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Nourrisson C, Moniot M, Tressol M, Lambert C, Fréalle E, Robert-Gangneux F, Costa D, Basmaciyan L, Poirier P. Multicenter comparative study of Enterocytozoon bieneusi DNA extraction methods from stool samples, and mechanical pretreatment protocols evaluation. Sci Rep 2024; 14:15404. [PMID: 38965323 PMCID: PMC11224372 DOI: 10.1038/s41598-024-66154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024] Open
Abstract
Nowadays, the use of qPCR for the diagnosis of intestinal microsporidiosis is increasing. There are several studies on the evaluation of qPCR performance but very few focus on the stool pretreatment step before DNA extraction, which is nevertheless a crucial step. This study focuses on the mechanical pretreatment of stools for Enterocytozoon bieneusi spores DNA extraction. Firstly, a multicenter comparative study was conducted evaluating seven extraction methods (manual or automated) including various mechanical pretreatment. Secondly, several durations and grinding speeds and types of beads were tested in order to optimize mechanical pretreatment. Extraction methods of the various centers had widely-varying performances especially for samples with low microsporidia loads. Nuclisens® easyMAG (BioMérieux) and Quick DNA Fecal/Soil Microbe Microprep kit (ZymoResearch) presented the best performances (highest frequencies of detection of low spore concentrations and lowest Ct values). Optimal performances of mechanical pretreatment were obtained by applying a speed of 30 Hz during 60 s with the TissueLyser II (Qiagen) using commercial beads of various materials and sizes (from ZymoResearch or MP Biomedicals). Overall, the optimal DNA extraction method for E. bieneusi spores contained in stool samples was obtained with a strong but short bead beating using small-sized beads from various materials.
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Affiliation(s)
- Céline Nourrisson
- Parasitology-Mycology Department, CHU Clermont-Ferrand, 3IHP, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte, M2iSH, UMR INSERM 1071, Clermont Auvergne University, Clermont-Ferrand, France
- National Reference Center (NRC) for Cyptosporidiosis, Microsporidia and Other Digestive Protozoa, Clermont-Ferrand, France
| | - Maxime Moniot
- Parasitology-Mycology Department, CHU Clermont-Ferrand, 3IHP, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- National Reference Center (NRC) for Cyptosporidiosis, Microsporidia and Other Digestive Protozoa, Clermont-Ferrand, France
| | - Maxime Tressol
- Parasitology-Mycology Department, CHU Clermont-Ferrand, 3IHP, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emilie Fréalle
- Laboratory of Parasitology-Mycology, CHU Lille, 59000, Lille, France
| | | | - Damien Costa
- Laboratory of Parasitology-Mycology, EA7510 ESCAPE, University Hospital of Rouen, Univ Rouen Normandie, Normandy, France
- National Reference Center (NRC) for Cyptosporidiosis, Microsporidia and Other Digestive Protozoa, Rouen, France
| | - Louise Basmaciyan
- Parasitology-Mycology Department, CHU Dijon, Dijon, France
- National Reference Center (NRC) for Cyptosporidiosis, Microsporidia and Other Digestive Protozoa, Dijon, France
| | - Philippe Poirier
- Parasitology-Mycology Department, CHU Clermont-Ferrand, 3IHP, 58 Rue Montalembert, 63000, Clermont-Ferrand, France.
- Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte, M2iSH, UMR INSERM 1071, Clermont Auvergne University, Clermont-Ferrand, France.
- National Reference Center (NRC) for Cyptosporidiosis, Microsporidia and Other Digestive Protozoa, Clermont-Ferrand, France.
