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Ataş AD, Akın-Polat Z, Gülpınar DG, Şahin N. The first evaluation of the in vitro effects of silver(I)-N-heterocyclic carbene complexes on Encephalitozoon intestinalis and Leishmania major promastigotes. J Biol Inorg Chem 2024:10.1007/s00775-024-02063-z. [PMID: 38918208 DOI: 10.1007/s00775-024-02063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024]
Abstract
Encephalitozoon intestinalis is an opportunistic microsporidian parasite that primarily infects immunocompromised individuals, such as those with HIV/AIDS or undergoing organ transplantation. Leishmaniasis is responsible for parasitic infections, particularly in developing countries. The disease has not been effectively controlled due to the lack of an effective vaccine and affordable treatment options. Current treatment options for E. intestinalis infection and leishmaniasis are limited and often associated with adverse side effects. There is no previous study in the literature on the antimicrosporidial activities of Ag(I)-N-heterocyclic carbene compounds. In this study, the in vitro antimicrosporidial activities of previously synthesized Ag(I)-N-heterocyclic carbene complexes were evaluated using E. intestinalis spores cultured in human renal epithelial cell lines (HEK-293). Inhibition of microsporidian replication was determined by spore counting. In addition, the effects of the compounds on Leishmania major promastigotes were assessed by measuring metabolic activity or cell viability using a tetrazolium reaction. Statistical analysis was performed to determine significant differences between treated and control groups. Our results showed that the growth of E. intestinalis and L. major promastigotes was inhibited by the tested compounds in a concentration-dependent manner. A significant decrease in parasite viability was observed at the highest concentrations. These results suggest that the compounds have potential anti-microsporidial and anti-leishmanial activity. Further research is required to elucidate the underlying mechanisms of action and to evaluate the efficacy of the compounds in animal models or clinical trials.
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Affiliation(s)
- Ahmet Duran Ataş
- Departments of Parasitology, Faculty of Medicine, Cumhuriyet University, 58140, Sivas, Turkey
| | - Zübeyda Akın-Polat
- Departments of Parasitology, Faculty of Medicine, Cumhuriyet University, 58140, Sivas, Turkey.
| | - Derya Gül Gülpınar
- Departments of Parasitology, Faculty of Medicine, Cumhuriyet University, 58140, Sivas, Turkey
| | - Neslihan Şahin
- Department of Science Education, Faculty of Education, Cumhuriyet University, 58040, Sivas, Turkey.
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Savigamin C, Khositharattanakool P, Somwang P, Wacharapluesadee S, Siriyasatien P, Preativatanyou K. Identification of common human infectious and potentially zoonotic novel genotypes of Enterocytozoon bieneusi in cavernicolous bats in Thailand. Parasitol Res 2024; 123:233. [PMID: 38850488 DOI: 10.1007/s00436-024-08253-7] [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: 03/21/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
Enterocytozoon bieneusi is a common cause of human microsporidiosis and can infect a variety of animal hosts worldwide. In Thailand, previous studies have shown that this parasite is common in domestic animals. However, information on the prevalence and genotypes of this parasite in other synanthropic wildlife, including bats, remains limited. Several pathogens have been previously detected in bats, suggesting that bats may serve as a reservoir for this parasite. In this study, a total of 105 bat guano samples were collected from six different sites throughout Thailand. Of these, 16 from Chonburi (eastern), Ratchaburi (western), and Chiang Rai (northern) provinces tested positive for E. bieneusi, representing an overall prevalence of 15.2%. Based on ITS1 sequence analysis, 12 genotypes were identified, including two known genotypes (D and type IV) frequently detected in humans and ten novel potentially zoonotic genotypes (TBAT01-TBAT10), all belonging to zoonotic group 1. Lyle's flying fox (Pteropus lylei), commonly found in Southeast Asia, was identified as the host in one sample that was also positive for E. bieneusi. Network analysis of E. bieneusi sequences detected in this study and those previously reported in Thailand also revealed intraspecific divergence and recent population expansion, possibly due to adaptive evolution associated with host range expansion. Our data revealed, for the first time, multiple E. bieneusi genotypes of zoonotic significance circulating in Thai bats and demonstrated that bat guano fertilizer may be a vehicle for disease transmission.
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Affiliation(s)
- Chatuthanai Savigamin
- Medical Science Program, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Pathamet Khositharattanakool
- School of Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
- Biomedical Technology Research Group for Vulnerable Populations, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Puckavadee Somwang
- School of Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
- Biomedical Technology Research Group for Vulnerable Populations, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - Supaporn Wacharapluesadee
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Padet Siriyasatien
- Center of Excellence in Vector Biology and Vector-Borne Disease, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kanok Preativatanyou
- Center of Excellence in Vector Biology and Vector-Borne Disease, Chulalongkorn University, Bangkok, 10330, Thailand.
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Antimicrobial Activity Developed by Scorpion Venoms and Its Peptide Component. Toxins (Basel) 2022; 14:toxins14110740. [PMID: 36355990 PMCID: PMC9693228 DOI: 10.3390/toxins14110740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 10/23/2022] [Indexed: 01/26/2023] Open
Abstract
Microbial infections represent a problem of great importance at the public health level, with a high rate of morbidity-mortality worldwide. However, treating the different diseases generated by microorganisms requires a gradual increase in acquired resistance when applying or using them against various antibiotic therapies. Resistance is caused by various molecular mechanisms of microorganisms, thus reducing their effectiveness. Consequently, there is a need to search for new opportunities through natural sources with antimicrobial activity. One alternative is using peptides present in different scorpion venoms, specifically from the Buthidae family. Different peptides with biological activity in microorganisms have been characterized as preventing their growth or inhibiting their replication. Therefore, they represent an alternative to be used in the design and development of new-generation antimicrobial drugs in different types of microorganisms, such as bacteria, fungi, viruses, and parasites. Essential aspects for its disclosure, as shown in this review, are the studies carried out on different types of peptides in scorpion venoms with activity against pathogenic microorganisms, highlighting their high therapeutic potential.
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Mülayim S, Dalkılıç S, Akbulut HH, Aksoy A, Kaplan M. Investigation of the relationship between lymphocyte subsets and intestinal parasites. Acta Trop 2022; 225:106221. [PMID: 34757042 DOI: 10.1016/j.actatropica.2021.106221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/21/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022]
Abstract
We analyzed the peripheral blood lymphocyte subsets of cancer patients infected with intestinal parasites, with an aim to find out the relationship between the levels of different types of lymphocytes with the prognosis of patients. 201 cancer patients aged 18 and over were included. Stool samples of the patients were examined using native-lugol, trichrome, modified trichrome (Weber's Trichrome stain), and modified Ziehl-Neelsen staining methods. Microsporidia and Cryptosporidium parvum were investigated at the genus and species levels using PCR. Lymphocyte subsets were determined by flow cytometry in blood samples. One or more parasite species were detected in 115 (56.7%) patients. The most common parasite species were Microsporidia, Blastocystis and Entamoeba coli, respectively. The frequency of parasites was high in patients with low lymphocyte percentage, CD3+ T cell and CD3+ CD4+ T (Th) cell levels in blood samples studied by flow cytometry. Microsporidia infection was significantly higher in patients with low lymphocyte percentage and Th cell levels. Similarly, C. parvum infection was found to be significantly higher in patients with low T lymphocyte percentage and Th cell level. Finally, Blastocystis infection was significantly higher in patients with low lymphocyte percentage and CD4/CD8 ratio higher than 1. The decrease in lymphocyte percentage, CD3+ T cell and Th cell count, and low CD4/CD8 ratio in cancer patients increase the frequency of intestinal parasitic infections. Based on these results, lymphocyte subsets may help identify cancer patients at high risk of opportunistic parasites. We suggest that opportunistic parasitic infections affecting the clinical course of the disease should be considered by clinicians during the follow-up and treatment of patients.
