RESUMO
The duties recently performed in the embryology laboratory have deeply increased compared to those realized a couple of decades ago. Currently, procedures include conventional in vitro fertilization (IVF) and ICSI techniques, or processing of surgically retrieved sperm, embryo culture and time-lapse monitoring, blastocyst culture, as well as trophectoderm biopsy for preimplantation genetic testing and cryopreservation. These techniques require not only time, but also high knowledge level and acutely concentration by the embryologist team. The existing data indicate that an IVF laboratory need to have adequate staffing levels to perform the required daily duties, and to work in optimal conditions that are critical to assure a high quality service, as well as avoiding incidents and to provide the best outcomes. As a result, IVF clinics have invested in human resources, but there is still a large discrepancy between IVF centres on the number of embryologists employed. Currently there is no golden standard on the human resource requirements for assisted reproductive technology procedures; therefore, in this review paper we aim to provide arguments to take into account to determine the embryology staffing requirements in an embryology laboratory to assure optimal safety and efficiency of operations.
Assuntos
Fertilização in vitro , Sêmen , Humanos , Masculino , Fertilização in vitro/métodos , Técnicas de Reprodução Assistida , Reprodução , Recursos HumanosRESUMO
BACKGROUND: Transmission of human herpesvirus 8 (HHV-8), the aetiological agent of Kaposi's sarcoma, is known to occur during sex among homosexual men. However, other modes of HHV-8 transmission remain to be elucidated in endemic populations. METHODS: We did a population-based seroepidemiological survey in a village in French Guiana among 1337 individuals of African origin (age 2-91 years) who had reliable genealogical data. Plasma samples were taken and tested for HHV-specific IgG by immunofluorescence assay. Risk factors and familial correlations for HHV-8 seropositivity were modelled by logistic regression analysis by use of the estimating equations approach, which expresses familial dependences in terms of odds ratios. Familial odds ratios were also acquired by use of the distribution of all possible pairs of a given familial dependence. FINDINGS: The overall HHV-8 seroprevalence was 13.2% with no difference according to sex. HHV-8 seropositivity was strongly age dependent: at 1.2% under 5 years, HHV-8 seroprevalence rose up to a plateau around 15% between 15 and 40 years, and showed a seroprevalence of more than 27% in individuals older than 40 years. Strong familial aggregation in HHV-8 seroprevalence was found with high mother-child (odd ratio 2.8 [95% CI 1.6-5.0]) and sib-sib (3.8 [1.6-9.5]) correlations. By contrast, no significant correlation between spouses (0.6 [0.2-1.9]) was seen. INTERPRETATION: This pattern of familial aggregation, together with the variation of HHV-8 seroprevalence with age, indicate that, in endemic populations, HHV-8 transmission mainly occurs from mother to child and between siblings during childhood and adolescence.
Assuntos
Transmissão de Doença Infecciosa , Infecções por Herpesviridae/transmissão , Transmissão Vertical de Doenças Infecciosas , Sarcoma de Kaposi/epidemiologia , Adolescente , Adulto , África/etnologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Estudos de Coortes , Doenças Endêmicas , Feminino , Guiana Francesa/epidemiologia , Infecções por Herpesviridae/imunologia , Infecções por Herpesviridae/virologia , Herpesvirus Humano 8/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Núcleo Familiar , Razão de Chances , Sarcoma de Kaposi/sangue , Sarcoma de Kaposi/virologia , Estudos SoroepidemiológicosRESUMO
The purpose of this study was to compare the CUE method for family planning with the Ovulation Detection Method for defining the fertile phase of the menstrual cycle. We evaluated 42 cycles from 10 women in Monterrey, Mexico, who were monitored by basal body temperatures, urinary LH, pelvic ultrasound, and the CUE monitor. The fertile phase of the cycle was adequately defined in all cycles using the CUE method, and in 35 cycles (83.3%) by the Ovulation Method. Using our protocol, the period of recommended abstinence with the CUE method is 9 days and with the Ovulation Method 11 days. The CUE method accurately defines the fertile phase of the menstrual cycle, thus improving the predictability of ovulation for women who use natural methods of birth control.
