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Pragmatic Combination of Available Diagnostic Tools for Optimal Detection of Intestinal Microsporidia
Stuti Kaushik1, Rumpa Saha2, Shukla Das1
1Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095, India.
Abstract:
Diarrhea is a debilitating condition in HIV infected individuals and with the finding that almost 1/4 cases of diarrhea in HIV are due to microsporidia, there is a dire need to institute measures for its detection on a regular basis. Keeping this in mind the study aims to determine the burden of intestinal microsporidiosis in HIV seropositive patients presenting with and without diarrhea and to compare the ability of microscopy and PCR in its detection.The study group consisted of 120 patients divided into four groups HIV seropositive with/without diarrhea, and HIV seronegative with/without diarrhea. Performance of four staining techniques including Modified Trichrome, Calcofluor White, Gram Chromotrope and Quick hot Gram Chromotrope stains were evaluated against PCR in diagnosing enteric microsporidiosis from stool samples.Overall prevalence of intestinal microsporidiosis was 10.83%. The same for HIV seropositive patients with diarrhea was 23.33%, HIV seropositive patients without diarrhea and in immune-competent hosts with diarrhea was 10% each. Enterocytozoon bieneusi was found to predominate. Calcofluor white stain detected maximum microsporidia in stool samples (76.92%), followed by Modified Trichrome stain (61.5%), PCR (46.15%) and Gram Chromotrope and Quick hot Gram Chromotrope stains (38.4% each). PCR exhibited the best performance with a sensitivity and specificity of 100%. Our data suggests screening of stool samples with either Modified Trichrome or Calcofluor white stain followed by PCR confirmation thus leading to maximum detection along with speciation for complete cure.
Insights
Microsporidia causes nearly a quarter of diarrhea cases in individuals with HIV (human immunodeficiency virus). Early detection through microscopy and PCR (polymerase chain reaction) is crucial for managing this opportunistic infection.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Gastroenterology
Background:
- Diarrhea is a significant issue for individuals with HIV.
- Microsporidia are a frequent cause of diarrhea in HIV patients.
- Accurate diagnostic methods are needed for intestinal microsporidiosis.
Purpose of the Study:
- To determine the prevalence of intestinal microsporidiosis in HIV-positive individuals with and without diarrhea.
- To compare the diagnostic capabilities of microscopy and PCR for enteric microsporidiosis.
- To identify the predominant microsporidia species in the study population.
Main Methods:
- A study involving 120 patients divided into four groups: HIV-seropositive with/without diarrhea and HIV-seronegative with/without diarrhea.
- Evaluation of four staining techniques (Modified Trichrome, Calcofluor White, Gram Chromotrope, Quick hot Gram Chromotrope) against PCR for diagnosing microsporidiosis from stool samples.
- PCR was used as the gold standard for detection.
Main Results:
- Overall prevalence of intestinal microsporidiosis was 10.83%.
- Prevalence was highest in HIV-positive patients with diarrhea (23.33%).
- Enterocytozoon bieneusi was the predominant species. Calcofluor white stain showed the highest detection rate (76.92%), while PCR demonstrated 100% sensitivity and specificity.
Conclusions:
- Intestinal microsporidiosis is prevalent in HIV-positive individuals, particularly those with diarrhea.
- A combination of staining techniques (Modified Trichrome or Calcofluor white) followed by PCR confirmation offers optimal detection and speciation.
- Effective diagnosis is essential for timely and complete treatment of microsporidiosis in HIV patients.