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Affiliation(s)
- Sefa Mülayim
- Department of Medical Parasitology, Faculty of Medicine, Fırat University, 23000, Elazığ, Turkey.
| | - Semih Dalkılıç
- Department of Biology, Faculty of Science, Firat University, 23000, Elazığ, Turkey
| | - H Handan Akbulut
- Department of Immunology, Firat University Faculty of Medicine, 23000, Elazig, Turkey
| | - Asude Aksoy
- Department of Medical Oncology, Faculty of Medicine, Fırat University, 23000, Elazig, Turkey
| | - Mustafa Kaplan
- Department of Medical Parasitology, Faculty of Medicine, Fırat University, 23000, Elazığ, Turkey
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Koehler AV, Zhang Y, Gasser RB. A Perspective on the Molecular Identification, Classification, and Epidemiology of Enterocytozoon bieneusi of Animals. EXPERIENTIA SUPPLEMENTUM (2012) 2022; 114:389-415. [PMID: 35544010 DOI: 10.1007/978-3-030-93306-7_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The microsporidian Enterocytozoon bieneusi is an obligate intracellular pathogen that causes enteric disease (microsporidiosis) in humans and has been recorded in a wide range of animal species worldwide. The transmission of E. bieneusi is direct and likely occurs from person to person and from animal to person via the ingestion of spores in water, food, or the environment. The identification of E. bieneusi is usually accomplished by molecular means, typically using the sequence of the internal transcribed spacer (ITS) region of nuclear ribosomal DNA. Currently, ~820 distinct genotypes of E. bieneusi have been recorded in at least 210 species of vertebrates (mammals, birds, reptiles, and amphibians) or invertebrates (insects and mussels) in more than 50 countries. In this chapter, we provide a perspective on (1) clinical aspects of human microsporidiosis; (2) the genome and DNA markers for E. bieneusi as well as molecular methods for the specific and genotypic identification of E. bieneusi; (3) epidemiological aspects of E. bieneusi of animals and humans, with an emphasis on the genotypes proposed to be zoonotic, human-specific, and animal-specific; and (4) future research directions to underpin expanded molecular studies to better understand E. bieneusi and microsporidiosis.
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Affiliation(s)
- Anson V Koehler
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Yan Zhang
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, China
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.
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Makharia G, Mohta S, Sridharan S, Gopalakrishnan R, Prasad N, Bansal S. Diarrhea in solid organ transplant recipients in the South Asian Region - Expert group opinion for diagnosis and management. INDIAN JOURNAL OF TRANSPLANTATION 2022; 16:23. [DOI: 10.4103/ijot.ijot_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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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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Maillard A, Scemla A, Laffy B, Mahloul N, Molina JM. Safety and efficacy of fumagillin for the treatment of intestinal microsporidiosis. A French prospective cohort study. J Antimicrob Chemother 2021; 76:487-494. [PMID: 33128055 DOI: 10.1093/jac/dkaa438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Intestinal microsporidiosis due to Enterocytozoon bieneusi is a cause of chronic diarrhoea in immunocompromised patients. Fumagillin has been approved in France for its treatment. OBJECTIVES To investigate the efficacy and safety of fumagillin in a real-life setting. METHODS As required by the French Medicine Agency, all patients receiving fumagillin were enrolled in a prospective study to evaluate its efficacy and safety. Stool examination with identification of E. bieneusi by PCR was performed at baseline, end of treatment and monthly thereafter for 6 months. Safety was monitored up to 6 months and full blood counts were monitored up to 42 days after treatment initiation. The primary endpoint was safety. Parasite clearance and relapses were secondary endpoints. RESULTS From 2007 to 2018, 166 patients received fumagillin, including 6 children. Patients were transplant recipients (84%), HIV-infected patients (13%) or had another cause of immunosuppression (5%). Serious adverse events were reported in 41 patients (25%), mainly thrombocytopenia (15%) and neutropenia (5%), with two haemorrhagic events leading to one death. Severe thrombocytopenia (<50 G/L) developed in 50 patients (29.6%), neutropenia (<1 G/L) in 20 patients (11.8%) and severe anaemia (<8 g/dL) in 21 patients (12.4%). At the end of treatment, 94% of patients with available stool examination (n = 132) had no spores detected. Among 99 patients with available follow-up after the end of treatment, three parasite relapses were documented. CONCLUSIONS E. bieneusi microsporidiosis was mainly diagnosed in transplant recipients. Fumagillin was associated with haematological toxicity but showed high efficacy with a low relapse rate.
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Affiliation(s)
- Alexis Maillard
- Department of Infectious Diseases, St-Louis Hospital, APHP and University of Paris, France
| | - Anne Scemla
- Kidney Transplant Unit, Hôpital Necker Enfants Malades, APHP and University of Paris, France
| | - Benjamin Laffy
- Kidney Transplant Unit, Hôpital Saint-Louis, APHP and University of Paris, France
| | - Nadir Mahloul
- Medical Department, Sanofi-Aventis France, Gentilly, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, St-Louis Hospital, APHP and University of Paris, France
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Abstract
Microsporidia are obligate intracellular pathogens identified ∼150 years ago as the cause of pébrine, an economically important infection in silkworms. There are about 220 genera and 1,700 species of microsporidia, which are classified based on their ultrastructural features, developmental cycle, host-parasite relationship, and molecular analysis. Phylogenetic analysis suggests that microsporidia are related to the fungi, being grouped with the Cryptomycota as a basal branch or sister group to the fungi. Microsporidia can be transmitted by food and water and are likely zoonotic, as they parasitize a wide range of invertebrate and vertebrate hosts. Infection in humans occurs in both immunocompetent and immunodeficient hosts, e.g., in patients with organ transplantation, patients with advanced human immunodeficiency virus (HIV) infection, and patients receiving immune modulatory therapy such as anti-tumor necrosis factor alpha antibody. Clusters of infections due to latent infection in transplanted organs have also been demonstrated. Gastrointestinal infection is the most common manifestation; however, microsporidia can infect virtually any organ system, and infection has resulted in keratitis, myositis, cholecystitis, sinusitis, and encephalitis. Both albendazole and fumagillin have efficacy for the treatment of various species of microsporidia; however, albendazole has limited efficacy for the treatment of Enterocytozoon bieneusi. In addition, immune restoration can lead to resolution of infection. While the prevalence rate of microsporidiosis in patients with AIDS has fallen in the United States, due to the widespread use of combination antiretroviral therapy (cART), infection continues to occur throughout the world and is still seen in the United States in the setting of cART if a low CD4 count persists.