PIP: To evaluate the potential utility of the CUE method in natural family planning (NFP), this method was compared with a standard NFP technique, the Ovulation Method, in 39 cycles of 10 women from Monterrey, Mexico. All women had more than 2 years' experience with the Ovulation Method. In the CUE method, ovulation prediction is based on a peak in salivary electrical resistance and its confirmation by a rise in vaginal resistance as monitored by a hand-held electronic instrument attached to a specially designed sensor. The CUE method defined the fertile period of all 39 cycles adequately, while the Ovulation Method resulted in incorrect definition of the fertile phase in 4 (10%) of 39 cycles. The salivary peak predicted ovulation an average of 8 days in advance of its occurrence and the increase in vaginal readings in the periovulatory period was seen within 1 day of follicle collapse in all subjects. The duration of abstinence required by the CUE method would have averaged 9.0 +or- 1.5 days (range, 6-13 days). In contrast, the average duration of abstinence associated with the Ovulation Method was 11.0 +or- 2.9 days (range, 6-16 days). 82% of cycles monitored by the CUE method compared with only 53% of those monitored by the Ovulation Method would have required a period of abstinence of 10 days or less. The simplicity and objectivity of the CUE method, combined with its requirement for fewer days of abstinence, offer the potential for improving NFP compliance and continuation.
Assuntos
Métodos Naturais de Planejamento Familiar , Detecção da Ovulação/métodos , Adulto , Temperatura Corporal , Feminino , Humanos , Hormônio Luteinizante/urina , México , Ultrassonografia , Vagina/diagnóstico por imagem , Vagina/fisiologiaRESUMO
OBJECTIVE: To determine the distribution of HIV-1 subtypes in Sao Paulo, Brazil. METHODS: Samples were obtained from 80 consecutive HIV-1-infected individuals attending the Immunodeficiency Clinic at the University of Sao Paulo in 1993. Peripheral blood mononuclear cells (PBMC) were separated by Ficoll-Hypaque gradient and a portion was used for routine CD4 counts; the remainder were frozen. PBMC were proteinase-K-digested and DNA-purified by organic extraction. Samples were amplified for the env region of HIV, and envelope sequence subtypes determined by heteroduplex mobility analysis using prototypic subtypes as references. A subset of these were also sequenced through the C2-V3 region of env. RESULTS: A total 69 of 80 samples yielded env polymerase chain reaction product enabling subtype determination; samples that did not amplify were those with low DNA yields. Among 12 injecting drug users (IDU) or sexual partners of IDU, four were typed as clade F and eight as clade B. Forty-three homosexual men or female sexual partners of bisexual men were typed as clade B. The 14 additional cases without known risk factors were typed as clade B. CONCLUSION: These data suggest that subtype F is related to injecting drug use in Brazil.
PIP: Serum samples from 80 consecutive HIV-1-infected individuals presenting to the Immunodeficiency Clinic at the University of Sao Paulo in 1993 were analyzed to determine the distribution of HIV-1 subtypes in the city. Peripheral blood mononuclear cells (PBMC) were separated using Ficoll-Hypaque gradient, a portion was used for routine CD4 counts, and the rest were frozen. PBMC were proteinase-K-digested and DNA-purified by organic extraction. The samples were amplified for the env region of HIV, and envelope sequence subtypes determined by heteroduplex mobility analysis using prototypic subtypes as references. A subset was also sequenced through the C2-V3 region of env. 69 samples yielded env polymerase chain reaction product enabling subtype determination. The samples which did not amplify had low DNA yields. Among 12 IV-drug users or their sex partners, four were typed as clade F and eight as clade B. 43 homosexual men or female sex partners of bisexual men were typed as clade B. The 14 additional cases with no known risk factor were typed as clade B.
