Skip to main content

Advertisement

SpringerLink
Log in

Clinical and microscopical features of small-intestinal microsporidiosis in patients with AIDS

Klinische und mikroskopische Befunde bei AIDS-Patienten mit Mikrosporidiose des Dünndarms

  • Originalia
  • Published:
Infection Aims and scope Submit manuscript

Summary

Intestinal microsporidiosis byEnterocytozoon bieneusi is an increasingly recognized infection in AIDS patients. We report eight cases of microsporidiosis. All patients were severely immunodepressed. Clinical features were highly variable. Patients were followed up for a mean period of 7.8 months. All patients had persistent infection during the follow-up and spore excretion remained constant. Two patients became asymptomatic during the follow-up. None of the patients presented clinical and echographic signs of biliary involvement. Treatment with albendazole, metronidazole or paromomycin failed to produce a durable clinical response or to eradicate the organism. Cases were identified by stool examination and additionally investigated with light and electron microscopy. It was found that light microscopy was a sensitive method, while electron microscopy was less sensitive but allowed the definition of the infecting species. The modified trichrome stain was a satisfactory method for diagnosis on fecal smears. The calcofluor stain and the combination of DAPI with calcofluor was a rapid and simple staining method for screening.

Zusammenfassung

Bei AIDS-Patienten werden mit zunehmender Häufigkeit Fälle von intestinaler Mikrosporidiose durchEnterocytozoon bineusi beobachtet. Wir berichten über 11 Mikrospordiosefälle. Bei allen Patienten bestand eine schwere Immundefizienz. Die klinische Symptomatik war sehr variabel. Die Patienten wurden im Mittel 7,8 Monate lang beobachtet. Alle Patienten hatten während der Beobachtungszeit eine persistierende Infektion und die Exkretion der Sporen blieb konstant. Zwei Patienten wurden während der Beobachtungszeit asymptomatisch. Bei keinem der Patienten bestanden klinische oder sonographische Zeichen für eine Beteiligung der Gallenwege. Die Therapie mit Albendazol, Metronidazol oder Paromomycin führte nicht zu einer bleibenden klinischen Besserung oder Erregereradikation. Die Diagnostik erfolgte durch Stuhluntersuchung unter Anwendung von Licht- und Elektronenmikroskopie. Die Lichtmikroskopie erwies sich als empfindliche Methode. Die Elektronenmikroskopie war weniger empfindlich, erlaubte jedoch die Spezifizierung des Erregers. Eine modifizierte Trichrom-Färbemethode war für die Beurteilung von Stuhlausstrichen brauchbar. Die Calcofluor-Färbung und die Kombination von DAPI mit Calcofluor erlaubte eine rasche und einfache Beurteilung für das Screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Asmuth, D. M., DeGirolami, P. C., Federman, M., Ezratty, C. R., Pleskow, D. K., Desai, G., Wanke, C. A. Clinical features of microsporidiosis in patients with AIDS. Clin. Infect. Dis. 18 (1994) 819–825.

    Google Scholar 

  2. Eeftinck Shattenkerk, J. K. M., Van Gool, T., van Ketel, R. J., Bartelsman, J. F. W. M., Kuiken, C. L., Terpstra, W. J., Reiss, P. Clinical significance of small-intestinal microsporidiosis in HIV-infected individuals. Lancet 337 (1991) 895–898.

    Google Scholar 

  3. Molina, J. M., Scarfati, C., Beauvais, B., Lemann, M., Lesourd, A., Ferchal, F., Casin, I., Lagrange, P., Modigliani, R., Derouin, F., Modai, J. Intestinal microsporidiosis in human-immunodeficiency-virus-infected patients with chronic unexplained diarrhea: prevalence and clinical and biological features. J. Infect. Dis. 167 (1993) 217–221.

    Google Scholar 

  4. Orenstein, G. M., Chiang, J., Steinberg, W., Smith, P. D., Rotterdam, H., Kotler, D. P. Intestinal microsporidiosis as a cause of diarrhea in human-immunodeficiency-virus-infected patients: a report of 20 cases. Human Pathol. 21 (1990) 475–481.

