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Abstract
Microsporidia are pathogenic organism related to fungi. They cause infections in a wide variety of mammals as well as in avian, amphibian, and reptilian hosts. Many microsporidia species play an important role in the development of serious diseases that have significant implications in human and veterinary medicine. While microsporidia were originally considered to be opportunistic pathogens in humans, it is now understood that infections also occur in immune competent humans. Encephalitozoon cuniculi, Encephalitozoon intestinalis, and Enterocytozoon bieneusi are primarily mammalian pathogens. However, many other species of microsporidia that have some other primary host that is not a mammal have been reported to cause sporadic mammalian infections. Experimental models and observations in natural infections have demonstrated that microsporidia can cause a latent infection in mammalian hosts. This chapter reviews the published studies on mammalian microsporidiosis and the data on chronic infections due to these enigmatic pathogens.
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Affiliation(s)
- Bohumil Sak
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, České Budějovice, Czech Republic.
| | - Martin Kváč
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, České Budějovice, Czech Republic
- Faculty of Agriculture, University of South Bohemia in České Budějovice, České Budějovice, Czech Republic
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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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Infections in Heart, Lung, and Heart-Lung Transplantation. PRINCIPLES AND PRACTICE OF TRANSPLANT INFECTIOUS DISEASES 2019. [PMCID: PMC7121494 DOI: 10.1007/978-1-4939-9034-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Half a century has passed since the first orthotopic heart transplant took place. Surgical innovations allowed for heart, lung, and heart-lung transplantation to save lives of patients with incurable chronic cardiopulmonary conditions. The complexity of the surgical interventions, chronic host health conditions, and antirejection immunosuppressive medications makes infectious complications common. Infections have remained one of the main barriers for successful transplantation and a source of significant morbidity and mortality. Recognition of infections and its management in this setting require outstanding clinical skills since transplant recipients may not exhibit classic signs or symptoms of disease, and laboratory work has some pitfalls. The prevention, identification, and management of infectious diseases complications in this population are a priority to undertake to improve the medical outcomes of transplantation. Herein, we reviewed the historical aspects, epidemiology, and prophylaxis of infections in heart, lung, and heart-lung transplantation. We also discuss the most prevalent organisms affecting the host and the organ systems involved.
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Garcia LS, Arrowood M, Kokoskin E, Paltridge GP, Pillai DR, Procop GW, Ryan N, Shimizu RY, Visvesvara G. Practical Guidance for Clinical Microbiology Laboratories: Laboratory Diagnosis of Parasites from the Gastrointestinal Tract. Clin Microbiol Rev 2018; 31:e00025-17. [PMID: 29142079 PMCID: PMC5740970 DOI: 10.1128/cmr.00025-17] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This Practical Guidance for Clinical Microbiology document on the laboratory diagnosis of parasites from the gastrointestinal tract provides practical information for the recovery and identification of relevant human parasites. The document is based on a comprehensive literature review and expert consensus on relevant diagnostic methods. However, it does not include didactic information on human parasite life cycles, organism morphology, clinical disease, pathogenesis, treatment, or epidemiology and prevention. As greater emphasis is placed on neglected tropical diseases, it becomes highly probable that patients with gastrointestinal parasitic infections will become more widely recognized in areas where parasites are endemic and not endemic. Generally, these methods are nonautomated and require extensive bench experience for accurate performance and interpretation.
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Affiliation(s)
| | - Michael Arrowood
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Waterborne Disease Prevention Branch, Atlanta, Georgia, USA
| | - Evelyne Kokoskin
- Public Health Ontario, Ottawa, Ontario, Canada
- Public Health Laboratories-Ottawa, Ottawa, Ontario, Canada
| | | | - Dylan R Pillai
- Calgary Laboratory Services, Diagnostic and Scientific Centre, Calgary, Alberta, Canada
| | - Gary W Procop
- Enterprise Test Utilization and Pathology Consultative Services, Cleveland, Ohio, USA
- Molecular Microbiology, Parasitology, and Mycology Laboratories, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Norbert Ryan
- Bacteriology and Parasitology, Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, Melbourne, Victoria, Australia
| | | | - Govinda Visvesvara
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne, and Environmental Diseases, Waterborne Disease Prevention Branch, Atlanta, Georgia, USA
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Desoubeaux G, Maakaroun-Vermesse Z, Lier C, Bailly É, Morio F, Labarthe F, Bernard L, Chandenier J. Successful treatment with fumagillin of the first pediatric case of digestive microsporidiosis in a liver-kidney transplant. Transpl Infect Dis 2013; 15:E250-9. [DOI: 10.1111/tid.12158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/13/2013] [Accepted: 09/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- G. Desoubeaux
- Service de Parasitologie - Mycologie - Médecine tropicale; CHU de Tours; Tours France
- Faculté de Médecine; Université François Rabelais; CEPR UMR INSERM U1100/E.A. 6305; Tours France
| | - Z. Maakaroun-Vermesse
- Service de Médecine Interne et Maladies Infectieuses; CHU de Tours; Tours France
- Service de Médecine Pédiatrique; CHU de Tours; Tours France
| | - C. Lier
- Service de Parasitologie - Mycologie - Médecine tropicale; CHU de Tours; Tours France
| | - É. Bailly
- Service de Parasitologie - Mycologie - Médecine tropicale; CHU de Tours; Tours France
| | - F. Morio
- Laboratoire de Parasitologie et Mycologie Médicale; CHU de Nantes; Nantes France
- IICiMed/E.A. 1155; Université de Nantes; Nantes France
| | - F. Labarthe
- Service de Médecine Pédiatrique; CHU de Tours; Tours France
- Faculté de Médecine; Université François Rabelais; N2C INSERM U1069; Tours France
| | - L. Bernard
- Faculté de Médecine; Université François Rabelais; CEPR UMR INSERM U1100/E.A. 6305; Tours France
- Service de Médecine Interne et Maladies Infectieuses; CHU de Tours; Tours France
| | - J. Chandenier
- Service de Parasitologie - Mycologie - Médecine tropicale; CHU de Tours; Tours France
- Faculté de Médecine; Université François Rabelais; CEPR UMR INSERM U1100/E.A. 6305; Tours France
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