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Chai JY, Jung BK, Hong SJ. Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update. THE KOREAN JOURNAL OF PARASITOLOGY 2021; 59:189-225. [PMID: 34218593 PMCID: PMC8255490 DOI: 10.3347/kjp.2021.59.3.189] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022]
Abstract
The use of albendazole and mebendazole, i.e., benzimidazole broad-spectrum anthelmintics, in treatment of parasitic infections, as well as cancers, is briefly reviewed. These drugs are known to block the microtubule systems of parasites and mammalian cells leading to inhibition of glucose uptake and transport and finally cell death. Eventually they exhibit ovicidal, larvicidal, and vermicidal effects on parasites, and tumoricidal effects on hosts. Albendazole and mebendazole are most frequently prescribed for treatment of intestinal nematode infections (ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis) and can also be used for intestinal tapeworm infections (taeniases and hymenolepiasis). However, these drugs also exhibit considerable therapeutic effects against tissue nematode/cestode infections (visceral, ocular, neural, and cutaneous larva migrans, anisakiasis, trichinosis, hepatic and intestinal capillariasis, angiostrongyliasis, gnathostomiasis, gongylonemiasis, thelaziasis, dracunculiasis, cerebral and subcutaneous cysticercosis, and echinococcosis). Albendazole is also used for treatment of filarial infections (lymphatic filariasis, onchocerciasis, loiasis, mansonellosis, and dirofilariasis) alone or in combination with other drugs, such as ivermectin or diethylcarbamazine. Albendazole was tried even for treatment of trematode (fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections) and protozoan infections (giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis). These drugs are generally safe with few side effects; however, when they are used for prolonged time (>14-28 days) or even only 1 time, liver toxicity and other side reactions may occur. In hookworms, Trichuris trichiura, possibly Ascaris lumbricoides, Wuchereria bancrofti, and Giardia sp., there are emerging issues of drug resistance. It is of particular note that albendazole and mebendazole have been repositioned as promising anti-cancer drugs. These drugs have been shown to be active in vitro and in vivo (animals) against liver, lung, ovary, prostate, colorectal, breast, head and neck cancers, and melanoma. Two clinical reports for albendazole and 2 case reports for mebendazole have revealed promising effects of these drugs in human patients having variable types of cancers. However, because of the toxicity of albendazole, for example, neutropenia due to myelosuppression, if high doses are used for a prolonged time, mebendazole is currently more popularly used than albendazole in anti-cancer clinical trials.
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Affiliation(s)
- Jong-Yil Chai
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649,
Korea
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul 03080,
Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07649,
Korea
| | - Sung-Jong Hong
- Department of Environmental Medical Biology, Chung-Ang University College of Medicine, Seoul 06974,
Korea
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Messaoud M, Abbes S, Gnaien M, Rebai Y, Kallel A, Jemel S, Cherif G, Skhairia MA, Marouen S, Fakhfekh N, Mardassi H, Belhadj S, Znaidi S, Kallel K. High Frequency of Enterocytozoon bieneusi Genotype WL12 Occurrence among Immunocompromised Patients with Intestinal Microsporidiosis. J Fungi (Basel) 2021; 7:jof7030161. [PMID: 33668221 PMCID: PMC7996336 DOI: 10.3390/jof7030161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Microsporidiosis is an emerging opportunistic infection causing severe digestive disorders in immunocompromised patients. The aim of this study was to investigate the prevalence of intestinal microsporidia carriage among immunocompromised patients hospitalized at a major hospital complex in the Tunis capital area, Tunisia (North Africa), and perform molecular epidemiology and population structure analyses of Enterocytozoon bieneusi, which is an emerging fungal pathogen. We screened 250 stool samples for the presence of intestinal microsporidia from 171 patients, including 81 organ transplant recipients, 73 Human Immunodeficiency Virus (HIV)-positive patients, and 17 patients with unspecified immunodeficiency. Using a nested PCR-based diagnostic approach for the detection of E. bieneusi and Encephalitozoon spp., we identified 18 microsporidia-positive patients out of 171 (10.5%), among which 17 were infected with E. bieneusi. Microsporidia-positive cases displayed chronic diarrhea (17 out of 18), which was associated more with HIV rather than with immunosuppression other than HIV (12 out of 73 versus 6 out of 98, respectively, p = 0.02) and correlated with extended hospital stays compared to microsporidia-negative cases (60 versus 19 days on average, respectively; p = 0.001). Strikingly, internal transcribed spacer (ITS)-based genotyping of E. bieneusi strains revealed high-frequency occurrence of ITS sequences that were identical (n = 10) or similar (with one single polymorphic site, n = 3) to rare genotype WL12. Minimum-spanning tree analyses segregated the 17 E. bieneusi infection cases into four distinct genotypic clusters and confirmed the high prevalence of genotype WL12 in our patient population. Phylogenetic analyses allowed the mapping of all 17 E. bieneusi strains to zoonotic group 1 (subgroups 1a and 1b/1c), indicating loose host specificity and raising public health concern. Our study suggests a probable common source of E. bieneusi genotype WL12 transmission and prompts the implementation of a wider epidemiological investigation.
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Affiliation(s)
- Mariem Messaoud
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Salma Abbes
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Mayssa Gnaien
- Institut Pasteur de Tunis, University of Tunis El Manar, Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique, Tunis 1002, Tunisia; (M.G.); (Y.R.); (M.A.S.); (H.M.)
| | - Yasmine Rebai
- Institut Pasteur de Tunis, University of Tunis El Manar, Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique, Tunis 1002, Tunisia; (M.G.); (Y.R.); (M.A.S.); (H.M.)
| | - Aicha Kallel
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
- Institut Pasteur de Tunis, University of Tunis El Manar, Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique, Tunis 1002, Tunisia; (M.G.); (Y.R.); (M.A.S.); (H.M.)
| | - Sana Jemel
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Ghaya Cherif
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Mohamed Amine Skhairia
- Institut Pasteur de Tunis, University of Tunis El Manar, Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique, Tunis 1002, Tunisia; (M.G.); (Y.R.); (M.A.S.); (H.M.)
| | - Sonia Marouen
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Najla Fakhfekh
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Helmi Mardassi
- Institut Pasteur de Tunis, University of Tunis El Manar, Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique, Tunis 1002, Tunisia; (M.G.); (Y.R.); (M.A.S.); (H.M.)
| | - Slaheddine Belhadj
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
| | - Sadri Znaidi
- Institut Pasteur de Tunis, University of Tunis El Manar, Laboratoire de Microbiologie Moléculaire, Vaccinologie et Développement Biotechnologique, Tunis 1002, Tunisia; (M.G.); (Y.R.); (M.A.S.); (H.M.)
- Institut Pasteur, INRA, Département Mycologie, Unité Biologie et Pathogénicité Fongiques, 75015 Paris, France
- Correspondence: (S.Z.); (K.K.)
| | - Kalthoum Kallel
- Laboratoire de Parasitologie et Mycologie, UR17SP03, La Rabta Hospital, Tunis 1007, Tunisia; (M.M.); (S.A.); (A.K.); (S.J.); (G.C.); (S.M.); (N.F.); (S.B.)
- Correspondence: (S.Z.); (K.K.)
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Zhang Y, Koehler AV, Wang T, Gasser RB. Enterocytozoon bieneusi of animals-With an 'Australian twist'. ADVANCES IN PARASITOLOGY 2021; 111:1-73. [PMID: 33482973 DOI: 10.1016/bs.apar.2020.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Enterocytozoon bieneusi is a microsporidian microorganism that causes intestinal disease in animals including humans. E. bieneusi is an obligate intracellular pathogen, typically causing severe or chronic diarrhoea, malabsorption and/or wasting. Currently, E. bieneusi is recognised as a fungus, although its exact classification remains contentious. The transmission of E. bieneusi can occur from person to person and/or animals to people. Transmission is usually via the faecal-oral route through E. bieneusi spore-contaminated water, environment or food, or direct contact with infected individuals. Enterocytozoon bieneusi genotypes are usually identified and classified by PCR-based sequencing of the internal transcribed spacer region (ITS) of nuclear ribosomal DNA. To date, ~600 distinct genotypes of E. bieneusi have been recorded in ~170 species of animals, including various orders of mammals and reptiles as well as insects in >40 countries. Moreover, E. bieneusi has also been found in recreational water, irrigation water, and treated raw- and waste-waters. Although many studies have been conducted on the epidemiology of E. bieneusi, prevalence surveys of animals and humans are scant in some countries, such as Australia, and transmission routes of individual genotypes and related risk factors are poorly understood. This article/chapter reviews aspects of the taxonomy, biology and epidemiology of E. bieneusi; the diagnosis, treatment and prevention of microsporidiosis; critically appraises the naming system for E. bieneusi genotypes as well as the phylogenetic relationships of these genotypes; provides new insights into the prevalence and genetic composition of E. bieneusi populations in animals in parts of Australia using molecular epidemiological tools; and proposes some areas for future research in the E. bieneusi/microsporidiosis field.