    Google Scholar 

  5. Peacock, C. S., Blanshard, C., Tovey, D. G., Ellis, D. S., Gazzard, B. G. Histological diagnosis of intestinal microsporidiosis in patient with AIDS. J. Clin. Pathol. 44 (1991) 558–563.

    Google Scholar 

  6. Rabeneck, L., Gyorkey, F., Genta, R. M. H., Gyorkey, P., Foote, L. W., Risser, J. M. H. The role of microsporidia in the pathogenesis of HIV-related chronic diarrhea. Ann. Intern. Med. 119 (1993) 895–899.

    Google Scholar 

  7. Weber, R., Bryan, R. T., Owen, R. L., Wilcox, C. M., Gorelkin, L., Visvesvara, G. S., andthe Enteric Opportunistic Working Group Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. N. Engl. J. Med. 326 (1992) 161–166.

    Google Scholar 

  8. Ryan, N. J., Sutherland, G., Coughlan, K., Globan, M., Doultree, J., Marshall, J., Baird, R. W., Pedersen, J., Dweyer, B. A new trichrome-blue stain for detection of microsporidial species in urine, stool, and nasopharyngeal specimens. J. Clin. Microbiol. 31 (1993) 3264–3269.

    Google Scholar 

  9. Kokoskin, E., Gyorkos, T. W., Camus, A., Cedilotte, L., Purtill, T., Ward, B. Modified technique for efficient detection of microsporidiosis. J. Clin. Microbiol. 32 (1994) 1074–1075.

    Google Scholar 

  10. van Gool, T., Snijders, F., Reiss, P., Eeftinck Schattenkerk, J. K. M., van den Bergh Weerman, M. A., Bartelsman, J. F. W. M., Bruins, J. J. M., Canning, E. U., Dankert, J. Diagnosis of intestinal and disseminated microsporidial infection in patients with HIV by a new rapid fluorescence technique. J. Clin. Pathol. 46 (1993) 694–699.

    Google Scholar 

  11. Orenstein, J. M., Benator, D., Kotler, D. P. Microsporidia and HIV-related diarrhea. Ann. Intern. Med. 126 (1994) 973.

    Google Scholar 

  12. Simon, D. Microsporidia in HIV diarrhea: present but pathogenic? Am. J. Gastroenterol. 89 (1994) 636–638.

    Google Scholar 

  13. van Gool, T., Canning, E. U., Dankert, J. An improved practical and sensitive technique for the detection of microsporidian spores in stool samples. Trans. R. Soc. Trop. Med. Hyg. 88 (1994) 189–190.

    Google Scholar 

  14. Orenstein, J. M., Tenner, M., Kotler, P. Localization of infection by the microsporidianEnterocytozoon bieneusi in the gastrointestinal tract of AIDS patients with diarrhea. AIDS 6 (1992) 195–197.

    Google Scholar 

  15. Greenson, J. K., Belitsos, P. C., Yardley, J. H., Bartlett, J. G. AIDS enteropathy: occult enteric infections and duodenal mucosal alterations in chronic diarrhea. Ann. Intern. Med. 114 (1991) 377–382.

    Google Scholar 

  16. Kotler, D. P., Francisco, A., Clayton, F., Scholes, J. V., Orenstein, J. M. Small intestinal injury and parasitic diseases in AIDS. Ann. Intern. Med. 113 (1990) 444–449.

    Google Scholar 

  17. Mannheimer, S. B., Soave, R. Protozoal infections in patients with AIDS:Cryptosporidium, Isospora, Cyclospora and Microsporidia. Infect. Dis. Clin. Norh. Am. 8 (1994) 483–498.

    Google Scholar 

  18. Pol, S., Romana, C. A., Richards, S., Amouyal, P., Desportes-Livages, J., Carnot, F., Pays, J-F., Berthelot, P. Microsporidia infection with the HIV and unexplained cholangitis. N. Engl. J. Med. 328 (1993) 95–99.

    Google Scholar 

  19. Blanshard, C., Ellis, D. S., Tovey, D. G., Dowell, S., Gazzard, B. G. Treatment of intestinal microsporidiosis with albendazole in patients with AIDS. AIDS 6 (1992) 311–313.

