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Kryptosporydioza u osob zakazonych HIV

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Cryptosporidium parvum is a coccidian parasite that affects millions of people worldwide. Clinical outcome of human cryptosporidiosis differs between immunocompetent and immunodeficient individuals. C. parvum is responsible for causing protracted and life-threatening diarrhea, biliary, and pulmonary infections in immunocompromised persons, especially in patients with AIDS. Though no effective treatment has been found so far, early diagnosis may be useful in controlling the infection. Thirty-eight stool specimens obtained from 35 HIV-positive patients admitted to the Clinic of Infectious Diseases in Poznań, Poland, were examined for the detection of oocysts, coproantigen and DNA of Cryptosporidium using standard microscopic, immunologic and molecular diagnostic methods. The presence of Cryptosporidium was detected in 10 HIV-positive patients. Oocysts, coproantigen and DNA of this parasite were identified solely in one specimen while Cryptosporidium DNA was detected in 8 specimens. Cryptosporidium coproantigen was found only in one sample. Although, the PCR was the most useful technique in the detection of Cryptosporidium in HIV-positive patients it should be noted that PCR has many pitfalls and needs to be carefully controlled to avoid both false positive and false negative results.
The article comprises a critical review on practical applications of molecular technology in parasitological diagnostics in a broad sense, also as a diagnosis of species and a method of epidemiological analysis. Techniques of genome analysis at different levels, as specific nucleic acid probes, DNA restriction profiles (RFLP), hybridization techniques, pulse-field gel electrophoresis, in vitro nucleic acid amplification, and DNA fingerprint technique used in studies on Giardia and Cryptosporidium were discussed. The essential reservation as far as this technology is concerned refers to its usefulness in parasitological diagnostics; there is no sense in working out methods for recognizing parasites which could otherwise be identified by well trained parasitologists and simple microscopic methods. The improved diagnosis of parasites resulting from the application of molecular technology significantly contributed to the armentarium of parasitologists. Application of recent molecular technology in diagnosis of giardiosis and cryptosporidiosis may basically support clinical diagnosis which provides possibilities of early and selective treatment and makes possible epidemiological studies. These assays will permit not only a rapid diagnosis and exact differentiation but will also enable a better recognition of Giardia and Cryptosporidium genome organization. However, in spite of the wide availability of this new techniques they have not been fully applied - as yet – in diagnosis and in epidemiological studies on these parasites. The authors share the opinion of BUSCH (1991) on the need of proper recognition of high-quality and rigorous work in employing new molecular assays, because their wide availability and high sensitivity could cause "false-positive" results by contamination with amplified DNA sequences. They totally support the conclusion made by THOMPSON and MELONI (1993) that the molecular data must be fairly interpreted by collaborating molecular biologists, parasitologists, and epidemiologists - and clinicians as well - to avoid forming of a confusing picture of genetic diversity of the parasites with no practical application.
The article reviews the problems on epidemiology of cryptosporidiosis and gives a detailed description of the massive waterborne outbreak in Milwaukee (Wisconsin, USA) associated with a break in filtration capacity of a public water supply. The authors emphasize the need for high-quality diagnostic procedures as current coprodiagnostic microscopical techniques seemed to fail to detect Cryptosporidium oocysts.
Cryptosporidium parvum is a zoonotic protozoan parasite occurring in a wide range of hosts. Invasions caused by this parasite have been reported in humans and in many animal species including birds. Despite its worldwide prevalence, infections have usually generated considerable losses in the livestock industry, mostly affecting calves, lambs and goat kids. It has previously been shown that ruminants are a major reservoir of zoonotic Cryptosporidium parvum and contact with an infected animal can lead to human infection. The application of molecular methods for parasitological diagnostics has increased our knowledge on the parasite hosts and its prevalence in humans and animals. They also confirmed their usefulness during epidemiological investigations and in surveillance studies of human and animal cryptosporidiosis. In this review the current state of knowledge concerning the importance of Cryptosporidium parvum invasions in farm and wild animals was presented.
Protozoa of the genus Cryptosporidium spp. are often an underestimated problem in livestock farms and poultry flocks. On account of difficult and time-consuming diagnostic methods cryptosporidiosis is rarely confirmed by laboratory tests. Occurring cases of persisting diarrhea are treated without a proper diagnosis. In addition, the lack of effective veterinary preparations on the market reduces treatment options. According to available literature, the estimated prevalence of Cryptosporidium spp. in cattle herds ranges from 17 to 100%. In the case of poultry flocks there is no accurate data. The paper presents the current state of knowledge about the biology, presence, methods of diagnosis, and treatments of Cryptosporidiosis.
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