SUMMARYThe objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5%) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.

Enterocytozoon bieneusi is the most prevalent microsporidian parasite that causes gastrointestinal infection in persons with AIDS. Microsporidia are increasingly recognized as important opportunistic pathogens all over the world but in Brazil only few cases have been reported due either to the non awareness of the clinical presentation of the disease or to difficulties in the laboratory diagnosis. We report a 3-year follow-up of a Brazilian HIV-positive patient in whom microsporidial spores were detected in stools and were identified as E. bieneusi using electron microscopy and PCR. The patient presented with chronic diarrhea, CD4 T-lymphocytes count below 100/mm3 and microsporidial spores were consistently detected in stools. Albendazole was given to the patient in several occasions with transient relief of the diarrhea, which reappeared as soon as the drug was discontinued. Nevertheless, a diarrhea-free period with weight gain up to 18 Kg occurred when a combination of nucleoside and protease inhibitors was initiated as part of the antiviral treatment.

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INTRODUÇÃOObesidade está descrita como associada ao aumento no risco do câncer colorretal CCR e do adenoma Ad, sendo a prevalência mais nítida no sexo masculino.1,2,3,4,5 Questiona-se no entanto, como fator mais importante, não a obesidade em si, quantificada pelo índice de massa corpórea IMC, mas a presença da obesidade visceral, melhor identificada pela distribuição andróide da gordura, podendo ser indiretamente estudada pela medida da circunferência abdominal ou melhor ainda, pela razão cintura quadril RCQ. 6,7,8,9,10,11,12 O objetivo deste trabalho foi avaliar estas duas variáveis como fator de risco no desenvolvimento do CCR/Ad em nosso meio. PACIENTES E MÉTODODe janeiro a dezembro de 2008 foram realizadas 1287 colonoscopias totais em duas instituições médicas, tendo os pacientes idade mínima de 50 anos e IMC e RCQ calculados. Foram excluídos do estudo, portadores de doença hepática e ou renal crônica, doença inflamatória intestinal, adenomatose familiar FAP, CCR não associado a polipose HNPCC, síndrome de Lynch. Foram considerados obesos os portadores de IMC>30 kg/m(2). O IMC foi avaliado em kg/m(2) e a RCQ medida em centímetros. O Teste t de Student foi usado para estudo da média e desvio padrão e qui-quadrado para comparar números absolutos. A significância estatística foi considerada quando P< 0,05. Todos assinaram consentimento in-

INTRODUCTION: Occult blood is strategy for colorectal cancer screening. The aim of this study is to analyze the value of quantitative monoclonal antibodies against human Hemoglobin for colonoscopy screening. METHODS: One hundred asymptomatic adult patients, aged over 40 up to 77, with no risky group, have had one sample of stool specimens collected for qualitative immunochromatography with monoclonal antibodies against human hemoglobin, following several days later by complete colonoscopy. Chi-square was used to compare proportional data whereas Student t test to compare means. P < 0.05 was considered significant. This was a prospective stufy, All patients signed the informed consent The author has no finantial disclosures. RESULTS: A total of 100 patients being 36 men aged 67 ± 7 and women 64 aged 65,5 ± 8 P > 0.05, distributed by age in patients with colon neoplasia and positve occult blood in stools, 67 ± 6 N1 = 20, with negative occult blood in stools with neoplasia aged 68 ± 6 N2 = 11, with positive occult blood in stools without neoplasia 65,5 ± 9 N3 = 21 and negative occult blood in stools withou neoplasia 64,5 ± 8 N4 = 48 P > 0.05.Thirty-one (31%) of the patients had diagnosisof colon neoplasia, being 20 (64%) with positive occult blood in stools and 11 (35%) negative, P < 0.01. In the Group with positive occult blood in stools, two patients had diagnosis of adenocarcinoma, the others were adenomas. In the Group of negative occult blood in stools all were adenomas. We had 69 patients without neoplasia, of whom 21 (30.5%) had positive occult blood in stools and 48 (69%) negative, P < 0.01. In this Group without neoplasia, 12 (17%) had an abnormal colonoscopy, 5 (41.5%) with positive occult blood in stools and 7 (58%) negative P > 0.05. Abnormalities without neoplasia in patients with or withou occult blood in stools were angiodysplasia in ascending colon, shallow ulcer in ileocecal valve or ascending colon in NSAID user and uncomplicated diverticular disease. CONCLUSION: The age of the Group studied was similar, Adenocarcinoma only occurred in patients with positive blood in stools. Adenoma was present in positive and negative, although significantly more frequent in the positive ones. For bether conclusion, we need a greater number of asymptomatic people to be studied. The ideal test would be one that diagnoses cancer for treatment and adenoma for endoscopic prevention.