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Affiliation(s)
- Yan Zhang
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anson V Koehler
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Tao Wang
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, VIC, Australia.
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Morio F, Poirier P, Le Govic Y, Laude A, Valot S, Desoubeaux G, Argy N, Nourrisson C, Pomares C, Machouart M, Dalle F, Botterel F, Bourgeois N, Cateau E, Leterrier M, Beser J, Lavergne RA, Le Pape P. Assessment of the first commercial multiplex PCR kit (ParaGENIE Crypto-Micro Real-Time PCR) for the detection of Cryptosporidium spp., Enterocytozoon bieneusi, and Encephalitozoon intestinalis from fecal samples. Diagn Microbiol Infect Dis 2019; 95:34-37. [DOI: 10.1016/j.diagmicrobio.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
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14
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La Hoz RM, Morris MI. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13618. [PMID: 31145496 DOI: 10.1111/ctr.13618] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid-organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post-transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor-derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid-organ transplant recipients are unmet needs.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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15
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Deltombe C, Lefebvre M, Morio F, Boutoille D, Imbert BM, Le Pape P, Raffi F, Hourmant M. Cryptosporidiosis and microsporidiosis as causes of diarrhea in kidney and/or pancreas transplant recipients. Med Mal Infect 2019; 50:407-413. [PMID: 31472993 DOI: 10.1016/j.medmal.2019.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/10/2018] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Gastrointestinal disorders in solid organ recipients may have various origins including cryptosporidiosis and microsporidiosis. The prevalence of these infections is poorly known in solid organ transplant (SOT) patients in industrialized countries. METHODS We prospectively assessed the infectious causes of diarrhea in SOT patients. Secondary objectives were to gain further insight into the main characteristics of cryptosporidiosis, and to assess risk factors for this infection. All adult kidney and/or pancreas recipients presenting with diarrhea and admitted to our facility between May 1, 2014 and June 30, 2015 were enrolled. A stool sample was analyzed using a standardized protocol including bacteriological, virological, and parasitological investigations. Data related to clinical symptoms, immunosuppression, and environmental potential risk factors were collected through a self-administered questionnaire and computerized medical records. RESULTS Out of 73 enrolled patients, 36 had infectious diarrhea (49.3%). Viruses ranked first (17/36), followed by parasites and fungi (11/17). Cryptosporidiosis was the most common parasitic disease (n=6 patients). We observed four microsporidiosis cases. The estimated prevalence of cryptosporidiosis and microsporidiosis in this cohort was 3.7 and 2.40/00, respectively. No significant risk factor for cryptosporidiosis or microsporidiosis, neither environmental nor immunological, could be evidenced. CONCLUSION Both cryptosporidiosis and microsporidiosis represent a significant cause of diarrhea in kidney transplant recipients.
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Affiliation(s)
- C Deltombe
- Institute for Transplantation, Urology and Nephrology (ITUN) Nantes University Hospital, 44000 Nantes, France.
| | - M Lefebvre
- Infectious Diseases Department and CIC 1413, Inserm, Nantes University Hospital, 44000 Nantes, France
| | - F Morio
- Parasitology and Medical Mycology Laboratory, Nantes University Hospital, 44000 Nantes, France
| | - D Boutoille
- Infectious Diseases Department and CIC 1413, Inserm, Nantes University Hospital, 44000 Nantes, France
| | - B M Imbert
- Virology Department, Nantes University Hospital, 4000 Nantes, France
| | - P Le Pape
- Parasitology and Medical Mycology Laboratory, Nantes University Hospital, 44000 Nantes, France
| | - F Raffi
- Infectious Diseases Department and CIC 1413, Inserm, Nantes University Hospital, 44000 Nantes, France
| | - M Hourmant
- Institute for Transplantation, Urology and Nephrology (ITUN) Nantes University Hospital, 44000 Nantes, France
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Doshi N, Thet Z, Han T, Martin J. A Case of Intestinal Microsporidiosis in a Renal Transplant Recipient. J Med Cases 2019; 10:229-233. [PMID: 34434311 PMCID: PMC8383712 DOI: 10.14740/jmc3340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
Post-renal transplant diarrhea is a common clinical presentation. An extensive list of potential etiology adds to the diagnostic dilemma. In cases of prolonged or intractable diarrhea, invasive tests are often performed. Intestinal microsporidia can be diagnosed with simple non-invasive stool polymerase chain reaction (PCR). Based on this case, we propose an easy to follow flow chart and present a literature review on post-renal transplant diarrhea. Further multicenter validation testing is required for the proposed flow chart.
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Affiliation(s)
- Nidhi Doshi
- Department of General Medicine, Gold Coast University Hospital, QLD, Australia
| | - Zaw Thet
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
| | - Thin Han
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia.,Rural Clinical School, University of Queensland, Rockhampton, QLD, Australia
| | - Julieanne Martin
- Department of Nephrology, Central Queensland Hospital and Health Service, Rockhampton, QLD, Australia
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Aşula MF, Onur IU, Yigit FU. Efficacy of fumagillin bicyclohexylamine on experimental corneal neovascularization in rat model. Int Ophthalmol 2019; 39:1553-1558. [PMID: 30006905 DOI: 10.1007/s10792-018-0964-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/16/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Fumagillin has been previously used to treat corneal microsporidial keratitis and also identified as an angiogenesis inhibitor. This study aimed to evaluate efficacy of fumagillin bicyclohexylamine on the rat model of corneal neovascularization induced by silver nitrate cauterization. METHODS Twenty-four Albino Wistar rats (n = 24) were divided into three groups. Following silver nitrate-induced corneal injury, eyes in Group 1 received one drop of 5 mg/mL topical fumagillin bicyclohexylamine four times daily for 10 days. Group 2 received subconjunctival injection of 0.1 mL fumagillin bicyclohexylamine (2.5 mg/mL) on day 1 and day 5. Group 3 received artificial tears and lubricants four times daily for 10 days as control. On day 10, animals were sacrificed. Corneal specimens were obtained and prepared to assess vascular endothelial growth factor (VEGF-C) levels and corneal angiogenic microvessel density. RESULTS There was no significant difference in VEGF-C levels between the groups (P = 0.994). Assessment of angiogenic microvessel density for peripheral corneal zone also did not reveal significant difference between the groups (P = 0.113). However, mean vascular density in Group 1 and Group 2 was significantly higher for both midperipheral and central corneal zones in comparison with Group 3 (P = 0.003, P = 0.015). CONCLUSIONS Previously proved to be effective for treatment of microsporidial keratitis in humans, topical and subconjunctival concentration or dosing of fumagillin bicyclohexylamine failed to reduce corneal neovascularization induced by silver nitrate in this study. Further studies comparing different concentrations and dosing may detect inhibitory effects of fumagillin on corneal neovascularization without inducing toxicity.
