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

First molecular detection and characterization of Enterocytozoon bieneusi different genotypes in human patients from Italy

Enterocytozoon bieneusi is one of the 17 microsporidian species pathogenic to humans in low and high-income countries, inducing both symptomatic and asymptomatic intestinal infections, independently of the immunological condition of the infected individual. Faecal-oral transmission occurs in a broad hosts range, including several animal species, but the parasite's zoonotic potential remains still unclear. Few studies are available in Italy regarding E. bieneusi presence in humans and no data on its genetic variability are so far reported. In this investigation, through the ITSr RNA sequences analysis, we provided the first E. bieneusi molecular characterization from symptomatic patients in Italy. Faecal samples from 410 patients sent for routine analyses to the Unit of Parasitology, Policlinico Tor Vergata, Rome, and resulted positive for E. bieneusi to a cartridge-based molecular test for qualitative detection (Novodiag® Stool Parasites assay), were collected. DNA was extracted, endpoint PCR performed and then sequences obtained for 3/410 patients (0.7 %). Genotype A (N = 1), genotype C (N = 1) and genotype K (N = 1) were identified, all belonging to phylogenetic Group 1. One patient (identified as genotype A) showed positivity to the same genotype previously characterized after a two-month period. Additional investigations are required, within a One Health framework, to review the importance of a zoonotic potential linked to E. bieneusi in human populations, animals and environmental reservoirs worldwide.

Prevalence of microsporidium and other intestinal parasites in children from malatya, Turkey

Parasite infections are common during the critical developmental period in children. The occurrences of intestinal parasites are also common in orphanage, nurseries and schools in Turkey. The study was carried out to determine the percentage of microsporidium and intestinal parasites in children from Malatya, Turkey. This study was carried out at the Department of Parasitology of Inonu University, Turgut Ozal Medical Center, during January-December 2006. Totally, 1,181 stool samples were examined using the native-Lugol, sedimentation-techniques, modified trichrome (MTS), acid-fast-trichrome stain and calcofluor staining methods. In addition, perianal region material was taken from the children to examine with cellophane tape method. Power analyses were performed for statistical analyses used. Microsporidia were found in 92 (7.8%) of the samples, and also intestinal parasites were detected in 329 (27.8%). The numbers of infections according to the species were as follows: 69 (5.8%) Entamoeba coli, 7 (0.6%) Blastocystis hominis, 114 (9.7%) Giardia intestinalis, 15 (1.3%) Iodomoeba butchlii, 8 (0.7%) Dientamoeba fragilis, 7 (0.6%) Taenia spp. 70 (5.9%) Enterobius vermicularis, 11 (0.9%) Hymenolepis nana, 25 (2.1%) Trichomonas intestinalis, 1 (0.1%) Ascaris lumbricoides and 2 (0.2%) Chilomastix mesnilii. Also, greater than 90% power values were achieved for statistical analyses. Whereas the detection rates of microsporidium and intestinal parasites were found to be low, it was concluded that in addition to intestinal parasites, microsporidium should be also searched for in children with complaints of intestinal system.

Assessment of bacterial endospore viability with fluorescent dyes

AIM

To validate three fluorescence viability assays designed primarily for vegetative cells on pure Bacillus endospores.

METHODS AND RESULTS

Purified fresh and gamma-irradiated Bacillus endospores (Bacillus cereus, B. coagulans and two strains of B. subtilis) were used. The viability assays were: 5-cyano-2,3-diotolyl tetrazolium chloride (CTC) to test respiratory activity and early germination, DiBAC4(3) and Live/Dead BacLight to measure membrane energization and permeabilization, respectively. Gamma irradiation treatment completely eliminated spore culturability and was used as negative control. The untreated spores showed respiratory activity after 1 h of incubation and this was characteristic of almost 100% of spores after 24 h. The membrane potential assessment gave no answer about spore viability. A lower proportion of untreated spores had permeabilized membrane compared with gamma-irradiated spores using Live/Dead BacLight (P < 0.02).

CONCLUSION

It is possible to use CTC and Live/Dead BacLight to rapidly test endospore viability and evaluate the proportion of spores in a preparation that could not be recovered with plate count.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study shows that fluorescence tests could be applied to assess viability in potentially pathogenic Bacillus spore preparations within 1 h.