    Google Scholar 

  20. Pol, S., Romana, C. A., Richard, S., Carnot, F., Dumont, J. L., Bouche, H., Pialoux, G., Stern, M., Pays, J-F., Berthelot, P. Enterocytozoon bieneusi infection in AIDS-related sclerosing cholangitis. Gastroenterology 102 (1992) 1778–1781.

    Google Scholar 

  21. Beeching, N. J. Chemotherapy of intestinal parasitoses. Current opinion in Infectious Diseases 7 (1994) 685–691.

    Google Scholar 

  22. Shelhamer, J. H., Obnibene, F. P., Macher, A. M., Tuazon, C., Steiss, R., Longo, D., Kovacs, J. A., Parker, M. M., Natanson, C., Lane, H. C., Fauci, A. S., Parrillo, J. E., Masur, H. Persistence ofPneumocystis carinii in lung tissue of acquired immunodeficiency syndrome patients treated forPneumocystis pneumonia. Am. Rev. Respir. Dis. 130 (1984) 1161–1165.

    Google Scholar 

  23. Fichtenbaum, C. J., Ritchie, D. J., Powderly, W. G. Use of paromomycin for treatment of cryptosporidiosis in patients with AIDS. Clin. Infect. Dis. 16 (1993) 298–300.

    Google Scholar 

  24. Hacque, M. A., Hollister, W. S., Willcox, A., Canning, U. The antimicrosporidial activity of albendazole. J. Invertebr. Pathol. 62 (1993) 171–177.

    Google Scholar 

  25. Dieterich, D. J., Lew, E. A., Kotler, D. P., Poles, M. A., Orenstein, J. M. Treatment with albendazole for intestinal disease due toEnterocytozoon bieneusi in patients with AIDS. J. Infect. Dis. 169 (1994) 178–183.

    Google Scholar 

  26. Leitch, G. J., Visvesvara, G. S., He, Q. Inhibition of microsporidian spore germination. Parasitology Today 9 (1993) 422–424.

    Google Scholar 

  27. Kotler, D. P., Giang, T. T., Garro, M. L., Orenstein, J. M. Light microscopic diagnosis of microsporidiosis in patients with AIDS. Am. J. Gastroenterol. 89 (1994) 540–544.

    Google Scholar 

  28. Chui, D. W., Owen, R. L. AIDS and the gut. J. Gastroenterol. Hepatol. 9 (1994) 291–303.

    Google Scholar 

  29. Cali, A., Owen, R. L. Microsporidiosis. In:Balows, A., Hausler Jr., W. andLennette, E. H. (eds.): The laboratory diagnosis of infectious diseases: principles and practice. Springer-Verlag, New York 1988 pp. 928–950.

    Google Scholar 

  30. Rijpstra, A. C., Canning, E. U., van Ketel, R. J., Eeftinck Schattenkerk, J. K., Laarman, J. J. Use of light microscopy to diagnose small-intestinal microsporidiosis in patients with AIDS. J. Infect. Dis. 157 (1988) 827–831.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Infectious Diseases, University of Turin, Amedeo di Savoia Hospital, C. Svizzera 164, I-10149, Turin

    P. Caramello M. D., M. Romeo M. D., A. Ullio M. D., A. Lucchini M. D., B. Forno M. D., T. Brancale & P. Gioannini

  2. Dept. of Biomedical Sciences and Human Oncology, University of Turin, San Giovanni Hospital, V. Santena 10, Turin

    G. Mazzucco M. D.

  3. Dept. of Pathology, Maria Vittoria Hospital, Turin

    G. DeRosa M. D.

  4. Dept. B., Amedeo di Savoia Hospital, C. Svizzera 164, Turin, Italy

    A. Macor M. D.

  5. Dept. C., Amedeo di Savoia Hospital, C. Svizzera 164, Turin, Italy

    C. Preziosi M. D.

Authors
  1. P. Caramello M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Romeo M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Ullio M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Lucchini M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Forno M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Brancale
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Gioannini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Mazzucco M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G. DeRosa M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. Macor M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Preziosi M. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Caramello, P., Romeo, M., Ullio, A. et al. Clinical and microscopical features of small-intestinal microsporidiosis in patients with AIDS. Infection 23, 362–368 (1995). https://doi.org/10.1007/BF01713566

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01713566

Keywords

Search

Navigation