Disseminated microsporidiosis with Encephalitozoon species in a renal transplant recipient

Abstract

To our knowledge, 5 cases of disseminated microsporidiosis with Encephalitozoon species have been reported worldwide in transplant recipients. George et al. present the first such case in Australia, to be reported and treated with good clinical recovery.

Microsporidiosis in pediatric renal transplant patients in Cape Town, South Africa: Two case reports

“…Chronic diarrhea, as in these cases, is the most common presentation of the intestinal form . Pyrexia of unknown origin is also a common finding, especially with dissemination . Although both our patients had diarrhea during the course of their illness, it was self‐limiting and the features of disseminated disease persisted.…”

“…Encephalitozoon cuniculi , which was identified in our patients, has a propensity for the kidney . Disseminated disease, which is potentially life‐threatening, has been associated with intense immunosuppression during treatment for rejection, as in both our patients . In particular, MMF, which both received as second‐line therapy for graft rejection, has been reported to be a major in trigger of microsporidial infections in transplant patients .…”

Microsporidia Infection in a Mexican Kidney Transplant Recipient

“…Sixty cases of microsporidia infection in bone marrow and solid organ transplant recipients have been informed all over the word since 1993 [11–34]. The highest informed prevalence has been reported in France with 40 cases [11–18], 26 of them in kidney transplant recipients, followed by Holland [19] and USA [20–25] with 5 cases each; the following countries have reported 2 cases each: Germany [26, 27], India [28, 29], Spain [30], and Mexico [31] including the present case, both Mexican cases in kidney transplant recipients.…”

“…The highest informed prevalence has been reported in France with 40 cases [11–18], 26 of them in kidney transplant recipients, followed by Holland [19] and USA [20–25] with 5 cases each; the following countries have reported 2 cases each: Germany [26, 27], India [28, 29], Spain [30], and Mexico [31] including the present case, both Mexican cases in kidney transplant recipients. One case has been reported in Canada [32], South Africa [33], and Australia [34]. Even when the majority of the cases of microsporidiosis in solid organ transplantation correspond to kidney transplant receptors, kidney involvement is observed in a minority of cases typically as a part of systemic infection [18, 22, 31–33], and only 7 out of 39 informed cases (17%) [22, 30, 33] with kidney involvement manifested with renal dysfunction.…”

“…Encephalitozoon species typically are responsible for disseminated infections [3]; E. intestinalis and E. cuniculi are the most common microsporidia infecting the kidney [1–3, 8]; from the 7 cases with kidney involvement, 4 (57%) were related with Encephalitozoon cuniculi , and one (14%) E. Intestinalis [18, 22, 31–33]; in the other cases Encephalitozoon was identified, but the species was not determined [34]. Possibly E. cuniculi has more avidity for renal tissue [18, 22, 31, 32].…”