DIAGNOSIS OF INTESTINAL AND DISSEMINATED MICROSPORIDIAL INFECTIONS INPATIENTS WITH HIV BY A NEW RAPID FLUORESCENCE TECHNIQUE

Aims-To assess the value of a new rapid fluorescence method for the di agnosis of microsporidiosis in HIV seropositive patients. Methods-Micr osporidian spores in stools were demonstrated by using the fluorochrom e stain Uvitex 2B. The new technique was evaluated in three groups of HIV seropositive patients with diarrhoea. Group 1: 19 patients with bi opsy confirmed E bieneusi infection (186 stool samples); group 2: 143 consecutive patients from whom faeces were submitted for routine inves tigation of diarrhoea (318 samples); group 3: 16 patients with small i ntestinal biopsy specimens negative for microsporidia (55 samples). Th e new method was used to monitor spore shedding during experimental tr eatment with paromomycin and albendazole in four patients. Results-Bri ghtly fluorescent spores were detected in all stool samples of patient s in group 1. In group 2 16 (11%) patients had spores in their stool s amples. E bieneusi was found in 11 patients; in the other five another genus of microsporidia, Encephalitozoon, was recognised. Encephalitoz oon spores were also found in the urine of three of these patients and in the maxillary sinus aspirate of two of them, suggesting disseminat ed infection. The results were confirmed by electron microscopic exami nation. In group 3 negative biopsy specimens were confirmed by negativ e stool samples in all cases. Treatment with albendazole and paromomyc in did not affect the spore shedding in three patients with E bieneusi infection. By contrast, in a patient with Encephalitozoon sp infectio n albendazole treatment resulted in clinical improvement together with complete cessation of spore excretion in the stool. Conclusion-The Uv itex 2B fluorescence method combines speed, sensitivity, and specifici ty for the diagnosis and treatment evaluation of intestinal and dissem inated microsporidiosis.