Microsporidiosis overview: Difference between revisions
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{{Microsporidiosis}} | {{Microsporidiosis}} | ||
{{CMG}};{{AE}}{{AY}} | {{CMG}}; {{AE}}{{AY}} | ||
==Overview== | ==Overview== | ||
Microsporidiosis is an [[Opportunistic infection|opportunistic intestinal infection]] that causes [[diarrhea]] and wasting in [[immunocompromised]] individuals ([[HIV]], for example). It results from different species of [[microsporidia]], a group of [[protozoa]]l parasites. In [[HIV]] infected individuals, microsporidiosis generally occurs when [[CD4+ T cells|CD4<sup>+</sup> T cell]] counts fall below 100. Microsporidiosis was first discovered in 1959 and its [[prevalence]] has increased in the late 20<sup>th</sup> century due to the worldwide spread of HIV. [[Immunodeficiency]] is the most common risk factor for developing microsporidiosis and leads to a worse outcome. | |||
Microsporidiosis presents in many forms and can affect many systems. The most common form is intestinal microsporidiosis, which causes [[diarrhea]] and [[weight loss]] and can be complicated with [[nutritional deficiencies]], [[weight loss]], and [[acalculous cholecystitis]]. Diagnosis is confirmed by microscopic identification of the organism and positive [[PCR]]. The mainstay of therapy is [[ | Microsporidiosis presents in many forms and can affect many systems. The most common form is intestinal microsporidiosis, which causes [[diarrhea]] and [[weight loss]] and can be complicated with [[nutritional deficiencies]], [[weight loss]], and [[acalculous cholecystitis]]. Diagnosis is confirmed by microscopic identification of the organism and positive [[PCR]]. The mainstay of therapy is [[HIV AIDS medical therapy|HAART]] aiming for a [[CD4+ T cells|CD4<sup>+</sup> T cell]] > 100 cell/mcm. | ||
==Historical Perspective== | ==Historical Perspective== | ||
[[Microsporidia|Phylum | [[Microsporidia|Phylum Microsporidia]] were first described in the 19<sup>th</sup> century, while the first human case was described in 1959. The number of cases increased after the spread of [[AIDS]]. | ||
==Classification== | ==Classification== | ||
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Microsporidiosis should be differentiated from other conditions that cause [[chronic diarrhea]] in [[immunocompromised]] patients. | Microsporidiosis should be differentiated from other conditions that cause [[chronic diarrhea]] in [[immunocompromised]] patients. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The overall [[prevalence]] is not accurately estimated especially in the whole population (because | The overall [[prevalence]] is not accurately estimated especially in the whole population (because microsporidiosis is usually investigated in [[Immunocompromised|immunocompromised patients]] with correlating [[Gastrointestinal tract|gastrointestinal]] symptoms to microsporidiosis. The disease is present worldwide. In [[HIV]] patients with [[diarrhea]], microsporidia were the most commonly isolated organism, with a [[prevalence]] of 39%. | ||
==Risk Factors== | ==Risk Factors== | ||
The most potent risk factor in the development of microsporidiosis is [[immunodeficiency]]. Other risk factors among [[Immunodeficiency|immunodeficient]] patients include poor sanitation and contact with poultry droppings.<ref name="pmid16940873">{{cite journal| author=Didier ES, Weiss LM| title=Microsporidiosis: current status. | journal=Curr Opin Infect Dis | year= 2006 | volume= 19 | issue= 5 | pages= 485-92 | pmid=16940873 | doi=10.1097/01.qco.0000244055.46382.23 | pmc=3109650 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16940873 }} </ref><ref name="pmid27405127">{{cite journal| author=Anuar TS, Bakar NH, Al-Mekhlafi HM, Moktar N, Osman E| title=PREVALENCE AND RISK FACTORS FOR ASYMPTOMATIC INTESTINAL MICROSPORIDIOSIS AMONG ABORIGINAL SCHOOL CHILDREN IN PAHANG, MALAYSIA. | journal=Southeast Asian J Trop Med Public Health | year= 2016 | volume= 47 | issue= 3 | pages= 441-9 | pmid=27405127 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27405127 }} </ref> | The most potent risk factor in the development of microsporidiosis is [[immunodeficiency]]. Other risk factors among [[Immunodeficiency|immunodeficient]] patients include poor [[sanitation]] and contact with poultry droppings.<ref name="pmid16940873">{{cite journal| author=Didier ES, Weiss LM| title=Microsporidiosis: current status. | journal=Curr Opin Infect Dis | year= 2006 | volume= 19 | issue= 5 | pages= 485-92 | pmid=16940873 | doi=10.1097/01.qco.0000244055.46382.23 | pmc=3109650 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16940873 }} </ref><ref name="pmid27405127">{{cite journal| author=Anuar TS, Bakar NH, Al-Mekhlafi HM, Moktar N, Osman E| title=PREVALENCE AND RISK FACTORS FOR ASYMPTOMATIC INTESTINAL MICROSPORIDIOSIS AMONG ABORIGINAL SCHOOL CHILDREN IN PAHANG, MALAYSIA. | journal=Southeast Asian J Trop Med Public Health | year= 2016 | volume= 47 | issue= 3 | pages= 441-9 | pmid=27405127 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27405127 }} </ref> | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
