Successful Treatment of Disseminated Anncaliia algerae Microsporidial Infection With Combination Fumagillin and Albendazole

Abstract

Anncaliia algerae myositis is a life-threatening, emerging microsporidiosis among immunocompromised hosts. We report a case of disseminated A algerae infection in a man previously treated with alemtuzumab. Due to failure of albendazole-based therapy, fumagillin was added as a novel approach to management, with a good clinical response and patient survival.

Anncaliia algerae Microsporidial Myositis, New South Wales, Australia

“…Our review of published case reports and patient records indicated that systemic A. algerae infection has manifested as a skeletal muscle myositis ( Table 1 ), with central nervous system and cardiac involvement documented in some cases ( 1 – 5 ). Dysphagia caused by bulbar muscle weakness is a particular concern because it has led to aspiration pneumonia ( 2 ).…”

“… *In 2 cases the clinical features were only sourced from published reports ( 1 , 5 ) rather than patient records ( 2 – 4 ). …”

“…Transmission occurs through contact with spores that are found in water, although the exact mechanism of transmission to humans is unknown ( 2 ). Myositis has been described in case-patients who were immunosuppressed because of rheumatoid arthritis, solid organ transplantation, and hematologic malignancy ( 1 – 5 ). It is currently unclear why 4 of the 6 previously published cases have originated in New South Wales, Australia, and the 2 other cases originated in North America ( 1 – 5 ).…”

“…Myositis has been described in case-patients who were immunosuppressed because of rheumatoid arthritis, solid organ transplantation, and hematologic malignancy ( 1 – 5 ). It is currently unclear why 4 of the 6 previously published cases have originated in New South Wales, Australia, and the 2 other cases originated in North America ( 1 – 5 ). We document successful treatment of A. algerae infection after hemopoietic stem cell transplantation, provide an update on clinical features and management, and discuss possible routes of transmission and risk-mitigation strategies.…”

A Metagenomic Approach to Evaluating Surface Water Quality in Haiti

“…Fungi of greatest concern include Onygenales spp., which dominated most of the samples and includes a number of emerging human pathogens [ 48 ], Candida parapsilosis [ 49 ], Enterocytozoon bieneusi [ 50 ], and Anncaliia algerae [ 51 ]. Unfiltered results also suggest the presence of Candida albicans , Alspergillus fumigates and Pneumocystis jirovecii (the causative organism of Pneumocystis pneumonia ).…”