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Ahmed SAA, Quattrocchi A, Karanis P. Cryptosporidium sp. infection in solid organ transplant recipients: A systematic review and meta-analysis. Pathog Glob Health 2024; 118:305-316. [PMID: 38054456 PMCID: PMC11234916 DOI: 10.1080/20477724.2023.2290379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
(1) Background: Organ transplant recipients (OTRs) are vulnerable groups at risk of parasitic infections. This systematic review and meta-analysis aimed to evaluate the overall prevalence of Cryptosporidium sp. in OTRs and shed light on this potentially serious complication of organ transplantation. (2) Methods: We systematically searched studies on Cryptosporidium sp. infections in OTRs in four databases (Academia, PubMed, Scopus, and Science Direct). Random effects models were used to calculate pooled prevalence estimates with 95% confidence intervals (CIs). Sub-group and meta-regression analyses were conducted. A quality assessment of the included studies was also performed. (3) Results: Among 876 articles retrieved, 21 were included, accounting for 2,642 OTRs. Twenty studies were cross-sectional in design, of which seven reported data on a comparison group, and one was a retrospective cohort. The pooled prevalence of Cryptosporidium sp. in OTRs was 15% (95% CI: 7.4-24.6). Subgroup analysis revealed that the prevalence of Cryptosporidium sp. infection was higher in adults, symptomatics and developing countries and in studies using only non-molecular methods. However, substantial heterogeneity was reported. Low to moderate heterogeneity was observed in subgroups reporting lower prevalence Cryptosporidium sp. including children (5.8; 95% CI: 2.8-9.6), studies conducted in developed countries (5.8; 95% CI: 3.0-9.4) and studies using both molecular and non-molecular diagnostics (11.4; 95% CI: 6.4-17.4). The majority of the listed research reported low-medium quality scores. (4) Conclusion: Cryptosporidium sp. infection is a significant complication in OTRs with underreported prevalence. Preventive strategies to reduce the burden should include Cryptosporidium sp. routine screening for OTRs, particularly post-transplantation in patients with diarrhea. Additional well-designed research studies are required to determine the extent of the Cryptosporidium sp. burden in OTRs.
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Affiliation(s)
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Panagiotis Karanis
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- Centre of Antomy, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
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Wang Y, Li XM, Yang X, Wang XY, Wei YJ, Cai Y, Geng HL, Yang XB, Yu HL, Cao H, Jiang J. Global prevalence and risk factors of Enterocytozoon bieneusi infection in humans: a systematic review and meta-analysis. Parasite 2024; 31:9. [PMID: 38345479 PMCID: PMC10860563 DOI: 10.1051/parasite/2024007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
Enterocytozoon bieneusi is one of the most important zoonotic pathogens. In this study, we present a systematic review and meta-analysis of the prevalence of human E. bieneusi infection in endemic regions and analyze the various potential risk factors. A total of 75 studies were included. Among 31,644 individuals tested, 2,291 (6.59%) were E. bieneusi-positive. The highest prevalence of E. bieneusi in the male population was 5.50%. The prevalence of E. bieneusi in different age groups was varied, with 10.97% in teenagers. The prevalence of E. bieneusi in asymptomatic patients (6.49%) is significantly lower than that in HIV-infected patients (11.49%), and in patients with diarrheal symptoms (16.45%). Rural areas had a higher rate (7.58%) than urban ones. The prevalence of E. bieneusi in humans was the highest (6.42%) at altitudes <10 m. Moreover, the temperate zone marine climate (13.55%) had the highest prevalence. A total of 69 genotypes of E. bieneusi have been found in humans. This is the first global study regarding E. bieneusi prevalence in humans. Not only people with low immunity (such as the elderly, children, people with HIV, etc.), but also people in Europe in temperate marine climates should exercise caution to prevent infection with E. bieneusi during contact process with animals.
