Prevalência de enteropatogenos em pacientes infectados pelo vírus da Imunodeficiência Humana (HIV): enfoque na Escherichia coli enteroagregativa (EAggEC)

Abstract

Diarrhea! disease is one of the foremost cause of morbidity and mortality associated with AIDS. The gastrointestinal tract is the target of many of the opportunistic infections that afflict the HIV infected population. Few studies in Brazil have described the frequency of such infections in this population. This study determined the prevalence of classic enteropathogens and enteroaggregative Escherichia coli (EAggEC) in a population of HIV-infected patients with and without diarrhea. A total of 100 HIV-infected patients were recruited from Hospital Sao Jose in Fortaleza, Brazil. Of those, 44 composed the diarrhea group and 56 the non-diarrhea group. Patients in the diarrhea group had a history of 3 liquid stools in the 24 hours prior to the interview

but less than 28 days (acute-persistent) or a history of diarrhea for ^28 days (chronic- intermittent). An association was found between weight loss and diarrhea, whereby

90.7% (30/43) of the diarrhea patients referred weight loss compared to 46.4% (26/56) in the non-diarrhea group (p<0.001). A poorer nutritional status was also found in the diarrhea group as 57.1% (24/42) of the patients had a Body Mass Index (BMI) equal or less to 20 kg/m2 compared to 31.5% (17/54) of the patients in the non-diarrhea group (p<0.05). Cryptosporidium parvum was found in 13.6% (6/44) of the patients with diarrhea being the most frequent opportunistic parasite found in the diarrhea group (p< 0.01), while not being detected in any of the non-diarrhea group. Of classical bacterial enteropathogens in the diarrhea group, Shigella flexneriwas isolated from 6.8% (3/44) of the patients, Salmonella spp. in 4.5% (2/44), Plesiomonas shigelloides and C. difficile in 2.3% (1/44) each. Shigella flexneriwas isolated from the stool sample of one patient in the non-diarrhea group and C. difficile was detected in one patient also in this group. Stools were also examined for enteroaggregative Escherichia coli (EAggEC) using the HEp-2 adherence assay. EAggEC was present in 38.6% (17/44) of the patients with diarrhea and in 41.1% (23/56) of the patients without diarrhea. Considering all enteropathogens, it was possible to identify an agent in 61 .4% (27/44) of the patients in the diarrhea group and 53.6% (30/56) in the non diarrhea group. Not including the EAggEC isolates, a pathogen was identified in 38.6% (17/44) of patients in the diarrhea group and 16.1% (9/56) of the non diarrhea group. A high prevalence of enteroaggregative E.co//was found in both groups. Further studies are necessary to determine which of these aggregative phenotypes seen on the HEp-2 assay can be implicated as a causal agent in the diarrhea! illness in this population.