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Affiliation(s)
- M Fatih Aşula
- Department of Ophthalmology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Caddesi No: 11 Zuhuratbaba, 34147, Istanbul, Turkey
| | - I Umut Onur
- Department of Ophthalmology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Caddesi No: 11 Zuhuratbaba, 34147, Istanbul, Turkey.
| | - F Ulviye Yigit
- Department of Ophthalmology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Caddesi No: 11 Zuhuratbaba, 34147, Istanbul, Turkey
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Esteghamati A, Khanaliha K, Bokharaei-Salim F, Sayyahfar S, Ghaderipour M. Prevalence of Intestinal Parasitic Infection in Cancer, Organ Transplant and Primary Immunodeficiency Patients in Tehran, Iran. Asian Pac J Cancer Prev 2019; 20:495-501. [PMID: 30803212 PMCID: PMC6897035 DOI: 10.31557/apjcp.2019.20.2.495] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Intestinal parasitic infection in immunodeficient patients especially those with impaired cellular immunity, like neoplasia, renal or heart transplant needs careful consideration. The objective of this study is to evaluate the prevalence of intestinal parasites in different group of patients including cancer patients; organ transplants recipients, and primary immunodeficiency patients. Methods: Stool samples from 190 patients including 80 patients with Primary Immunodeficiency, 85 cancer patients and 25 organ transplant recipients were collected; a direct examination with Phosphate buffered saline (PBS) and formalin ether concentration was performed. The DNA was extracted from parasitologically confirmed patients and nested PCR and sequencing was performed and new obtained sequences of Cryptosporidium parvum and Enterocytozoon bieneusi were compared with deposited ones. Results: In general, the prevalence of parasites was 26/80 (32.5%) in primary immunodeficiency, 22/85(25.9%) in cancer group, and 7/25 (28%) in organ transplant. The prevalence of intestinal parasitic infections in primary immunodeficiency patients were Blastocystis hominis 13 (16.2%), Giardia lamblia 10 (12.5%), Cryptosporidium 1(1.2%), Chilomastix mesnilii 1 (1.2%), Dientamoeba fragilis 1(1.2%). Of 25 organ transplants, 6 (24%) Cryptosporidium sp were found, all of which were confirmed as Cryptosporidium parvum and one case of Microspora in a heart transplant recipient was confirmed as Enterocytozoon bieneusi by PCR sequencing. The predominant intestinal parasitic infection in cancer patients was 19 (22.3%) Blastocystis hominis followed by two (2.3%) Giardia lamblia and one Dientamoeba fragilis 1 (1.1%). Conclusion: The high rate of infection with Blastocystis hominis was found in cancer patients especially colorectal cancer patients, so careful consideration should be given by physicians. Cryptosporidium sp was found to be the major cause of parasitic intestinal infection in patients with organ transplant compared to primary immunodeficiency patients; so transplant recipients undergoing immunosuppressive therapy should be considered as a risk group for acquiring microsporidiosis and Cryptosporidium infection.
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Affiliation(s)
- Abdoulreza Esteghamati
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
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Devresse A, Morin L, Aulagnon F, Taupin JL, Scemla A, Lanternier F, Aubert O, Aidoud AA, Lebreton X, Sberro-Soussan R, Snanoudj R, Amrouche L, Tinel C, Martinez F, Bererhi L, Anglicheau D, Lortholary O, Legendre C, Avettand-Fenoel V, Zuber J. Baseline graft status is a critical predictor of kidney graft failure after diarrhoea. Nephrol Dial Transplant 2019; 34:1597-1604. [DOI: 10.1093/ndt/gfy386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Diarrhoea is one of the most frequent complications after kidney transplantation (KT). Non-infectious diarrhoea has been associated with reduced graft survival in kidney transplant recipients. However, the risk factors for renal allograft loss following diarrhoea remain largely unknown.
Methods
Between January 2010 and August 2011, 195 consecutive KT recipients who underwent standardized microbiological workups for diarrhoea at a single centre were enrolled in this retrospective study.
Results
An enteric pathogen was readily identified in 91 patients (47%), while extensive microbiological investigations failed to find any pathogen in the other 104. Norovirus was the leading cause of diarrhoea in these patients, accounting for 30% of the total diarrhoea episodes. The baseline characteristics were remarkably similar between non-infectious and infectious diarrhoea patients, with the exception that the non-infectious group had significantly lower graft function before diarrhoea (P = 0.039). Infectious diarrhoea was associated with a longer duration of symptoms (P = 0.001) and higher rates of acute kidney injury (P = 0.029) and hospitalization (P < 0.001) than non-infectious diarrhoea. However, the non-infectious group had lower death-censored graft survival than the infectious group (Gehan–Wilcoxon test, P = 0.038). Multivariate analysis retained three independent predictors of graft failure after diarrhoea: diarrhoea occurring ≥5 years after KT [hazard ratio (HR) 4.82; P < 0.001], re-transplantation (HR 2.38; P = 0.001) and baseline estimated glomerular filtration rate <30 mL/min/1.73 m2 (HR 11.02; P < 0.001).
Conclusion
Our study shows that pre-existing conditions (re-transplantation, chronic graft dysfunction and late occurrence) determine the primary functional long-term consequences of post-transplant diarrhoea.
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Affiliation(s)
- Arnaud Devresse
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Service de Néphrologie des Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgique
| | - Lise Morin
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Florence Aulagnon
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Jean-Luc Taupin
- Faculté de médecine, Université Paris Diderot, Paris, France
| | - Anne Scemla
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Fanny Lanternier
- Faculté de Médecine, Université Paris Descartes, Paris, France
- Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, AP-HP, Centre d’infectiologie Necker Pasteur, IHU Imagine, Paris, France
| | - Olivier Aubert
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Adel A Aidoud
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Xavier Lebreton
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Rebecca Sberro-Soussan
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Renaud Snanoudj
- Département de Virologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Lucile Amrouche
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Claire Tinel
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Frank Martinez
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Lynda Bererhi
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Dany Anglicheau
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Olivier Lortholary
- Faculté de Médecine, Université Paris Descartes, Paris, France
- Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, AP-HP, Centre d’infectiologie Necker Pasteur, IHU Imagine, Paris, France
| | - Christophe Legendre
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Véronique Avettand-Fenoel
- Faculté de Médecine, Université Paris Descartes, Paris, France
- Service de Néphrologie et Transplantation, Hôpital Foch, Suresnes, France
| | - Julien Zuber
- Service de Transplantation Rénale et Unité de Soins Intensifs, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- Faculté de Médecine, Université Paris Descartes, Paris, France
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Traveler's Diarrhea Recommendations for Solid Organ Transplant Recipients and Donors. Transplantation 2018; 102:S35-S41. [PMID: 29381576 DOI: 10.1097/tp.0000000000002015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wijayawardene NN, Pawłowska J, Letcher PM, Kirk PM, Humber RA, Schüßler A, Wrzosek M, Muszewska A, Okrasińska A, Istel Ł, Gęsiorska A, Mungai P, Lateef AA, Rajeshkumar KC, Singh RV, Radek R, Walther G, Wagner L, Walker C, Wijesundara DSA, Papizadeh M, Dolatabadi S, Shenoy BD, Tokarev YS, Lumyong S, Hyde KD. Notes for genera: basal clades of Fungi (including Aphelidiomycota, Basidiobolomycota, Blastocladiomycota, Calcarisporiellomycota, Caulochytriomycota, Chytridiomycota, Entomophthoromycota, Glomeromycota, Kickxellomycota, Monoblepharomycota, Mortierellomycota, Mucoromycota, Neocallimastigomycota, Olpidiomycota, Rozellomycota and Zoopagomycota). FUNGAL DIVERS 2018. [DOI: 10.1007/s13225-018-0409-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fabiani S, Fortunato S, Bruschi F. Solid Organ Transplant and Parasitic Diseases: A Review of the Clinical Cases in the Last Two Decades. Pathogens 2018; 7:pathogens7030065. [PMID: 30065220 PMCID: PMC6160964 DOI: 10.3390/pathogens7030065] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to evaluate the occurrence of parasitic infections in solid organ transplant (SOT) recipients. We conducted a systematic review of literature records on post-transplant parasitic infections, published from 1996 to 2016 and available on PubMed database, focusing only on parasitic infections acquired after SOT. The methods and findings of the present review have been presented based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. From data published in the literature, the real burden of parasitic infections among SOT recipients cannot really be estimated. Nevertheless, publications on the matter are on the increase, probably due to more than one reason: (i) the increasing number of patients transplanted and then treated with immunosuppressive agents; (ii) the “population shift” resulting from immigration and travels to endemic areas, and (iii) the increased attention directed to diagnosis/notification/publication of cases. Considering parasitic infections as emerging and potentially serious in their evolution, additional strategies for the prevention, careful screening and follow-up, with a high level of awareness, identification, and pre-emptive therapy are needed in transplant recipients.