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Affiliation(s)
- Yanchun Wang
- School of Pharmacy, Yancheng Teachers University Yancheng 224002 Jiangsu Province PR China
- College of Life Sciences, Changchun Sci-Tech University Shuangyang 130600 Jilin Province PR China
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd Ningbo 315000 Zhejiang Province PR China
| | - Xiao-Man Li
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Xing Yang
- Department of Medical Microbiology and Immunology, School of Basic Medicine, Dali University Dali 671000 Yunnan Province PR China
| | - Xiang-Yu Wang
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Yong-Jie Wei
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Yanan Cai
- College of Animal Science and Technology, Jilin Agricultural University Changchun 130118 Jilin Province PR China
| | - Hong-Li Geng
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Xin-Bo Yang
- College of Animal Science and Technology, Jilin Agricultural University Changchun 130118 Jilin Province PR China
| | - Hai-Long Yu
- College of Animal Science and Technology, Jilin Agricultural University Changchun 130118 Jilin Province PR China
| | - Hongwei Cao
- School of Pharmacy, Yancheng Teachers University Yancheng 224002 Jiangsu Province PR China
| | - Jing Jiang
- College of Life Sciences, Changchun Sci-Tech University Shuangyang 130600 Jilin Province PR China
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Mallier C, Creuzet E, Lambert C, Delmas J, Mirand A, Rochette E, Valot S, Moniot M, Dalle F, Henquell C, Merlin E, Poirier P, Verdan M, Nourrisson C. Summer diarrhea in children: a monocentric French epidemiological observational study. Sci Rep 2023; 13:15078. [PMID: 37700075 PMCID: PMC10497495 DOI: 10.1038/s41598-023-42098-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Pediatric diarrhea is a major public health problem worldwide. In France, continuous surveillance shows a winter epidemic peak and a more modest summer recrudescence. Few studies describe the infectious agents responsible for pediatric summer diarrhea in France. The objectives were to estimate the prevalence of infectious diarrhea and describe the pathogens responsible for summer diarrhea in children; and to describe common factors that can be used as guidance on the etiology of these diarrheas. A cross-sectional, single-center, epidemiological observational study was conducted in the pediatric emergency department of a French hospital between June and September in 2019 and 2020. Multiplex gastrointestinal pathogen panels were used for diagnostics. A multiple correspondence analysis was used to determine profiles of patients. A total of 95 children were included, of whom 82.1% (78/95) were under five years old. The prevalence of infectious summer diarrhea was 81.1% (77/95, 95%CI 71.7-88.4%). A total of 126 infectious agents were detected (50.0% bacteria, 38.1% viruses, 11.9% parasites). The main enteric pathogens were enteropathogen Escherichia coli (24/126), rotavirus (17/126) and Salmonella (16/126). A co-detection was found in 51.9% (40/77) of cases. Four patient profiles, considering the severity and the pathogen involved, were highlighted.
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Affiliation(s)
- Camille Mallier
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Elisa Creuzet
- Service de Parasitologie-Mycologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Céline Lambert
- DRCI, Unité de Biostatistiques, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Julien Delmas
- Service de Bactériologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Audrey Mirand
- Service de Virologie, CNR des Entérovirus et Parechovirus, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- LMGE UMR CNRS 6023, Equipe EPIE - Epidémiologie et Physiopathologie des Infections à Entérovirus, Faculté de Médecine, Université Clermont Auvergne, 63001, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Stéphane Valot
- Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gérard Mack, 21000, Dijon, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 21000, Dijon, France
| | - Maxime Moniot
- Service de Parasitologie-Mycologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 63000, Clermont-Ferrand, France
| | - Frédéric Dalle
- Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gérard Mack, 21000, Dijon, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 21000, Dijon, France
- AgroSup Dijon, Equipe Vin, Aliment, Microbiologie, Stress, UMR PAM L'Université de Bourgogne Franche-Comté (UBFC), 21000, Dijon, France
| | - Cécile Henquell
- Service de Virologie, CNR des Entérovirus et Parechovirus, 3IHP, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- LMGE UMR CNRS 6023, Equipe EPIE - Epidémiologie et Physiopathologie des Infections à Entérovirus, Faculté de Médecine, Université Clermont Auvergne, 63001, Clermont-Ferrand, France
| | - Etienne Merlin
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
- Unité CRECHE (INSERM CIC1405), Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Philippe Poirier
- Service de Bactériologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 63000, Clermont-Ferrand, France
- Service de Parasitologie-Mycologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France
| | - Matthieu Verdan
- Service de Pédiatrie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Céline Nourrisson
- Service de Bactériologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
- Laboratoire associé du Centre National de Référence "Cryptosporidioses, microsporidies et autres protozooses digestives", 63000, Clermont-Ferrand, France.
