Frequency of Microsporidial Infection in Immunocompromised Patients with Staining and Molecular Methods Based on Internal Transcribed Spacer Region Gene in Two Cities of Southwest Iran during 2013-2014

Abstract

Microsporidiosisis anopportunistic infection frequently diagnosed in immunocompromised patients. Microsporidiosis causes symptomatic or asymptomatic infections immunocompromised/immunosuppressed patients may experience severe and disseminated microsporidiosis. Fecal samples were taken from 186 patients with human immunodeficiency virus (86) and cancer (100). Microsporidia spp. were detected 27.9% (24/86) and 11.6% (10/86) in HIV + patients, 18% (18/100) and 7% (7/100) of cancer patients using polymerase chain reaction (PCR) and trichrome staining respectively. Enterocytozoon bieneusi was detected in 28(66.7%) patients, while Encephalitozoon intestinalis was detected in 10 (23.8%) patients. Encephalitozoon cuniculi was detected in only one patient, while Encephalitozoon hellem was detected in three patients. Microsporidia was significantly higher in patients with diarrhea than those without diarrhea (P=0.001). CD4 T cells blood count was significantly lower (<200 cells/µl blood) in HIV+ patients with Microsporidia (P=0.001). Also, there was significant difference between contact with animals with positive results of HIV+ and cancer patients (P< 0.005). This study confirmed that PCR technique was more sensitive than trichrome staining for diagnosis. Moreover, intestinal microsporidiosis caused diarrhea in HIV+ and cancer patients. This influenced treatment. Therefore, early diagnosis of microsporidiosis is effective on treatment strategies.

Intestinal Microsporidiosis in Iran (Kerman): Comparison in immune-compromised patients and immune competent people with diarrhea

“…Kazemi et al performed a study to identify the prevalence of microsporidiosis in the southwest of Iran. They reported both E. bieneusi and E. intestinalis in the samples [ 19 ]. In contrast, in a study in India, E. intestinalis was the most common cause of microsporidiosis in patients with diarrhea [ 21 ].…”

“…The reports on the incidence of microsporidiosis in cancer-positive patients are insufficient [28]. It seems that those taking immunosuppressive drugs are more susceptible to infection presumably because their immune response is affected by these drugs [ 19 ]. We found that the prevalence of E. bieneusi was significantly different based on patients' immune state.…”

“…Kezemi et al presented that cancer-positive patients were more at risk for microsporidiosis. They detected Microsporidia in 18% of these cases [ 19 ]. In our study, there was no significant difference in microsporidiosis rate between males and females.…”

Systematic review of opportunistic parasites among Egyptian immunocompromised individuals from 2010 to 2020

“…Microsporidiosis in immunocompromised patients is characterized by severe and chronic diarrhea with massive weight loss especially in HIV/AIDS patients, as well as nausea, vomiting, malabsorption, and dyspepsia [85][86][87] . In 2017, Kazemi et al [88] reported that multiplex nested PCR targeting internal transcribed spacer (ITS), small subunits (SSU) and large subunits (LSU) of ribosomal DNA (rDNA) identified intestinal Microsporidium with high sensitivity as compared to traditional techniques such as modified trichrome staining. Albendazole is effective against Encephalitozoon (Enc.)…”