Assuntos
Síndrome da Imunodeficiência Adquirida/virologia , Genes env , HIV-1/classificação , HIV-1/genética , Sequência de Aminoácidos , Sequência de Bases , Brasil/epidemiologia , DNA Viral/análise , Feminino , HIV-1/isolamento & purificação , Humanos , Masculino , Dados de Sequência Molecular , Ácidos Nucleicos Heteroduplexes , Estudos RetrospectivosRESUMO
Two hundred and thirty paraffin-embedded biopsies obtained from female cervical lesions were tested for the presence of human papillomavirus (HPV) types 6/11, 16/18 and 31/33/35 DNA using non-isotopic in situ hybridization. Specimens were classified according to the Bethesda System in low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL) and squamous cell carcinoma (SCC). HPV prevalence ranged from 92.5% in LSIL to 68.5% in SCC. Benign types were prevalent in LSILs while oncogenic types infected predominantly HSILs and SCC. HPV infection showed to be age-dependent, but no significant relation to race has been detected. Patients were analyzed through a five-year period: 20.7% of the lesions spontaneously regressed while 48.9% persisted and 30.4% progressed to carcinoma. Patients submitted to treatment showed a 19.4% recurrence rate. High risk types were present in 78.6% (CrudeOR 13.8, P = 0.0003) of the progressive lesions, and in 73.7% of the recurrent SILs (COR 19.3, P = 0.0000001). Possible co-factors have also been evaluated: history of other sexually transmitted diseases showed to be positively related either to progression (Adjusted OR 13.0, P = 0.0002) or to recurrence (AOR 17.2, P = 0.0002) while oral contraceptive use and tobacco smoking were not significantly related to them (P > 0.1). Association of two or more co-factors also proved to be related to both progression and recurrence, indicating that they may interact with HPV infection in order to increase the risk of developing malignant lesions.
PIP: 230 paraffin-embedded biopsies obtained from female cervical lesions were tested for the presence of human papillomavirus (HPV) type 6/11, 16/18, and 31/33/35 DNA using non-isotopic in situ hybridization. Specimens were classified according to the Bethesda System as low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL), and squamous cell carcinoma (SCC). HPV prevalence ranged from 92.5% in LSIL to 68.5% in SCC. Benign types were prevalent in LSILs, while oncogenic types infected predominantly HSILs and SCC. HPV infection was found to be age-dependent, but no significant relation to race has been detected. Patients were analyzed through a 5-year period: 20.7% of the lesions spontaneously regressed, while 48.9% persisted and 30.4% progressed to carcinoma. Patients submitted to treatment showed a 19.4% recurrence rate. High risk types were present in 78.6% (crude OR (COR), 13.8; P = 0.0003) of the progressive lesions, and in 73.7% of the recurrent SILs (COR, 19.3; P = 0.0000001). Possible cofactors have also been evaluated: history of other sexually transmitted diseases was found to be positively related either to progression (adjusted OR (AOR), 13.0; P = 0.0002) or to recurrence (AOR, 17.2; P = 0.0002), while oral contraceptive use and tobacco smoking were not significantly related to them (P 0.1). Association of two or more cofactors also proved to be related to both progression and recurrence, indicating that they may interact with HPV infection in order to increase the risk of developing malignant lesions.
Assuntos
Carcinoma de Células Escamosas/epidemiologia , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Brasil , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Progressão da Doença , Feminino , Humanos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Infecções Tumorais por Vírus/patologia , Infecções Tumorais por Vírus/virologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologiaRESUMO
OBJECTIVE: This study aimed to evaluate fetal fibronectin concentrations in cervical secretions measured by either a rapid immunoassay or an enzyme-linked immunosorbent assay as a tool for the screening of premature delivery in otherwise asymptomatic pregnant women at high risk for prematurity. STUDY DESIGN: One hundred two pregnant women at high risk for premature delivery were followed up. Samples of the cervical secretion were taken every 2 weeks between the twenty-fourth and the thirty-fourth weeks of pregnancy. The samples were obtained from the ectocervix with two swabs. One cervical sample was used for the immediate-reading membrane test, and the other one for the immunoenzyme test. The correlation between the presence of fetal fibronectin in the cervical secretions and preterm birth was evaluated. In addition, a comparison between tests was made. RESULTS: The rate of preterm birth was 37.25% (38/102). Membrane tests revealed a sensitivity of 73.68% and a specificity of 92.18%; its positive predictive value was 84.84% and the negative predictive value was 85.50%. The enzyme-linked immunosorbent assays revealed a sensitivity of 78.94% and a specificity of 85.93%; its positive predictive value was 76.92%, and the negative predictive value was 87.30%. When compared with each other, the tests were found essentially concordant (p < 0.05). The elapsed time between the last sampling and the occurrence of preterm birth was 2.9 +/- 1.8 weeks. CONCLUSION: The rapid result membrane test is comparable to the standard fetal fibronectin enzyme-linked immunosorbent assays for the detection of fetal fibronectin in cervical secretions between the twenty-fourth and thirty-fourth weeks of gestation. Moreover, both assays were found to be good tools for the prediction of premature delivery in asymptomatic pregnant women at high risk for prematurity. The availability of a rapid search for the presence of cervical fetal fibronectin should improve our ability to efficiently identify patients at risk for preterm delivery to discriminate between such patients and those with benign Braxton Hicks contractions.