- Service de Parasitologie-Mycologie, 3IHP, INSERM, CHU Clermont-Ferrand, Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
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5
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Einhorn N, Lamphier I, Klinkova O, Baluch A, Pasikhova Y, Greene J. Intestinal Coccidian Infections in Cancer Patients: A Case Series. Cureus 2023; 15:e38256. [PMID: 37252590 PMCID: PMC10225162 DOI: 10.7759/cureus.38256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Coccidian protozoa and microsporidian fungi are opportunistic pathogens increasingly implicated in infections in immunosuppressed individuals. These parasites typically infect the intestinal epithelium, resulting in secretory diarrhea and malabsorption. The disease burden and timeline are both greater and longer among immunosuppressed patients. Therapeutic options for immunocompromised individuals are limited. As a result, we wanted to better characterize the disease course and treatment efficacy of these parasitic gastrointestinal infections. Methods We performed a single-center, retrospective MedMined (BD Healthsight Analytics, Birmingham, AL, USA) chart review of patients between January 2012 and June 2022 diagnosed with coccidian or microsporidian infections. Relevant data were collected from Cerner's PowerChart (Oracle Cerner, Austin, TX, USA). Descriptive analysis was performed with IBM SPSS Statistics (IBM Corp., Armonk, NY, USA), and Microsoft Excel (Microsoft, Redmond, WA, USA) was used to generate graphs and tables. Results In these 10 years, there were 17 patients with Cryptosporidium infections, four with Cyclospora infections, and no positive cultures for Cystoisospora belli or microsporidian infections. In both infections, the majority of patients experienced diarrhea, fatigue, and nausea, with vomiting, abdominal pain, appetite loss, weight loss, and fever occurring to a lesser degree. Nitazoxanide was the most common treatment for Cryptosporidium, while trimethoprim-sulfamethoxazole or ciprofloxacin were the treatments of choice for Cyclospora. Of the Cryptosporidium infections, three received combination therapy with azithromycin, immunoreconstitution, or IV immunoglobulins. Among the four Cyclospora-infected patients, one received combination therapy of ciprofloxacin and trimethoprim-sulfamethoxazole. Treatment lasted around two weeks, and 88% of Cryptosporidium patients and 75% of Cyclospora patients had a resolution of symptoms. Conclusion The most detected coccidian infection was Cryptosporidium, followed by Cyclospora, with the lack of Cystoisospora or microsporidian infections likely due to diagnostic limitations and prevalence. Cryptosporidium and Cyclospora likely caused their associated symptoms in most cases, with other possible etiologies, including graft-versus-host disease, medications, and feeding tubes. The small number of patients receiving combination therapy prohibited a comparison with monotherapy. In our patient population, though, there was a clinical response to treatment despite immunosuppression. While promising, additional randomized control experiments are required to fully understand the efficacy of parasitic treatments.
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Affiliation(s)
- Nathan Einhorn
- Infectious Diseases, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Isis Lamphier
- Infection Control, Moffitt Cancer Center, Tampa, USA
| | - Olga Klinkova
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
| | - Aliyah Baluch
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
| | | | - John Greene
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
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Moniot M, Nourrisson C, Bonnin V, Damiani C, Argy N, Bonhomme J, Fréalle E, Angebault C, Debourgogne A, Sitterlé E, Flori P, Brunet J, Dalle F, Favennec L, Poirier P. Evaluation of the Bio-Evolution Microsporidia generic and typing real-time PCR assays for the diagnosis of intestinal microsporidiosis. Parasite 2022; 29:55. [PMID: 36426934 PMCID: PMC9879149 DOI: 10.1051/parasite/2022055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
Cases of intestinal microsporidiosis infection are underestimated and affect both immunocompromized and immunocompetent patients. Real-time PCR is superseding microscopic examination for its diagnosis in medical analysis laboratories. However, few manufacturers include microsporidia in their PCR panel for the diagnosis of infectious gastroenteritis. Here, we evaluated the performances of the real-time PCR assays microsporidia generic and microsporidia typing (Bio-Evolution, France) on the Rotor-Gene Q real-time PCR cycler (Qiagen, France). We included 45 negative and 44 positive stool samples for Enterocytozoon bieneusi (n = 34, with various genotypes), Encephalitozoon intestinalis (n = 4), Encephalitozoon hellem (n = 4), and Encephalitozoon cuniculi (n = 2). We also studied a four-year survey of an inter-laboratory quality control program including 9 centers that used this commercial assay. Sensitivity and specificity of the microsporidia generic assay were 86.4% and 93.3%, respectively. Encephalitozoon hellem and Encephalitozoon cuniculi were detected by the microsporidia generic PCR assay but not by the microsporidia typing PCR assay. These results were consistent with the results of the inter-laboratory quality control program. In conclusion, Bio-Evolution Real-time PCR assays are useful tools for intestinal microsporidiosis, but negative results for microsporidia typing assays require supplementary analyses to confirm E. hellem or E. cuniculi infections.