Alpha and beta subunits of pyruvate dehydrogenase E1 from the microsporidian Nosema locustae: mitochondrion-derived carbon metabolism in microsporidia

Microsporidia are highly adapted eukaryotic intracellular parasites that infect a variety of animals. Microsporidia contain no recognisable mitochondrion, but recently have been shown to have evolved from fungi and to possess heat shock protein genes derived from mitochondria. These findings make it clear that microsporidian ancestors were mitochondrial, yet it remains unknown whether they still contain the organelle, and if so what its role in microsporidian metabolism might be. Here we have characterised genes encoding the alpha and beta subunits of pyruvate dehydrogenase complex E1 (PDH, EC 1.2.4.1) from the microsporidian Nosema locustae. All other amitochondriate eukaryotes studied to date have lost the PDH complex and replaced it with pyruvate:ferredoxin oxidoreductase (PFOR). Nevertheless, molecular phylogeny shows that these Nosema enzymes are most closely related to mitochondrial PDH from other eukaryotes, demonstrating that elements of mitochondrial metabolism have been retained in microsporidia, and that PDH has not been wholly lost. However, there is still no evidence for a mitochondrion in microsporidia, and neither PDH subunit is predicted to encode an amino terminal leader sequence that could function as a mitochondrion-targeting transit peptide, raising questions as to whether these proteins function in a relic organelle or in the cytosol. Moreover, it is also unclear whether these proteins remain part of the PDH complex, or whether they have been retained for another purpose. We propose that microsporidia may utilise a unique pyruvate decarboxylation pathway involving PDH, demonstrating once again the diversity of core metabolism in amitochondriate eukaryotes.

[Trichome staining method applied to stools from HIV-infected patients with diarrhea, for microsporidia investigation]

The microsporidia have been involved in several clinical manifestations in patients with AIDS, of whom diarrhoea is the commonest. The diagnosis of microsporidiasis depended on invasive procedures and the identification of the organisms is made by electron microscopy. The modified trichrome staining method allows that the diagnosis be made without such procedures by using light microscopy. In the present work, the modified trchrome method was applied in stools from 62 patients with diarrhoea, who had asymptomatic HIV infection or AIDS. Of the 62 samples analyzed, there was detection of microsporidial spores in one. This work confirms the existence of such protozoans in our patients, associated with manifestations of chronic diarrhoea in patients with AIDS who have severe immunodeficiency and ascertains that this staining method allows satisfactory identification of microsporidia from faeces, as well points out some directions to further studies.

Molecular techniques for detection, species differentiation, and phylogenetic analysis of microsporidia

Microsporidia are obligate intracellular protozoan parasites that infect a broad range of vertebrates and invertebrates. These parasites are now recognized as one of the most common pathogens in human immunodeficiency virus-infected patients. For most patients with infectious diseases, microbiological isolation and identification techniques offer the most rapid and specific determination of the etiologic agent. This is not a suitable procedure for microsporidia, which are obligate intracellular parasites requiring cell culture systems for growth. Therefore, the diagnosis of microsporidiosis currently depends on morphological demonstration of the organisms themselves. Although the diagnosis of microsporidiosis and identification of microsporidia by light microscopy have greatly improved during the last few years, species differentiation by these techniques is usually impossible and transmission electron microscopy may be necessary. Immunfluorescent-staining techniques have been developed for species differentiation of microsporidia, but the antibodies used in these procedures are available only at research laboratories at present. During the last 10 years, the detection of infectious disease agents has begun to include the use of nucleic acid-based technologies. Diagnosis of infection caused by parasitic organisms is the last field of clinical microbiology to incorporate these techniques and molecular techniques (e.g., PCR and hybridization assays) have recently been developed for the detection, species differentiation, and phylogenetic analysis of microsporidia. In this paper we review human microsporidial infections and describe and discuss these newly developed molecular techniques.

Microsporidia infection in transplant patients

BACKGROUND

Microsporidia are the most common cause of chronic diarrhea in patients infected with human immunodeficiency virus. Patients who have undergone organ transplantation may also be infected. The precise immune defect and the clinical picture in transplant patients have not been studied.

METHODS

We report a case of microsporidia infection in a heart transplant patient and review three other cases reported in the literature.

RESULTS

Infection in three solid organ transplant patients occurred when the patients were receiving immunosuppressive therapy for rejection 1.5-3 years after transplantation. Patients had chronic diarrhea, vomiting, dyspepsia, and weight loss for 1 month to 3 years.

CONCLUSIONS

Microsporidia may be the cause of chronic unexplained diarrhea and gastrointestinal disturbances in transplant patients. Defects in cell-mediated immunity probably play a role in maintaining the chronicity of this infection. Specific screening requests should be made to the microbiology laboratory when microsporidia infection is suspected.

Microsporidial disease in HIV-infected patients: a report of 42 patients and review of the literature

Microsporidiosis is recognized as an increasingly important infection, particularly in patients with human immunodeficiency virus (HIV) infection. In this retrospective study we have reviewed the clinical features, laboratory findings and management of 42 HIV positive patients co-infected with microsporidia. All patients had spores identified in faeces stained with a modified trichome blue stain. Patients were all markedly immunosuppressed (median CD4 20 cells/microl). Common symptoms included weight loss, diarrhoea, abdominal pain, anorexia and nausea. 29 patients were diagnosed with Enterocytozoon bieneusi infection; 13 were infected with Encephalitozoon intestinalis, and disseminated disease was confirmed in 8. Albendazole therapy in patients with E. intestinalis (but not E. bieneusi) resulted in good clinical response.