PIP: Researchers evaluated the comparative effectiveness of measuring fetal fibronectin concentrations in cervical secretions by either a rapid immunoassay or an enzyme-linked immunosorbent assay as a tool for the screening of premature delivery in otherwise asymptomatic pregnant women at high risk for prematurity. Cervical secretion samples from the ectocervix were taken every two weeks between the 24th and the 34th week of pregnancy from 102 pregnant women at high risk for premature delivery. The samples were obtained with two swabs. One sample was used for the immediate-reading membrane test while the other was used for the immunoenzyme test. There was a 37.25% rate of preterm birth. Membrane tests yielded a 73.68% sensitivity and a 92.18% specificity, with a positive predictive value of 84.84% and a negative predictive value of 85.50%. The enzyme-linked immunosorbent assays were 78.94% sensitive and 85.93% specific, with a positive predictive value of 76.92% and a negative predictive value of 87.30%. The two tests were concordant with each other. There was a mean of 2.9 weeks between the last sampling and the occurrence of preterm birth. The rapid result membrane test is comparable to the standard fetal fibronectin enzyme-linked immunosorbent assays for the detection of fetal fibronectin in cervical secretions between the 24th and the 34th weeks of pregnancy.
Assuntos
Colo do Útero/metabolismo , Proteínas Fetais/metabolismo , Fibronectinas/metabolismo , Trabalho de Parto Prematuro , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoensaio , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Fatores de RiscoRESUMO
We evaluated phytohemagglutinin (PHA) lymphocyte proliferation and delayed-type hypersensitivity tests in 130 Brazilian HIV-infected patients with the objective of assessing the value of these tests in staging HIV infection. Patients were divided into three groups according to their CD4+ cell counts (cells/mm3): < 200 (n = 28); 200 to 499 (n = 50); and > or = 500 (n = 52). An additional 114 individuals, who had come to the same institution for elective surgeries, were enrolled as controls. Results showed a significant decrease in PHA responses when CD4+ cell counts fell below 500 cells/mm3. This decrease was, however, indistinguishable from that of patients with < 200 cells/mm3. In contrast, skin test anergy to common antigenic preparations was only evident in the group of patients with less than 200 CD4+ cells/mm3. Decreases in PHA responses and in CD4+ cell counts were significantly correlated. Since the introduction of antiretroviral therapy is recommended when CD4+ cell counts are below 500 cells/mm3, the PHA proliferation test, in our conditions, could be useful as an additional parameter to initiate antiretroviral therapy. Further prospective studies are needed to establish the value of this test in HIV-infected patients.
PIP: During 1993-94, in Sao Paulo, Brazil, clinical investigators used the phytohemagglutinin (PHA) lymphocyte proliferation and delayed-type hypersensitivity tests to determine the stage of HIV infection among 130 adult HIV-infected patients. They aimed to evaluate the value of these tests. 28 (21.5%) patients had CD4+ cell counts of less than 200 cells/sq m. 50 had 200-499 CD4+ cells/sq m. The remaining 52 had at least 500 CD4+ cells/sq m. The researchers compared data on the HIV-positive adults with data on 111 HIV-negative controls. When patients had a CD4+ count of less than 500 cells/sq m, PHA responses were significantly lower than those for a CD4+ cell count of more than 500 cells/sq m and the controls (p 0.01 and p 0.001; respectively). Reductions in PHA responses and in CD4+ cell counts had a significant association. HIV-positive patients with less than 200 CD4+ cells/sq m were less likely to exhibit skin test anergy to common antigenic preparations than other HIV-positive patients (5% vs. 46%; p = 0.003). These findings suggest that the PHA proliferation test could help providers determine at what point in an individual's progression of HIV disease to initiate antiretroviral therapy (i.e., 500 cells/sq m). Further prospective studies are warranted to confirm the value of this test in HIV-positive individuals.