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Affiliation(s)
- Maxime Moniot
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, 3IHP 63003 Clermont-Ferrand France
| | - Céline Nourrisson
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, 3IHP 63003 Clermont-Ferrand France,Microbes, Intestin, Inflammation et Susceptibilité de l’Hôte (M2iSH), UMR Inserm/Université Clermont Auvergne U1071, USC INRA 2018 63000 Clermont-Ferrand France
| | - Virginie Bonnin
- Microbes, Intestin, Inflammation et Susceptibilité de l’Hôte (M2iSH), UMR Inserm/Université Clermont Auvergne U1071, USC INRA 2018 63000 Clermont-Ferrand France
| | - Céline Damiani
- Laboratoire de Parasitologie et Mycologie Médicales, CBH, CHU Amiens Picardie; Equipe Agents Infectieux, Résistance et Chimiothérapie (AGIR) UR4294, Université de Picardie Jules Verne 80480 Amiens France
| | - Nicolas Argy
- Service de Parasitologie Mycologie, CHU Bichat-Claude-Bernard, Assistance Publique des Hôpitaux de Paris (APHP); IRD UMR MERIT 261, Faculté de Pharmacie, Université de Paris Cité 75018 Paris France
| | - Julie Bonhomme
- Service de Microbiologie, CHU Caen, ToxEMAC-ABTE, Normandie Univ, Unicaen & Unirouen 14033 Caen France
| | - Emilie Fréalle
- Laboratoire de Parasitologie et Mycologie Médicale, CHU Lille 59037 Lille France
| | - Cécile Angebault
- Unité de Parasitologie-Mycologie, Département de Prévention, Diagnostic et Traitement des Infections, CHU Henri Mondor, AP-HP; EA DYNAMiC 7380, Faculté de Santé, Univ Paris-Est Créteil 94000 Créteil France
| | | | - Emilie Sitterlé
- Unité de Parasitologie-Mycologie, Service de Microbiologie clinique, GHU Necker-Enfants-Malades, Assistance Publique des Hôpitaux de Paris (APHP) 75743 Paris France
| | - Pierre Flori
- Laboratoire de Parasitologie Mycologie, CHU Saint-Etienne 42055 Saint-Etienne France
| | - Julie Brunet
- Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg 67091 Strasbourg France
| | - Frédéric Dalle
- Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-universitaire CHU Dijon; UMR PAM Univ Bourgogne Franche-Comté – AgroSup Dijon – Equipe Vin, Aliment, Microbiologie, Stress 21079 Dijon France,CNR LE Cryptosporidioses, Santé Publique France 76031 Rouen France
| | - Loïc Favennec
- Service de Parasitologie Mycologie, CHU Rouen; EA ESCAPE 7510, Université de Rouen Normandie 76031 Rouen France,CNR LE Cryptosporidioses, Santé Publique France 76031 Rouen France
| | - Philippe Poirier
- Laboratoire de Parasitologie-Mycologie, CHU Clermont-Ferrand, 3IHP 63003 Clermont-Ferrand France,Microbes, Intestin, Inflammation et Susceptibilité de l’Hôte (M2iSH), UMR Inserm/Université Clermont Auvergne U1071, USC INRA 2018 63000 Clermont-Ferrand France,Corresponding author:
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Tomczak E, McDougal AN, White AC. Resolution of Cryptosporidiosis in Transplant Recipients: Review of the Literature and Presentation of a Renal Transplant Patient Treated With Nitazoxanide, Azithromycin, and Rifaximin. Open Forum Infect Dis 2022; 9:ofab610. [PMID: 34993260 PMCID: PMC8719605 DOI: 10.1093/ofid/ofab610] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/02/2021] [Indexed: 01/15/2023] Open
Abstract
Background Cryptosporidium is a major cause of diarrheal disease worldwide, including chronic disease in malnourished children and patients with acquired immune deficiency syndrome. There are increasing reports of cryptosporidiosis in transplant patients, especially from middle-income countries. Methods The literature on treatment of cryptosporidiosis in transplant patients was reviewed and included no controlled trials but only small case series. Nitazoxanide, azithromycin, spiramycin, and combination therapies have been used, but none are consistently efficacious. Results We present a case of chronic diarrhea from cryptosporidiosis in a renal transplant patient. His illness resolved with decreasing immunosuppression and treatment with the 3-drug combination of nitazoxanide, azithromycin, and rifaximin. Conclusions Although current therapies are not reliably effective in the absence of an effective cellular immune response, combination therapies hold promise for improved responses.