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Affiliation(s)
- Silvia Fabiani
- Infectious Disease Department, Azienda Ospedaliera Pisana, 56124 Pisa, Italy.
- School of Infectious Diseases, Università di Pisa, 56124 Pisa, Italy.
| | - Simona Fortunato
- School of Infectious Diseases, Università di Pisa, 56124 Pisa, Italy.
| | - Fabrizio Bruschi
- School of Infectious Diseases, Università di Pisa, 56124 Pisa, Italy.
- Department of Translational Research, N.T.M.S., Università di Pisa, 56124 Pisa, Italy.
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Greigert V, Pfaff AW, Abou-Bacar A, Candolfi E, Brunet J. Intestinal microsporidiosis in Strasbourg from 2014 to 2016: emergence of an Enterocytozoon bieneusi genotype of Asian origin. Emerg Microbes Infect 2018; 7:97. [PMID: 29872051 PMCID: PMC5988701 DOI: 10.1038/s41426-018-0099-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/16/2018] [Accepted: 04/29/2018] [Indexed: 11/09/2022]
Abstract
Microsporidia cause opportunistic infections in highly immunodeficient individuals. Few studies on the epidemiology of these infections have been conducted in France. Between 2014 and 2016, we undertook a study to estimate the prevalence and circulating genotypes of this fungus-related micro-organism among the population of Strasbourg University Hospital. Samples were collected from hospitalized patients and analyzed using microscopy and molecular assays. Strains from positive subjects were sequenced for genotyping. Only 7/661 patients (1.1%) were positive for microsporidia, and the only species identified was Enterocytozoon bieneusi. Two patients presented immunodeficiency linked to AIDS, and five transplant recipients presented immunodeficiency linked to immunosuppressive therapies. Only five patients received specific antimicrosporidial treatment, but clinical outcomes were good in all cases. We identified four genotypes: A and D in patients with AIDS, and C and S9 in transplant recipients. To date, genotype S9 has been described only once. This genotype is similar to those found in farm animals in China. Because some of these animals have been introduced to Central Europe, we postulate that this genotype might be of Asian origin. Thus, genotyping microsporidial strains may be of epidemiological and clinical interest to identify potential outbreak sources depending on the infecting strains.
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Affiliation(s)
- Valentin Greigert
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 39 Avenue de la Liberté, Colmar, France. .,Institute of Parasitology and Tropical Diseases, EA 7292, University of Strasbourg, 3 rue Koeberlé, Strasbourg, France.
| | - Alexander W Pfaff
- Institute of Parasitology and Tropical Diseases, EA 7292, University of Strasbourg, 3 rue Koeberlé, Strasbourg, France.,Department of Parasitology and Mycology, University Hospital of Strasbourg, 3 rue Koeberlé, Strasbourg, France
| | - Ahmed Abou-Bacar
- Institute of Parasitology and Tropical Diseases, EA 7292, University of Strasbourg, 3 rue Koeberlé, Strasbourg, France.,Department of Parasitology and Mycology, University Hospital of Strasbourg, 3 rue Koeberlé, Strasbourg, France
| | - Ermanno Candolfi
- Institute of Parasitology and Tropical Diseases, EA 7292, University of Strasbourg, 3 rue Koeberlé, Strasbourg, France.,Department of Parasitology and Mycology, University Hospital of Strasbourg, 3 rue Koeberlé, Strasbourg, France
| | - Julie Brunet
- Institute of Parasitology and Tropical Diseases, EA 7292, University of Strasbourg, 3 rue Koeberlé, Strasbourg, France.,Department of Parasitology and Mycology, University Hospital of Strasbourg, 3 rue Koeberlé, Strasbourg, France
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24
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Brown M, Longano A, Dendle C, Polkinghorne KR, Kanellis J. Confirmed microsporidial graft infection in a HIV-negative renal transplant recipient: A case report and review of the literature. Transpl Infect Dis 2018; 20:e12888. [PMID: 29570921 DOI: 10.1111/tid.12888] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 12/31/2022]
Abstract
Microsporidia are intracellular organisms most commonly known to cause opportunistic infection in patients with human immunodeficiency virus (HIV). There have been several case reports of infection in solid organ and bone marrow transplant recipients. Here, we report a case of a non-HIV-infected renal transplant patient with microsporidiosis of the renal tract associated with acute graft dysfunction. We also review the literature of 12 previously reported cases of microsporidiosis in patients with renal transplants who had described graft involvement. We review the pattern of illness as well as the common renal biopsy features when microsporidial infection is associated with renal graft infection.
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Affiliation(s)
- M Brown
- Department of Nephrology, Monash Health, Clayton, VIC, Australia
| | - A Longano
- Department of Anatomical Pathology, Monash Health, Clayton, VIC, Australia
| | - C Dendle
- Monash Infectious Diseases, School of Clinical Sciences, Monash University, Prahran, VIC, Australia
| | - K R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, VIC, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Prahran, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - J Kanellis
- Department of Nephrology, Monash Health, Clayton, VIC, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Prahran, VIC, Australia
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25
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Bukreyeva I, Angoulvant A, Bendib I, Gagnard JC, Bourhis JH, Dargère S, Bonhomme J, Thellier M, Gachot B, Wyplosz B. Enterocytozoon bieneusi Microsporidiosis in Stem Cell Transplant Recipients Treated with Fumagillin. Emerg Infect Dis 2018; 23:1039-1041. [PMID: 28518017 PMCID: PMC5443440 DOI: 10.3201/eid2306.161825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Enterocytozoon bieneusi microsporidiosis is an emerging disease in immunocompromised patients. We report 2 cases of this disease in allogeneic hematopoietic stem cell transplant patients successfully treated with fumagillin. Thrombocytopenia occurred but without major adverse events. Modifications of immunosuppression could be avoided when E. bieneusi is rapidly identified and fumagillin therapy is started promptly.