Assuntos
Infecções por HIV/imunologia , Ativação Linfocitária , Adulto , Brasil , Contagem de Linfócito CD4 , Humanos , Fito-Hemaglutininas/farmacologia , Estudos Prospectivos , Testes CutâneosRESUMO
To characterize antibody binding to a panel of V3 loop peptides representing diverse HIV-1 neutralization epitopes, 149 HIV-1 infected individuals from Rio de Janeiro (RJ) were investigated. Results were analyzed with respect to risk factors for infection and other epidemiological and clinical data. Peptide reactivity was not associated with sex, clinical status, CD4 counts, antigenemia or beta 2-microglobulin serum level. A segregation of peptide reactivity according to route of infection was encountered. This finding suggests that more then one viral strain may be circulating in RJ, in subjects with different risk factors for HIV-1 infection. An investigation of prevalent HIV-1 genotypes, serotypes and immunotypes may be of importance for the design and selection of potential vaccines to be used in Brazil as well as for the selection of populations to be included in future vaccine efficacy trials.
PIP: HIV-1 is highly polymorphic both genetically and antigenically. The HIV-1 principal neutralizing determinant (PND) is located in the third hypervariable domain (V3 loop) of gp120. The V3 loop is an important epitope for neutralization, viral tropism, host range, and syncytium inducing capability. An epitope localized at its tip is the major binding site for type-specific neutralizing antibodies, and anti-V3 loop antibodies have protective capabilities. Enzyme immunoassays based upon synthetic peptides derived from known V3 loop sequences have been developed. 149 serum samples were collected during August-December 1991 from HIV-infected outpatients attending a prospective cohort study of HIV infection in Rio de Janeiro in a study to characterize antibody binding to a panel of V3 loop peptides representing diverse HIV-1 neutralization epitopes. 134 subjects acquired HIV through sexual intercourse, while 15 reported parenteral risk factors such as IV drug use or blood transfusion. Peptide reactivity was not associated with sex, clinical status, CD4 counts, antigenemia, or B2-microglobulin serum level, and a segregation of peptide reactivity according to route of infection was encountered. Study findings suggest that more than one viral strain may be circulating in Rio de Janeiro, in subjects with different risk factors for HIV-1 infection. An investigation of prevalent HIV-1 genotypes, serotypes, and immunotypes is warranted with regard to vaccine research, development, and use in Brazil.
Assuntos
Síndrome da Imunodeficiência Adquirida/transmissão , Variação Antigênica/imunologia , HIV/imunologia , Síndrome da Imunodeficiência Adquirida/imunologia , Brasil , Genótipo , Anticorpos Anti-HIV/imunologia , Antígenos HIV/genética , Humanos , Peptídeos Cíclicos/metabolismo , Fatores de RiscoRESUMO
Schistosoma mansoni was introduced in the Senegal basin around 1988, due to man-made ecological changes. Since 1991, we investigate a recent but very intense focus, Ndombo, a village near the city of Richard Toll where the outbreak was first described. Four cohorts, each a random sample (+/- 400 subjects each) from this community, were examined and followed up after treatment, starting at 8 month intervals over a 2-year period. Each cohort is examined parasitologically (Kato-Katz), clinically, serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; followed up 6-10 weeks, one and two years after treatment; and monitored for water contact patterns and local snail densities. In the first cohort, the prevalence was 91%, with a mean egg count of 663 epg. Prevalences are near 100% in all age groups, but egg counts decline strongly in adults. Antigen detection in serum and urine confirmed that the egg counts genuinely reflect variations of worm burdens, not e.g. of worm fecundity. This is surprising, as in this focus acquired immunity in adults should not have yet developed according to current hypothesis. The antigen detection assays (CAA/CCA) showed high sensitivity and quantitative power, and promising perspectives as a research tool and possibly as a method for non-invasive diagnosis and screening in urine. Epidemiological in subsequent cohorts were highly similar, although seasonal variations were observed possibly due to transmission fluctuations. Anti-AWA and anti-SEA IgE levels increased with age, while IgG4 peaked in the age-group 10 years and correlated well with egg counts.