Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

308 Abstracts 22229-22233

12th World AIDS Conference

amination confirmed reduction of air flow in both lung fields, crepitant bilateral
basal rales, hepatosplenomegaly and an ulcerated lesion with granulomatous
base on the right anterior palatine pilar. Chest xray showed bilateral interstitial
infiltrates extending from the apices to the bases of the lungs.
Results: Examination of spontaneous sputum samples using indirect immunofluorescent monoclonal antibodies was positive for P carinii, H. capsulatum
was isolated from sputum samples and scrapings from the oral lesion (colored
with Giemsa). Growth of H. capsulatum was seen in blood cultures using the
centrifugation/lysis technique. The patient was treated with Amphotericin B (subsequently Itraconazol) plus a combination of primaquine and clindamycin for
pneumocystosis. Evolution was favorable.
Conclusions: The severe deterioration of cellular immunity in AIDS enhances
the association of H. capsulatum with other pathogens, especially those affecting
the respiratory system
22229 1 Opportunistic fungal infections in HIV/AIDS patients
Aza Rakhmanova1, O.H. Gyaurgieva1, E.I. Romanova', G.M. Gurkalo1,
V.K. Prigozhina1, N.N. Vlasov2, N.A. Chaika2. 1Medical Postgraduate Academy
193015 St. Petersburg; 2Pasteur Institute St Petersburg, Russia
Objectives: To study clinical peculiarities of superficial and deep mycoses in
HIV/AIDS patients and to compare the effectivity of different antifungal drugs.
Design: Clinical study in HIV positive persons and AIDS patients.
Methods: Over 160 patients (including 25 children) with positive HIV serology
were followed prospectively for fungal infections during several years.
Results: Different mycoses or asymptomatic fungal infections were diagnosed
in 92% of HIV/AIDS patients (at early stages - 33-45%, in late diseases -
95-100%). The occurrence of mycoses correlated with CD4 counts: >500 cells
- 56%, 200-500 cells - 85%, <200 cells - 95%. One fungal infection was
diagnosed in 51 patients, double and triple mycoses - in 26 and 23 patients
respectively; 4-6 pathogenic and/or opportunistic fungi were isolated in 14 cases.
The most common agents were Candida albicans and Trichophyton rubrum.
Candidosis was diagnosed in most cases (oro-pharyngeal lesions - 78, oesophageal - 18, cutaneous - 14, vulvo-vaginal - 6, pulmonary - 4, disseminated
- 3), dermatophytoses - in 72 patients. Seventeen patients had cryptococcosis
(meningitis/meningoencephalitis - 6, cryptococcemia - 4, pulmonary cryptococcosis - 4, disseminated forms - 3 cases). Single cases due to Rhodotorula rubra,
Penicillium chrysogenum, Trichophyton violaceum and Microsporum canis were
also found among HIV/AIDS patients. Combined therapy with zovirax and other
drugs was very effective in patients with multiple infections.
Conclusion: Fungal infections were diagnosed in most HIV/AIDS patients (with
dominance of candidosis, dermatophytoses and cryptococcosis); their frequency
correlated with CD4 counts. In patients with simultaneous mycoses and herpes
simplex infection combined therapy (zovirax and antifungals) was very efficient.
Early treatment with Retrovir prevented disseminated fungal infections.
22230 A powerful DNA-extraction method and polymerase chain
reaction for detection of microsporidia in clinical stool
specimens
Caspar Franzen, Andreas Mbller, K. Stellermann, P. Hartmann, G. Fdtkenheuer,
B. Salzberger, V. Diehl. Department of Internal Medicine I, University of Cologne,
Joseph-Stelzmann Str. 9, 50924 Kdln, Germany
Objectives: Diagnosis of intestinal microsporidiosis has been depended on direct visualisation of the parasite in stool specimens or intestinal biopsies by light
and/or electron microscopy. Limited informations are available about specificity
and sensitivity of PCR in clinical stool specimens. To establish a sensitive and
specific method for detection of microsporidia in clinical samples, we studied
clinical stool specimens of 104 unselected HIV-infected patients with acute or
chronic gastrointestinal symptoms comparing light microscopy and polymerase
chain reaction (PCR).
Design: Prospective, diagnostic laboratory study.
Methods: As standard staining method we applied the fluorochrome Uvitex
2B stain. PCRs were performed with primer pairs V1/PMP2, V1/EB450, and
V1/SI500. The nature of the PCR products was confirmed by Southern blot hybridization with species specific probes. To raise the sensitivity of PCR we used
a powerful and fast DNA extraction method including spore concentration by
water-ether-sedimentation, glass bead disruption, and proteinase K and chitinase
digestion.
Results: Microsporidiosis was diagnosed by light microscopy in eight patients.
Ten patients were positive by PCR. Enterocytozoon bieneusi were found in seven
cases, Encephalitozoon intestinalis in four cases. In one case a double infection
with Enterocytozoon bieneusi and Encephalitozoon intestinalis was diagnosed
by PCR, whereas light microscopy has shown only Enterocytozoon bieneusi
infection.
Conclusion: The results suggest that a powerful DNA extraction method shortens the procedure of DNA isolation and raises the sensitivity of PCR. PCR testing
of stool specimens is useful for diagnosis and species-differentiation of intestinal

microsporidiosis in HIV-infected patients.