If left untreated, [[immunocompetent]] patients resolve the | If left untreated, [[immunocompetent]] patients resolve the disease completely within 2 weeks while [[immunocompromised]] patients might develop [[chronic diarrhea]]. Common [[complications]] of microsporidiosis include [[weight loss]], [[dehydration]], and [[acalculous cholecystitis]]. Prognosis is generally excellent in [[immunocompetent]] patients while [[Immunocompromised|immunocompromised patients]] are more vulnerable to developing [[chronic]] disease and [[complications]]. | ||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Symptoms of intestinal microsporidiosis include [[chronic diarrhea]], [[abdominal pain]], and [[weight loss]]. | Symptoms of intestinal microsporidiosis include [[chronic diarrhea]], [[abdominal pain]], and [[weight loss]]. | ||
===Physical Examination=== | ===Physical Examination=== | ||
Patients with microsporidiosis usually appear ill. Physical examination of patients with microsporidiosis is usually remarkable for [[weight loss]], wasting and [[abdominal tenderness]]. | Patients with microsporidiosis usually appear ill. Physical examination of patients with microsporidiosis is usually remarkable for [[weight loss]], [[wasting]] and [[abdominal tenderness]]. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Laboratory findings consistent with the diagnosis of microsporidiosis include microscopic identification of the organism in fecal smears using chromotrope 2R or | Laboratory findings consistent with the diagnosis of microsporidiosis include microscopic identification of the organism in fecal smears using chromotrope 2R method or “Quick-Hot Gram Chromotrope technique”, positive [[PCR]], and [[Serology|positive serology]] using indirect [[immunofluorescence]]. | ||
===Imaging Findings=== | ===Imaging Findings=== | ||
There are no imaging findings associated with microsporidiosis. | There are no imaging findings associated with microsporidiosis. | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
The mainstay of therapy for microsporidiosis in immunocompromised patients is [[HIV AIDS medical therapy|highly active antiretroviral therapy (HAART)]]. [[Albendazole]] and [[fumagillin]] have demonstrated consistent activity against other microsporidia in vitro and in vivo. | The mainstay of therapy for microsporidiosis in [[immunocompromised]] patients is [[HIV AIDS medical therapy|highly active antiretroviral therapy (HAART)]]. [[Albendazole]] and [[fumagillin]] have demonstrated consistent activity against other microsporidia in vitro and in vivo. | ||
===Surgery=== | ===Surgery=== | ||
Surgical intervention is not recommended in the management of microsporidiosis. | Surgical intervention is not recommended in the management of microsporidiosis. | ||
===Prevention=== | ===Prevention=== | ||
Effective measures for the primary prevention of microsporidiosis include [[AIDS antiretroviral drugs|HAART]], avoiding contact with poultry and avoiding swimming pools while secondary prevention strategies following microsporidiosis include continuing treatment indefinitely after ocular microsporidiosis and continued [[AIDS antiretroviral drugs|HAART]] for [[HIV]] patients. | Effective measures for the [[primary prevention]] of microsporidiosis include [[AIDS antiretroviral drugs|HAART]], avoiding contact with poultry and avoiding swimming pools while [[secondary prevention]] strategies following microsporidiosis include continuing treatment indefinitely after [[ocular]] microsporidiosis and continued [[AIDS antiretroviral drugs|HAART]] for [[HIV]] patients. | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Microsporidiosis is an opportunistic intestinal infection that causes diarrhea and wasting in immunocompromised individuals (HIV, for example). It results from different species of microsporidia, a group of protozoal parasites. In HIV infected individuals, microsporidiosis generally occurs when CD4+ T cell counts fall below 100. Microsporidiosis was first discovered in 1959 and its prevalence has increased in the late 20th century due to the worldwide spread of HIV. Immunodeficiency is the most common risk factor for developing microsporidiosis and leads to a worse outcome.