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27
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Prevalence and molecular characteristics of urinary and intestinal microsporidia infections in renal transplant recipients. Clin Microbiol Infect 2016; 22:462.e5-9. [PMID: 26827672 DOI: 10.1016/j.cmi.2016.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/05/2016] [Accepted: 01/17/2016] [Indexed: 11/23/2022]
Abstract
Transplant recipients have been identified as a new risk group for microsporidia infection. We characterize for the first time the prevalence of microsporidia in intestinal and urinary tracts of renal transplant recipients. Molecular examination of 86 patients showed that 25.5% of them were infected; 86% were confirmed to have pathogens in their urine and 45.5% in stool. Among positive patients, 32% had microsporidia confirmed in both urine and stool. Genotyping revealed Encephalitozoon cuniculi (59%) and Enterocytozoon bieneusi (23%) monoinfections as well as coinfections with both species (18%). Moreover, we found diarrhoea and fever as symptoms significantly associated with microsporidia presence. Our results indicate that microsporidial infection should be considered in the assessment of renal transplant recipients, especially in the urinary tract, even if asymptomatic. Molecular identification of microsporidia species is relevant because of their different susceptibility for treatment.
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29
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Nevez G, Le Gal S, Quinio D, Ianotto JC, Berthou C, Hamane S, Sarfati C, Menotti J. Encephalitozoon hellem in a patient with CD4+ T-cell prolymphocytic leukemia: case report and genomic identification. Diagn Microbiol Infect Dis 2015; 83:245-7. [DOI: 10.1016/j.diagmicrobio.2015.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
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30
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Ghoshal U, Khanduja S, Pant P, Prasad KN, Dhole TN, Sharma RK, Ghoshal UC. Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization. Indian J Med Microbiol 2015; 33:357-63. [DOI: 10.4103/0255-0857.158551] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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31
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Abstract
Diarrhea is a frequent but overlooked complication of kidney transplantation. Diarrhea is repeatedly neglected, often considered by patients and clinicians an unavoidable side effect of immunosuppressive regimens. It is, however, associated with a significant impairment in life quality. Severe and chronic posttransplant diarrhea may lead to dehydration, malabsorption, rehospitalization, immunosuppression, noncompliance, and a greater risk of graft loss and death. There is thus a need to optimize and standardize the management of posttransplant diarrhea with consistent diagnostic and therapeutic strategies. A recent study has suggested that the increased sensitivity of molecular tools might help in early pathogen identification and guidance of antimicrobial treatment. Most bacterial and protozoan infections are readily curable with appropriate antimicrobial agents; cryptosporidiosis and C. difficile infections may however be complicated by relapsing courses. In addition, identification of enteric viral genomes in stool has further reduced posttransplant diarrhea of unknown origin. Chronic norovirus-related posttransplant diarrhea, arising from the interplay of the virus and immunosuppressive drugs, has emerged as a new challenge in the field. Prospective and controlled studies are necessary to evaluate the efficacy and safety of innovative anti-norovirus therapeutics, as well as optimal immunosuppressive regimens, to enable viral clearance while preventing rejection and donor-specific antibody formation. This review seeks to provide a basis for the design of future clinical prospective studies.
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32
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A novel nested multiplex PCR for the simultaneous detection and differentiation of Cryptosporidium spp., Enterocytozoon bieneusi and Encephalitozoon intestinalis. Parasitol Int 2014; 63:664-9. [DOI: 10.1016/j.parint.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 04/22/2014] [Accepted: 05/09/2014] [Indexed: 11/18/2022]
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33
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Watts MR, Chan RCF, Cheong EYL, Brammah S, Clezy KR, Tong C, Marriott D, Webb CE, Chacko B, Tobias V, Outhred AC, Field AS, Prowse MV, Bertouch JV, Stark D, Reddel SW. Anncaliia algerae microsporidial myositis. Emerg Infect Dis 2014; 20:185-91. [PMID: 24447398 PMCID: PMC3901472 DOI: 10.3201/eid2002.131126] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The insect microsporidian Anncaliia algerae was first described in 2004 as a cause of fatal myositis in an immunosuppressed person from Pennsylvania, USA. Two cases were subsequently reported, and we detail 2 additional cases, including the only nonfatal case. We reviewed all 5 case histories with respect to clinical characteristics, diagnosis, and management and summarized organism life cycle and epidemiology. Before infection, all case-patients were using immunosuppressive medications for rheumatoid arthritis or solid-organ transplantation. Four of the 5 case-patients were from Australia. All diagnoses were confirmed by skeletal muscle biopsy; however, peripheral nerves and other tissues may be infected. The surviving patient received albendazole and had a reduction of immunosuppressive medications and measures to prevent complications. Although insects are the natural hosts for A. algerae, human contact with water contaminated by spores may be a mode of transmission. A. algerae has emerged as a cause of myositis, particularly in coastal Australia.
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34
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Wright AJ, Fishman JA. Central nervous system syndromes in solid organ transplant recipients. Clin Infect Dis 2014; 59:1001-11. [PMID: 24917660 DOI: 10.1093/cid/ciu428] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Solid organ transplant recipients have a high incidence of central nervous system (CNS) complications, including both focal and diffuse neurologic deficits. In the immunocompromised host, the initial clinical evaluation must focus on both life-threatening CNS infections and vascular or anatomic lesions. The clinical signs and symptoms of CNS processes are modified by the immunosuppression required to prevent graft rejection. In this population, these etiologies often coexist with drug toxicities and metabolic abnormalities that complicate the development of a specific approach to clinical management. This review assesses the multiple risk factors for CNS processes in solid organ transplant recipients and establishes a timeline to assist in the evaluation and management of these complex patients.
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Affiliation(s)
- Alissa J Wright
- Transplant Infectious Disease Program, Massachusetts General Hospital
| | - Jay A Fishman
- Transplant Infectious Disease Program, Massachusetts General Hospital Transplant Center, Harvard Medical School, Boston, Massachusetts
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35
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Microsporidiosis: an unusual endoscopic finding. Clin Gastroenterol Hepatol 2014; 12:e37-8. [PMID: 23978344 DOI: 10.1016/j.cgh.2013.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023]
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36
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Application of PCR-based methods for diagnosis of intestinal parasitic infections in the clinical laboratory. Parasitology 2014; 141:1863-72. [DOI: 10.1017/s0031182014000419] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SUMMARYFor many years PCR- and other DNA-based methods of pathogen detection have been available in most clinical microbiology laboratories; however, until recently these tools were not routinely exploited for the diagnosis of parasitic infections. Laboratories were initially reluctant to implement PCR as incorporation of such assays within the algorithm of tools available for the most accurate diagnosis of a large variety of parasites was unclear. With regard to diagnosis of intestinal parasitic infections, the diversity of parasites that one can expect in most settings is far less than the parasitological textbooks would have you believe, hence developing a simplified diagnostic triage is feasible. Therefore the classical algorithm based on population, patient groups, use of immuno-suppressive drugs, travel history etc. is also applicable to decide when to perform and which additional techniques are to be used, if a multiplex PCR panel is used as a first-line screening diagnostic.
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37
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van den Heever JP, Thompson TS, Curtis JM, Ibrahim A, Pernal SF. Fumagillin: an overview of recent scientific advances and their significance for apiculture. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2014; 62:2728-37. [PMID: 24621007 DOI: 10.1021/jf4055374] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fumagillin is a potent fungal metabolite first isolated from Aspergillus fumigatus. It is widely used in apiculture and human medicine against a variety of microsporidian fungal infections. It has been the subject of research in cancer treatments by employing its angiogenesis inhibitory properties. The toxicity of fumagillin has limited its use for human applications and spurred the development of analogues using structure-activity relationships relating to its angiogenesis properties. These discoveries may hold the key to the development of alternative chemical treatments for use in apiculture. The toxicity of fumagillin to humans is important for beekeeping, because any residues remaining in hive products pose a direct risk to the consumer. The analytical methods published to date measure fumagillin and its decomposition products but overlook the dicyclohexylamine counterion of the salt form widely used in apiculture.
