The Epidemiology of Intestinal Microsporidiosis in Patients with HIV/AIDS in Lima, Peru

Abstract

We studied microsporidiosis in human immunodeficiency virus-positive patients in 2 Lima hospitals. Of 2652 patients, 66% were male, 6% received antiretroviral therapy (ART), and the median CD4 lymphocyte count was 131 cells/microL. Sixty-seven patients (3%) had microsporidiosis; stool specimens from 56 were identified as having Enterocytozoon bieneusi of 10 different genotypes. The 2 most common genotypes, Peru-1 and Peru-2, were not associated with significant increases in chronic diarrhea; other genotypes were associated with a 4-fold increased risk. Risk factors for E. bieneusi infection segregated by genotype: contact with duck or chicken droppings and lack of running water, flush toilet, or garbage collection with genotype Peru-1 and watermelon consumption with other genotypes. Shortened survival was associated with low CD4 lymphocyte count (P<.0001), no ART (P<.0001), and cryptosporidiosis (P=.004) but not with microsporidiosis (P=.48). Our data suggest the possibility of zoonotic E. bieneusi transmission and an association with poor sanitary conditions.

Microsporidiosis in South Africa: PCR detection in stool samples of HIV-positive and HIV-negative individuals and school children in Vhembe district, Limpopo Province

“…However, HIV-positive patients infected with Cryptosporidium had more diarrhea and more lactoferrin than those who were not infected, indicating that the expected outcome would be worse with Cryptosporidium than with E. bieneusi in this population. This observation is similar to those described by Bern et al (2005) in Peru, where microsporidiosis did not appear to have a major impact on survival among AIDS patients compared to cryptosporidiosis, even though some genotypes of E. bieneusi caused chronic diarrhea in these patients.…”

Microsporidia

“…Many early reports have associated this infection with chronic diarrhea in HIV-infected patients throughout the world (Weber and Bryan, 1994;Asmuth et al, 1994;Kotler and Orenstein, 1998;Bern et al, 2005). Persistent diarrhea, malabsorption, and wasting, which are the most common clinical manifestations associated with the infection in patients with AIDS, are observed in those with ≤ 100 CD4 cells/mm 3 .…”

Deforestation and Water Borne Parasitic Zoonoses

“…It is believed that the ingestion of spores is an important route for the species that infect the gastrointestinal tract of man and that environmental contamination occurs by the spread of the spores contained in faeces, urine and other excretions. In foxes, domestic dogs and squirrels, it was observed that transplacental transmission is an important mechanism of spread of the disease (Bern, 2005;Weiss, 2001). Although microsporidia spores are resistant to the environment, can be inactivated when exposed for 30 minutes at 70% alcohol, 1% formaldehyde or hydrogen peroxide 1% as well as when they are autoclaved for 10 minutes at 120ºC (Méténier & Vivarès, 2001).…”

“…The phenotypic and genotypic differences among strains of Encephalitozoon cuniculi can be used to indicate the main sources of infection for man. The lack of a specific host, coupled with the fact that the primate is susceptible to encephalitozoonosis suggests that man can become infected when exposed to an infected animal (Bern, 2005).…”

“…However, there are few drugs licensed for human use. Albendazol seems to be the most appropriate drug to combat infection by microsporidia (Bern, 2005;Weiss, 2001). Measures aimed at preventing infection by microsporidia are not specific, since the mode of transmission and sources of infection for the disease remain uncertain.…”