Multimethodological Approach to Gastrointestinal Microsporidiosis in HIV-Infected Patients

Abstract

Purpose Microsporidiosis is an opportunistic infection that produces chronic diarrhoea and cholangiopathy in patients with AIDS, mainly caused by two species of microsporidia, Enterocytozoon bieneusi and Encephalitozon intestinalis. The aim of this work was to develop an integral system for the diagnosis of microsporidiosis of the intestine and biliary tract in HIVinfected patients, comprising microscopic and molecular techniques. Methods The study population comprised 143 adult patients of both sexes with diagnosis of HIV infection, with chronic diarrhoea, and with or without HIV-associated cholangiopathy. Stool studies for microsporidia identification of spores were performed on each patient. A video esofagogastroduodenoscopy with biopsy collection was also carried out for routine histology and semi-thin sections stained with Azure II. Species identification was carried out by transmission electron microscopy and/or polymerase chain reaction for the species E. bieneusi and E. intestinalis. Results Out of the 143 patients a total of 12.6% (n = 18) were infected with microsporidia. Microsporidia species identified in most cases was E. bieneusi (16/18 cases), followed by E. intestinalis (4/18), all of these last ones in coinfection with E. bieneusi. Conclusions Clinical, imaging, microscopic and molecular analyses, when applied in a systematic and integrated approach, allow diagnosis and identification of microsporidia at species level in AIDS patients with chronic diarrhoea, and with or without HIV-associated cholangiopathy.

Intestinal microsporidiosis among HIV/AIDS patients receiving antiretroviral therapy in Sana’a city, Yemen: first report on prevalence and predictors

“…The prevalence of intestinal microsporidiosis in the present study is comparable to the pooled prevalence of 13.0% in Eastern Europe and Central Asia, 14.4% in Western and Central Europe and North America and 15.4% in sub-Saharan Africa [ 25 ]. Compared to the present study, prevalence rates of 11.3–16.6% among HIV/AIDS patients were reported from Mali, Venezuela, Addis Ababa of Ethiopia, Benin city of Nigeria, Chandigarh city of India and Burkina Faso (using microscopy), from Kerman city of Iran, Tunisia and Guangxi region of China (using PCR), Russia (using serological testing) and Argentina using TEM [ 16 , 17 , 30 – 38 ]. However, much lower prevalence rates of 0.8–8.5% were reported among HIV/AIDS patients from the United States of America, France, Kinshasa city of the Democratic Republic of the Congo (using PCR), Shiraz city of Iran, Bamenda city of Cameroon, Lucknow city of India (using PCR), Malaysia, the Abeokuta and Niger states of Nigeria and Hunan province of China [ 39 – 48 ].…”

“…Different laboratory techniques have been used to identify microsporidian spores in various clinical specimens, including light and fluorescence microscopy, transmission electron microscopy (TEM) as well as immunological and molecular techniques [ 16 ]. TEM is the gold standard technique to identify the specific species; however, it is time-consuming, expensive and cannot be performed on a large number of samples [ 17 ].…”

“…TEM is the gold standard technique to identify the specific species; however, it is time-consuming, expensive and cannot be performed on a large number of samples [ 17 ]. Polymerase chain reaction (PCR)-based techniques have improved the sensitivity and specificity of detection to the species level [ 16 ]. However, such techniques are not used routinely because they are time-consuming, labor-intensive and costly in addition to the difficulty in isolating the nucleic acids from the spores and the presence of PCR inhibitors in stool samples [ 6 , 18 ].…”

Causes of Mortality and Disease in Rabbits and Hares: A Retrospective Study

“…A significant number of rabbits in which encephalitozoonosis was diagnosed were simultaneously affected by other diseases such as myxomatosis, pneumonic pasteurellosis or skin abscesses, or were highly parasitized. As described in humans, it seems feasible that immunosuppressive conditions might have encouraged infection and the clinical picture [24,25]. In the cases of intestinal coccidiosis, the severity of the clinical and pathological findings made highly pathogenic species such as E. magna and E. intestinalis the most likely etiology.…”

Enterocytozoon bieneusi Infection after Hematopoietic Stem Cell Transplant in Child, Argentina

“…Although intestinal microsporidiosis is prevalent in children residing in developing countries, scarce studies have been reported in Argentina ( 1 , 5 , 6 ). We present a case of E. bieneusi (genotype D) infection in a child who underwent unrelated allogeneic HSCT in Buenos Aires, Argentina.…”