justified, since the parasite causes in these patients severe opportunistic also extra-intestinal infections.

Adolescent↗
PubMed1988

[Opportunistic parasitic diseases and mycoses in AIDS. Their frequencies in Brazzaville (Congo)].

To determine the frequency of opportunistic parasitic and mycotic diseases in adult AIDS patients in the Congo, a study was conducted at l'Hôpital Universitaire de Brazzaville in 1986 and 1987. Diagnosis of AIDS was made using the WHO clinical definition for Africa (Bangui, 1985) and HIV seropositivity Pasteur Elisa test. Oral pharyngeal candidiasis occurred in 36% of cases. Intestinal parasitic profile found in 118 patients, 2/3 of whom were associated with chronic diarrhoea showed clearly relative frequency of isosporiasis (Isospora belli): 9.3% and rarity of crystosporidiosis: 4.2%. 12 meningitic cryptococcosis cases out of 139 patients was confirmed (8.6%); for cerebral toxoplasmosis, it was by comparing the serum toxoplasmosis antibody and cerebrospinal fluid rates on 75 patients that an estimation of 20% was reached. Pneumocytis carinii pneumonia seems to be rare, lower than 10%. No case of disseminated histoplasmosis and malignant strongyloidiasis was observed.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Endoparasitic infestation of wild hedgehogs and hedgehogs in human care with a contribution to therapy].

In order to confirm the prevalence of endoparasites fecal samples from 127 hedgehogs living outdoors as well as from 85 in an animal home and from 542 hedgehogs hibernating in private homes were examined. 52.0%-72.3% of the animals from natural surroundings proved to be infested with the lung worm and 72.3%-74.0% with Capillaria species of the intestine, respectively. Capillaria aerophila were found in 15.1%-40.7%, whereas coccidia (1.4%-12.9%) were less frequent. In animal homes and private care hibernating hedgehogs excreted larvae of Crenosoma striatum (23.5% and 21.0%, respectively), eggs of Capillaria species of the intestine (47.1% and 37.1%), and eggs of Capillaria aerophila (7.1% and 19.4%), but oocysts of Isospora rastegaievae were found to be predominant (44.7% and 32.3%). Proglottides of Hymenolepis erinacei and eggs of Brachylaemus erinacei appeared only in the faeces of 3 and 2 hedgehogs, respectively. Helminths of the lung and gut were already found in May, therefore it must be concluded that these parasites are able to survive the winter in the host during the hibernation period. Even young hedgehogs (400-500 g) were infected with Crenosoma and/or Capillaria spp. of the intestine, however, compared with the adults the excretion of eggs and larvae was rather low. The antiparasitic agent Ivermectin (0.3 mg/100 g body-weight) was effective against Crenosoma striatum (efficacy: 95.9%) and Capillaria spp. (100%); therefore it can be recommended as a new, well tolerated anthelmintic against nematodes of the hedgehog.

Animals↗
PubMed1987

[Pathomorphological changes in the small intestine of pigs with rotavirus diarrhea].

Studied were the pathohistological changes and the morphologic-structural injuries of intestinal mucosa of pigs (5-7 days old), spontaneously affected with rotavirus diarrhea, raised by traditional methods. Simultaneously with the rotavirus invasion was established Isospora suis. In spite of the early time of the disorder (the test was carried out 24 hours after the appearance of the first clinical symptoms) there were established different in degree and expression morphologic changes; atrophy and fusion of the fibrils, replacement of the cylindrical epithelium with cubic, dystrophy and exfoliation of the enterocytes with exposure of the lamina propria. The burden of the dystrophic processes, which has affected the intestinal mycosis, was registered by scanning electronic microscopy. The dystrophic processes start at the top of the intestinal fibrils, the fusion of the fibrils spreads over a big number of them, forming a conglomerate mass. Simultaneously with the fibrils, affected by dystrophy, were observed fibrils with normal shape and size. During immunofluorescent examinations also is observed focal distribution of enterocytes, containing antigen on some of the fibrils. Now is discussed the importance of the pathogenic microflora, in the intestinal track of pigs, raised by traditional methods, for the early appearance and for the burden of the morphologic-structural changes.

Animals↗
PubMed1987

Anthelmintic efficacy of ivermectin in naturally parasitized cats.

Ivermectin was administered per os [( PO]; n = 15) or subcutaneously [( SC]; n = 3) to naturally parasitized cats at 10 (n = 6), 100 (n = 6), or 300 (n = 6) micrograms/kg of body weight. Nontreated control cats were given sterile isotonic saline solution PO (n = 5) or SC (n = 1). Qualitative fecal examinations were performed on each cat 1 day before treatment and 14 days after treatment. Cats were euthanatized 14 days after treatment, at which time parasites from the gastrointestinal tracts were recovered, identified, and enumerated. Lungs and urinary bladders were examined histologically or by digestion (lungs only) for Capillaria spp and/or Aelurostrongylus abstrusus. Ivermectin was effective in removing Ancylostoma spp at all doses, but removal of Toxocara cati required 300 micrograms of ivermectin/kg. Efficacies against A abstrusus, Capillaria spp, and Physaloptera spp could not be determined definitively. Ivermectin had no effect on Dipylidium caninum, Hydatigera taeniaeformis, Spirometra mansonoides, or Isospora spp. Adverse reactions were not observed in cats given ivermectin PO; however, 3 cats given ivermectin SC reacted as though they experienced pain at the injection site.

Animals↗