Confirmed microsporidial graft infection in a HIV‐negative renal transplant recipient: A case report and review of the literature

Abstract

Microsporidia are intracellular organisms most commonly known to cause opportunistic infection in patients with human immunodeficiency virus (HIV). There have been several case reports of infection in solid organ and bone marrow transplant recipients. Here, we report a case of a non-HIV-infected renal transplant patient with microsporidiosis of the renal tract associated with acute graft dysfunction. We also review the literature of 12 previously reported cases of microsporidiosis in patients with renal transplants who had described graft involvement. We review the pattern of illness as well as the common renal biopsy features when microsporidial infection is associated with renal graft infection.

A Case of Intestinal Microsporidiosis in a Renal Transplant Recipient

“…Microsporidia have been known to cause infection in HIV patients [6][7][8]. Over the last 20 years, 31 cases of intestinal and disseminated microsporidiosis have been cited in renal transplant recipients [9][10][11][12][13][14]. It has been estimated that microsporidia accounts for approximately 3.5% of all post-transplant diarrhea [12,13].…”

Epidemiological and clinical study of microsporidiosis in French kidney transplant recipients from 2005 to 2019: TRANS‐SPORE registry

“…5,6 Infection usually occurs after the ingestion of spores and mainly results in gastrointestinal symptoms. [7][8][9] Other clinical manifestations are very unusual and include biliary or pulmonary disorders, as well as cardiac, renal and central nervous system involvement. 2,5,10 Rarely, disseminated infections have been reported in transplanted patients following infection with Encephalitozoon cuniculi [11][12][13] or Anncaliia algerae.…”

“…infections. 7,8,11,[19][20][21] For the treatment of E. bieneusi infections, several strategies have been suggested, such as immunosuppression tapering 7,22 and fumagillin, a mycotoxin produced by Aspergillus fumigatus. 7,[22][23][24][25][26] However, serious side effects have sometimes been observed with fumagillin, especially deep thrombocytopenia and/or neutropenia, which can lead to treatment discontinuation.…”

“…Both of these pathogens are ubiquitous in the environment and have been identified in surface waters and a wide range of animals 5,6 . Infection usually occurs after the ingestion of spores and mainly results in gastrointestinal symptoms 7–9 . Other clinical manifestations are very unusual and include biliary or pulmonary disorders, as well as cardiac, renal and central nervous system involvement 2,5,10 .…”

“…Thus, albendazole is used for Encephalitozoon spp. infections 7,8,11,19–21 . For the treatment of E. bieneusi infections, several strategies have been suggested, such as immunosuppression tapering 7,22 and fumagillin, a mycotoxin produced by Aspergillus fumigatus 7,22–26 .…”