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Affiliation(s)
- Ewa Tomczak
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - April N McDougal
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Dumond C, Aulagnon F, Etienne I, Heng AE, Bougnoux ME, Favennec L, Kamar N, Iriart X, Pereira B, Büchler M, Desoubeaux G, Kaminski H, Lussac-Sorton F, Gargala G, Anglicheau D, Poirier P, Scemla A, Garrouste C. Epidemiological and clinical study of microsporidiosis in French kidney transplant recipients from 2005 to 2019: TRANS-SPORE registry. Transpl Infect Dis 2021; 23:e13708. [PMID: 34324771 DOI: 10.1111/tid.13708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Microsporidiosis is an emerging opportunistic infection in renal transplantation (RT) recipients. We aimed to describe its clinical presentation and treatment. MATERIALS AND METHODS We collected microsporidiosis cases identified in RT recipients between 2005 and 2019 in six French centers from the Crystal, Divat and Astre prospective databases. RESULTS We report 68 RT recipients with intestinal microsporidiosis; the patients were predominantly male (61.8%), with a median age of 58 (46-69) years. Infection occurred at a median time of 3 (0.8-6.8) years posttransplant. Only Enterocytozoon bieneusi was found. Microsporidiosis manifested as diarrhea (98.5% of patients) with weight loss (72.1%) and acute renal injury (57.4%) without inflammatory biological parameters. The therapeutic approaches were no treatment (N = 9), reduction of the immunosuppressive regimen (∆IS) (N = 22), fumagillin alone (N = 9), fumagillin and ∆IS (N = 19), and albendazole or nitazoxanide and ∆IS (N = 9). Overall clinical remission was observed in 60 patients (88.2%). We observed no acute kidney rejection, renal transplant failure, or death within 6 months after microsporidiosis. CONCLUSION E. bieneusi is an underestimated opportunistic pathogen in RT recipients, and infection with E. bieneusi leads to diarrhea with important dehydration and acute renal injury. The treatment is based on the reduction of the immunosuppressive regimen and the administration of fumagillin if available.
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Affiliation(s)
- Clément Dumond
- Department of Nephrology, 3iHP, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Florence Aulagnon
- Department of Nephrology and Kidney Transplantation, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Paris, France
| | - Isabelle Etienne
- Department of Nephrology, Rouen University Hospital, Rouen, France
| | - Anne-Elisabeth Heng
- Department of Nephrology, 3iHP, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marie-Elisabeth Bougnoux
- Department of Parasitology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loic Favennec
- Department of Parasitology, Rouen University Hospital, University of Rouen, Mont-Saint-Aignan, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Center for Pathophysiology of Toulouse Purpan, Paul Sabatier University, Toulouse, France
| | - Xavier Iriart
- Service de Parasitologie-Mycologie, CHU Toulouse, Hôpital Purpan, Toulouse, France.,Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), CNRS UMR5051, INSERM UMR1291, UPS, Université Toulouse, Toulouse, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Mathias Büchler
- Department of Nephrology and Clinical Immunology, Tours University Hospital, Tours, France
| | - Guillaume Desoubeaux
- Department of Parasitology-Mycology- Tropical Medicine, Tours University Hospital, Tours, France
| | - Hannah Kaminski
- Department of Nephrology, Bordeaux University Hospital, Bordeaux, France
| | | | - Gilles Gargala
- Department of Parasitology, Rouen University Hospital, University of Rouen, Mont-Saint-Aignan, France
| | - Dany Anglicheau
- Department of Nephrology and Kidney Transplantation, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Paris, France
| | - Philippe Poirier
- Department of Parasitology, Clermont-Ferrand University Hospital, 3iHP, Clermont-Ferrand, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Scemla
- Department of Nephrology and Kidney Transplantation, Assistance Publique-Hôpitaux de Paris, Necker Hospital, Paris, France
| | - Cyril Garrouste
- Department of Nephrology, 3iHP, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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- Department of Nephrology, 3iHP, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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9