22231 Long-term serologic study of toxoplasmosis in HIV
patients
Alberto Delgado-lribarren, J. Gomez, M. Alamo, A.F. Perez, A. Arribi, M.T. Calvo.
Microbiologia Hospital Servero Ochoa, Avda Orellana, 28911 Leganes, Madrid,
Spain
Background: cerebral toxoplasmosis (CT) is a relevant opportunistic infection in
HIV patients which justifies routinely serologic examination in endemic countries,
although its clinical value is limited. In this study we try to demonstrate two
premises: 1. Basal serologic study of Toxoplasma infection have to be done in
early stages of HIV infection 2. Serological follow up in CT may be useful.
Methods: toxoplasma serological follow up (mean time 39.2 months) of 71 HIV
positive patients (51 males, 20 females, mean age in the first serological study of
30.6 years and mean CD4 count 366, clinical situation following CDC classification: 45% A, 20% B, 14% C), 8 (11.27%) with CT. 27 HIV negative patients were
used as a control group (mean age 35, mean time serological follow up 38.2).
Toxoplasma IgG and IgM detected by MEIA, IMX, Abbott Diagnostics.
Results: Although there were no difference between the control group and HIV
patients in toxoplasma IgG mean titre descent (38.6/38.1), there were quite different evolution titres in this last group. 47 patients (mean basal IgG titre 127.45,
mean follow up time 40.7, 14 IgM+) presented a mean descent of 127 I.U, with 17
seronegativizations (23.9%), meanwhile all control patients remain seropositive
(mean basal IgG titre 83.45). Two patients of this group presented CT, althoug
they had no follow up after the episode. 21 HIV patients showed an increment in
IgG titres (mean follow up time 35.6, 2 IgM+), with five cases of CT (all x2 titre, 1
IgM+); last three remained with the same levels, one of them with CT but without
further serological follow up.
Conclusions: 1. Basal serologic study of Toxoplasma infection have to be done
in early stages of HIV infection because almost 24% of the patients may become
seronegative. 2. Serological follow up of IgG titres may confirm the diagnostic of
CT when the patient still presents detectable antibodies.
|22232 1 Efficacy and safety of intermittent oral fumagillin for the
treatment of Enterocytozoon bieneusi infections in
patients with AIDS (ANRS 054)
Jean-Michel Molina', J. Goguel, C. Sarpati, J.F. Michiels3, I. Desportes-Livage4
C.L. Chastang2, L. Cotte5. Saint Louis Hospital, Paris - 'Department of
Infectious Diseases, 2DBIM; 3Hopital De Nice, Nice; 41NSERM U313, Paris;
5Hotel Dieu, Lyon, France
Objectives: To determine the efficacy and safety of intermittent oral fumagillin for
the treatment of Enterocytozoon bieneusi infections in patients with AIDS.
Design: A prospective unblinded study.
Methods: 6 patients were consecutively enrolled in this study and assigned to
receive oral fumagillin (60 mg/d) for 7 days. Following at least one week of washout, patients received a second course of oral fumagillin (60 mg/d) for 7 days
when their platelet count was above 150.000/mm3. Efficacy was assessed by the
clearance of microsporidial spores from stools and duodenal biopsies. Patients
were assessed twice weekly for platelet counts and other safety parameters.
Results: All 6 patients cleared their microsporidial infection during the first
course of oral fumagillin. Only 3 of them however, were able to receive a second
course one week later. None of these patients relapsed during follow-up. Parasitic
clearance was associated with clinical benefit. The three others patients however,
had to postpone their second course of fumagillin because of thrombocytopenia.
All relapsed during the wash-out period. The second course of oral fumagillin was
again able to clear their microsporidia, but they eventually relapsed.
No significant side effects were noted during the trial, except for mild reversible
thrombocytopenia.
Conclusions: In AIDS patients with E. bieneusi infection, oral fumagillin has
parasitological and clinical efficacy. Relapses are however frequent, unless patients can tolerate two one-week courses of fumagillin with only one week of
wash-out.
S22233 | Intestinal microsporidiosis as a waterborn disease:
Report of an outbreak in HIV-infected and non-infected
patients
Laurent Cotte1, M. Rabodonirina2, F. Chapuis3, C. Raynal4, F. Bissuel4,
I. Schlienger4, C. Trepo4. 'Gastro Enterology-AIDS Unit, Hotel Dieu 1, Place de
I'hopital 69288, Lyon; 2Parasitology Lab. C. Bernard University, Lyon; 3Medical
Information Dep. Hospices Civils, Lyon; 4Gastroenterology-Hotel Dieu Hospital,
Lyon, France
Objectives: To study the epidemiology of intestinal microsporidiosis in HIVinfected and non-infected patients. To report an outbreak and to assess factors
associated with microsporidiosis.
Design: Retrospective study over a 4 years period.
Methods: All patients with stool examinations for Microsporidia from April 1993
to December 1996 in a single laboratory. Identification of Microsporidia using

Modified Trichrome or Uvitex 2B staining. Cross linking of laboratory data with
epidemiological data for the survey of HIV-infection.
Results: 1453 patients (6924 stool samples) were studied (male 1102, female
351, HIV+ 978, HIV-395, unknown serology 80). Microsporidia were identified in
338 patients (HIV+ 261, HIV- 68, unknwon status 9). Intestinal microsporidiosis
displays and endemic pattern without seasonal variations in HIV-infected patients
(prevalence rate: 0.1% HIV-infected patients per month). The disease appears