Microsporidiosis presents in many forms and can affect many systems. The most common form is intestinal microsporidiosis, which causes diarrhea and weight loss and can be complicated with nutritional deficiencies, weight loss, and acalculous cholecystitis. Diagnosis is confirmed by microscopic identification of the organism and positive PCR. The mainstay of therapy is HAART aiming for a CD4+ T cell > 100 cell/mcm.
Historical Perspective
Phylum Microsporidia were first described in the 19th century, while the first human case was described in 1959. The number of cases increased after the spread of AIDS.
Classification
There is no classification system established for Microsporidiosis.
Pathophysiology
Microsporidia are a group of obligate intracellular parasitic fungi with more than 1,200 species belonging to 143 genera that infect a wide range of vertebrate and invertebrate hosts. They are characterized by the production of resistant spores that vary in size, depending on the species. After ingestion, microsporidia infect intestinal epithelial cells and cause chronic diarrhea with the possibility of distant spread. The microorganism can be visualized in stool samples using "Quick-Hot Gram Chromotrope technique."
Causes
Microsporidiosis is an infection caused by microsporidia.
Differentiating Microsporidiosis from other diseases
Microsporidiosis should be differentiated from other conditions that cause chronic diarrhea in immunocompromised patients.
Epidemiology and Demographics
The overall prevalence is not accurately estimated especially in the whole population (because microsporidiosis is usually investigated in immunocompromised patients with correlating gastrointestinal symptoms to microsporidiosis. The disease is present worldwide. In HIV patients with diarrhea, microsporidia were the most commonly isolated organism, with a prevalence of 39%.
Risk Factors
The most potent risk factor in the development of microsporidiosis is immunodeficiency. Other risk factors among immunodeficient patients include poor sanitation and contact with poultry droppings.[1][2]
Natural History, Complications, and Prognosis
If left untreated, immunocompetent patients resolve the disease completely within 2 weeks while immunocompromised patients might develop chronic diarrhea. Common complications of microsporidiosis include weight loss, dehydration, and acalculous cholecystitis. Prognosis is generally excellent in immunocompetent patients while immunocompromised patients are more vulnerable to developing chronic disease and complications.
Diagnosis
History and Symptoms
Symptoms of intestinal microsporidiosis include chronic diarrhea, abdominal pain, and weight loss.
Physical Examination
Patients with microsporidiosis usually appear ill. Physical examination of patients with microsporidiosis is usually remarkable for weight loss, wasting and abdominal tenderness.
Laboratory Findings
Laboratory findings consistent with the diagnosis of microsporidiosis include microscopic identification of the organism in fecal smears using chromotrope 2R method or “Quick-Hot Gram Chromotrope technique”, positive PCR, and positive serology using indirect immunofluorescence.
Imaging Findings
There are no imaging findings associated with microsporidiosis.
Treatment
Medical Therapy
The mainstay of therapy for microsporidiosis in immunocompromised patients is highly active antiretroviral therapy (HAART). Albendazole and fumagillin have demonstrated consistent activity against other microsporidia in vitro and in vivo.
Surgery
Surgical intervention is not recommended in the management of microsporidiosis.
Prevention
Effective measures for the primary prevention of microsporidiosis include HAART, avoiding contact with poultry and avoiding swimming pools while secondary prevention strategies following microsporidiosis include continuing treatment indefinitely after ocular microsporidiosis and continued HAART for HIV patients.
References
- ↑ Didier ES, Weiss LM (2006). "Microsporidiosis: current status". Curr Opin Infect Dis. 19 (5): 485–92. doi:10.1097/01.qco.0000244055.46382.23. PMC 3109650. PMID 16940873.
- ↑ Anuar TS, Bakar NH, Al-Mekhlafi HM, Moktar N, Osman E (2016). "PREVALENCE AND RISK FACTORS FOR ASYMPTOMATIC INTESTINAL MICROSPORIDIOSIS AMONG ABORIGINAL SCHOOL CHILDREN IN PAHANG, MALAYSIA". Southeast Asian J Trop Med Public Health. 47 (3): 441–9. PMID 27405127.