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Dumortier J, Radenne S, Kamar N, Conti F, Abergel A, Coilly A, Francoz C, Houssel-Debry P, Vanlemmens C, Laverdure N, Duvoux C, Iriart X, Thellier M, Angoulvant A, Argy N, Autier B, Bellanger AP, Botterel F, Garrouste C, Rabodonirina M, Poirier P. Microsporidiosis after liver transplantation: A French nationwide retrospective study. Transpl Infect Dis 2021; 23:e13665. [PMID: 34101311 DOI: 10.1111/tid.13665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Microsporidiosis has been largely reported in patients with acquired immunodeficiency syndrome, but emerged as a cause of persistent diarrhea in solid organ transplant patients. METHODS Through the French Microsporidiosis Network and the Groupe français de recherche en greffe de foie, we collected all microsporidiosis cases identified in liver transplant patients between 1995 and 2020 in France. RESULTS We identified 24 liver transplant recipients with microsporidiosis. Sex ratio was balanced and median age was 58.8 (3.5-83.5) years (there were 4 children). Microsporidiosis occurred at a median time of 3.9 (0.1-18.9) years post-transplant. Median duration of diarrhea before diagnosis was 22 days (12-45). Therapeutic care included immunosuppressive therapy changes in 20 patients, as follows: stop cyclosporine or tacrolimus (n = 2), dose reduction of cyclosporine or tacrolimus (n = 12), stop MMF (n = 5), and dose reduction of corticosteroids (n = 1). In addition, 15 patients received specific therapy against microsporidiosis: fumagillin (n = 11) or albendazole (n = 4). Median duration of treatment was 14 days (8-45 days). Finally, 7 patients had immunosuppressive treatment tapering only. Microsporidiosis was complicated by renal failure in 15 patients, requiring dialysis in one case. Two patients had infection relapse. No patient presented proven rejection within the 3 months after microsporidiosis. None of the patients died within the 3 months after microsporidiosis. CONCLUSIONS Microsporidiosis is a very rare infection after liver transplantation but can induce severe dehydration and renal failure. Therefore, it must be systematically sought in any case of persistent diarrhea after first line screening of frequent infectious causes.
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Affiliation(s)
- Jérôme Dumortier
- Hospices civils de Lyon, Hôpital Edouard Herriot, Unité de transplantation hépatique, et Université Claude Bernard Lyon 1, Lyon, France
| | - Sylvie Radenne
- Service d'Hépato-Gastroentérologie, Hospices civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Toulouse Rangueil, INSERM U1043, Université Paul Sabatier, Toulouse, France
| | - Filomena Conti
- Service d'hépatologie et transplantation hépatique, APHP - Hôpital de la Pitié Salpêtrière, Paris, France
| | - Armand Abergel
- CHU Clermont-Ferrand, Médecine digestive, Institut Pascal., UMR 6602 UCA CNRS SIGMA, Clermont-Ferrand, France
| | - Audrey Coilly
- AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, et INSERM, Unité 1193, Villejuif, France
| | - Claire Francoz
- APHP, Hôpital Beaujon, Service d'Hépatologie et Transplantation Hépatique, Université Paris Diderot - INSERM U1149, Clichy, France
| | - Pauline Houssel-Debry
- Service des Maladies du foie, CHU de Rennes, Hôpital de Pontchaillou, Rennes, France
| | - Claire Vanlemmens
- Service d'Hépatologie et Soins Intensifs Digestifs, CHU de Besançon, Hôpital Jean Minjoz, Besançon, France
| | - Noémie Laverdure
- Service d'Hépato-Gastroentérologie et Nutrition pédiatriques, Hospices civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | | | - Xavier Iriart
- Service de Parasitologie-Mycologie, CHU Toulouse, Hôpital Purpan, et Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse, CNRS UMR5051, INSERM UMR1291, UPS, Toulouse, France
| | - Marc Thellier
- Service de Parasitologie-Mycologie, APHP - Hôpital de la Pitié Salpêtrière, Paris, France
| | - Adela Angoulvant
- Service de Maladies infectieuses et Tropicale, APHP -Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Nicolas Argy
- Service de Parasitologie-Mycologie, APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Brice Autier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, Rennes, France
| | | | - Françoise Botterel
- Service de Maladies infectieuses et Tropicale, APHP -Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Cyril Garrouste
- Service de Néphrologie et transplantation rénale, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Meja Rabodonirina
- Service de Parasitologie, Hospices civils de Lyon, Hôpital de la Croix-Rousse, et Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Poirier
- Service de Parasitologie-Mycologie, CHU Clermont-Ferrand, 3iHP, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
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10
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Etymologia: Enterocytozoon bieneusi. Emerg Infect Dis 2021. [PMCID: PMC8153887 DOI: 10.3201/eid2706.et2706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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