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: A cohort analysis was performed in Ndombo, Senegal, a community of about 4000, in the epicenter of the schistosomiasis outbreak. Four randomly selected cohorts of +or- 400 subjects were surveyed. Each cohort was examined parasitologically, clinically, and serologically (circulating antigen and antibody profiles); treated with praziquantel 40 mg/kg; and followed up at 6-12 weeks and at 1 and 2 years after treatment. The first cohort numbered 422 individuals, of which 91% had positive egg counts, with a mean egg count of 663 eggs per gram feces (epg). Quantitative egg counts in those aged 10-14 were 1409 epg and then declined to 632 epg in the age group 20-29 and to 266 epg in the age group over 40. In cohorts 2 and 3, examined in the spring and autumn, egg counts were substantially lower, particularly in adults, as compared with cohorts 1 and 4, which were both examined in the summer season. 94% of the subjects were positive in the serum circulating anodic antigen (CAA) ELISA, 83% in the serum CAA ELISA, and 95% in the urine circulating cathodic antigen (CCA) ELISA; CAA in urine was less sensitive, and was negative in half of the urine samples. Positivity rates for all assays increased with rising egg counts, and circulating antigen concentrations in both serum and urine correlated well with egg counts. IgE showed a significant increase with age, while IgG4 peaked in the age groups 10-15 and/or 15-19 years. A strong correlation between IgG, IgGl, and IgG4 against both crude antigens with pretreatment egg load was observed. Of the subjects in the first cohort, 61% reported abdominal pain, 33% diarrhea; only 16% showed mild hepatomegaly and only a few children had mild splenomegaly. In the first cohort, 82% of 298 reexamined subjects were still positive for S. mansoni 12 weeks after treatment with praziquantel 40 mg/kg. One year after treatment, cohort 1 showed mean egg counts in children (5-19 years) at 358 epg as compared with 1188 epg pretreatment.
Assuntos
Serviços de Saúde Comunitária , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/imunologia , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Estudos de Coortes , Fezes/parasitologia , Feminino , Humanos , Imunidade , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas , Prevalência , Esquistossomose mansoni/tratamento farmacológico , Estações do Ano , Senegal/epidemiologiaRESUMO
To evaluate the ability of different diagnostic methods for the detection of AIDS-related diarrhoeal pathogens in developing countries, we studied 40 HIV-infected patients with diarrhoea. All patients were subjected to stool examinations for parasites, stool culture and peroral jejunal biopsy. Jejunal specimens were processed for histological examination with several stains and for transmission electron microscopy (TEM). Jejunal juice and mucosa were cultured. An aetiologic agent was found in twenty patients. Eleven stool specimens were positive for parasites and stool culture was positive in three patients. The enteropathogens detected by these two methods included every microorganism amenable to treatment. Histological examination revealed four agents not previously identified. TEM added to diagnosis in only two patients. All cultures of jejunal mucosa and jejunal juice were negative, even when stool culture was positive. We conclude that a minimal investigation consisting of stool examination for parasites and stool culture is a cost-effective strategy in the management of AIDS-related diarrhoea in developing countries.
PIP: The authors report findings from their evaluation of the ability of different diagnostic methods to detect AIDS-related diarrheal pathogens in developing countries. 40 HIV-infected patients with diarrhea participated in the study, having their stools examined for parasites and submitting to stool culture and peroral jejunal biopsy. Jejunal specimens were processed for histological examination with several stains and for transmission electron microscopy (TEM). Jejunal juice and mucosa were cultured. An etiologic agent was found in 20 patients, with 11 stool specimens positive for parasites and stool culture positive in three patients. The enteropathogens detected by these two methods included every microorganism amenable to treatment. Histological examination revealed four agents not previously identified. TEM added to diagnosis in only two patients. All cultures of jejunal mucosa and jejunal juice were negative, even when stool culture was positive. The authors conclude that a minimal investigation consisting of stool examination for parasites and stool culture is a cost-effective strategy in the management of AIDS-related diarrhea in developing countries.