Avaliação etiológica de enterobactérias em pacientes soropositivos (HIV) e marcadores inflamatórios para disbiose intestinal e translocação microbiana

Abstract

Even though diarrhea was considered a major cause of mortality in HIV patients, our study demonstrated a different profile, presenting high incidence of intestinal constipation, but the high frequency of enteric bacteria with pathogenic potential and the presence of the sCD14 inflammatory marker in these individuals, demonstrated a possible process of microbial translocation and dysbiosis, this scenario is responsible for promoting a state of constant inflammation, which induces the rapid clinical progression of AIDS. Therefore, in this study, we sought to verify the occurrence of bacterial co-infections with pathogenic potential and to evaluate immunological markers of inflammation as predictors of microbial translocation and chronic activation in patients with HIV / AIDS in Manaus. 52 HIV patients, registered at the Heitor Vieira Dourado Tropical Medicine Foundation, were distributed, as well as their viral load (<500 copies of RNA and <200 CD4 + mm3). For the identification of the etiological agents associated with diarrhea, isolation was performed by classical methodology, where we found a frequency of (38.46%) of Escherichia coli, followed by Klebsiella spp. E Pseudomonas spp. (15.38%) respectively and less frequently Salmonella (3.84%) and Shigella (1.92%). The isolates of Escherihia coli and Klebsiella, were submitted to PCR for virulence and resistance genes were amplified for the eae, uidA, ast1 and dAAe (E.coli) and Kvar, blaCTX-M, blaKPC, blaVIM and blaIMP (Klebsiella spp). The antimicrobial resistance evaluation was performed by disc diffusion test, where it was observed that most of the isolates tested were resistant to the antimicrobial class of Cephalosporins, the cell assay for the verification of the adhesion phenotypes in Eschrichia coli detected a higher frequency of diffuse adhesion (55%) followed by an atypical adhesion phenotype (20%) for the isolates of Klebsiella spp. (12.5%), a biofilm assay found that the isolates of Klebsiella spp. and Pseudomonas spp. presented high potential for its production. Chronic inflammation was assessed by cytokine dosing by flow cytometry where significant differences were observed between TNFα levels when compared to each other, especially group 1 and 3 (p = 0.001). The evaluation of the translocation of microbial products by search of soluble CD14 ELISA marker demonstrated significant differences in all groups evaluated when compared to the group 1: 4953 ± 4570; Group 2: 582 ± 1983; Group 3: 3396 ± 4240; Group 4: 3769 ± 4752. Finally, the presence of bacterial pathogens in the flora of people with HIV as well as the presence of markers of plasma inflammation may indicate factors of worsening of the general health picture, as well as the chronicity of inflammatory states.