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Affiliation(s)
- Johan P van den Heever
- Alberta Agriculture and Rural Development , Animal Health and Assurance Division, Agri-Food Laboratories Branch, 6909-116 Street, Edmonton, Alberta, Canada T6H 4P2
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38
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Hocevar SN, Paddock CD, Spak CW, Rosenblatt R, Diaz-Luna H, Castillo I, Luna S, Friedman GC, Antony S, Stoddard RA, Tiller RV, Peterson T, Blau DM, Sriram RR, da Silva A, de Almeida M, Benedict T, Goldsmith CS, Zaki SR, Visvesvara GS, Kuehnert MJ. Microsporidiosis acquired through solid organ transplantation: a public health investigation. Ann Intern Med 2014; 160:213-20. [PMID: 24727839 PMCID: PMC4627638 DOI: 10.7326/m13-2226] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of a temporally associated cluster of febrile illness among 3 solid organ transplant recipients from a common donor. OBJECTIVE To confirm the source of the illness, assess donor and recipient risk factors, and provide therapy recommendations for ill recipients. DESIGN Public health investigation. SETTING Two transplant hospitals and community interview with the deceased donor's family. PATIENTS Three transplant recipients and the organ donor. MEASUREMENTS Specimens were tested for microsporidia by using culture, immunofluorescent antibody, polymerase chain reaction,immunohistochemistry, and electron microscopy. Donor medical records were reviewed and a questionnaire was developed to assess for microsporidial infection. RESULTS Kidneys and lungs were procured from the deceased donor and transplanted to 3 recipients who became ill with fever 7 to 10 weeks after the transplant. Results of urine culture, serologic,and polymerase chain reaction testing were positive for E. cuniculi of genotype III in each recipient; the organism was also identified in biopsy or autopsy specimens in all recipients. The donor had positive serologic test results for E. cuniculi. Surviving recipients received albendazole. Donor assessment did not identify factors for suspected E. cuniculi infection. LIMITATION Inability to detect organism by culture or polymerase chain reaction in donor due to lack of autopsy specimens. CONCLUSION Microsporidiosis is now recognized as an emerging transplant-associated disease and should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing. Donor-derived disease is critical to assess when multiple recipients from a common donor are ill.
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39
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Intestinal microsporidiosis due to Enterocytozoon bieneusi in a pediatric kidney transplant recipient successfully treated with fumagillin. Transplantation 2013; 96:e66-7. [PMID: 24132119 DOI: 10.1097/tp.0b013e3182a902e7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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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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Pant C, Deshpande A, Larson A, O'Connor J, Rolston DDK, Sferra TJ. Diarrhea in solid-organ transplant recipients: a review of the evidence. Curr Med Res Opin 2013; 29:1315-28. [PMID: 23777312 DOI: 10.1185/03007995.2013.816278] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To provide a comprehensive review of the literature as it relates to diarrhea in solid organ transplant (SOT) recipients. In this article, we review the epidemiology, pathogenesis, clinical manifestations, diagnosis and management of diarrhea in SOT recipients and discuss recent advances and challenges. METHODS Two investigators conducted independent literature searches using PubMed, Web of Science, and Scopus until January 1st, 2013. All databases were searched using a combination of the terms diarrhea, solid organ transplant, SOT, transplant associated diarrhea, and transplant recipients. Articles that discussed diarrhea in SOT recipients were reviewed and relevant cross-references also read and evaluated for inclusion. Selection bias could be a possible limitation of the approach used in selecting or finding articles for this article. FINDINGS Post-transplant diarrhea is a common and distressing occurrence in patients, which can have significant deleterious effects on the clinical course and well-being of the organ recipient. A majority of cases are due to infectious and drug-related etiologies. However, various other etiologies including inflammatory bowel disease must be considered in the differential diagnosis. A step-wise, informed approach to post-transplant diarrhea will help the clinician achieve the best diagnostic yield. The use of diagnostic endoscopy should be preceded by exclusion of an infectious or drug-related cause of diarrhea. Empiric management with antidiarrheal agents, probiotics, and lactose-free diets may have a role in managing patients for whom no cause can be determined even after an extensive investigation. CONCLUSIONS Physicians should be familiar with the common etiologies that result in post-transplant diarrhea. A directed approach to diagnosis and treatment will not only help to resolve the diarrhea but also prevent potentially life-threatening consequences including loss of the graft as well. Prospective studies are required to determine the etiology of post-transplant diarrhea in different clinical and geographic settings.
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Affiliation(s)
- Chaitanya Pant
- University of Oklahoma Health Sciences Center , Oklahoma City, OK , USA
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42
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Şıvgın S, Eser B, Kaynar L, Kurnaz F, Şıvgın H, Yazar S, Çetin M, Ünal A. Encephalitozoon intestinalis: A Rare Cause of Diarrhea in an Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Recipient Complicated by Albendazole-Related Hepatotoxicity. Turk J Haematol 2013; 30:204-8. [PMID: 24385787 PMCID: PMC3878461 DOI: 10.4274/tjh.90692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 01/02/2012] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED A 50-year-old male patient previously diagnosed with acute myelomonocytic (M4) leukemia in July 2009 underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). During the pre-transplant period complete blood count (CBC), liver and renal function tests, coagulation tests, and other parameters were normal. On the first day of transplantation teicoplanin (400 mg d-1 for the first 3 d, and then 400 mg d-1) and caspofungin (first dose was 1×70 mg d-1, followed by 1×50 mg d-1) were started intravenously due to white plaques and oropharyngeal candidiasis in the patient's mouth and perianal erythema. On the 14th d of transplantation watery diarrhea occurred, along with abdominal discomfort, nausea, and fatigue. Stool examination was negative for findings of bleeding. Investigation of Microsporidia confirmed a rare pathogen Encephalitozoon intestinalis in the patient's stool sample via species-specific immunofluorescence antibody (IFA) assay and albendazole treatment was started at a dose of 2×400 mg d-1. On the 5th d of albendazole treatment (d 18 of treatment) liver function test (LFT) results began to deteriorate. As LFT results continued to deteriorate, albendazole was withdrawn on the 7th d of treatment. Biopsy was performed on the 22nd d of transplantation and histopathological analysis confirmed the diagnosis of toxic hepatitis. LFT results began to decrease after withdrawal of albendazole treatment. On the 13th d of albendazole treatment all LFT values returned to normal. The presented allo-HSCT case had a rare pathogenic agent (E. intestinalis) that caused diarrhea, as well as hepatotoxicity due to albendazole treatment. This is the first reported case of E. intestinalis diagnosed via IFA in Turkey. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Serdar Şıvgın
- Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey
- * Address for Correspondence: Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey Phone: +90 352 437 49 37 E-mail:
| | - Bülent Eser
- Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey
| | - Leylagül Kaynar
- Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey
| | - Fatih Kurnaz
- Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey
| | - Hülya Şıvgın
- Erciyes University, School of Medicine, Department of Medical Genetics, Kayseri, Turkey
| | - Süleyman Yazar
- Erciyes University, School of Medicine, Department of Parasitology, Kayseri, Turkey
| | - Mustafa Çetin
- Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey
| | - Ali Ünal
- Erciyes University, School of Medicine, Department of Hematology, Dedeman Stem Cell Transplantation Hospital, Kayseri, Turkey
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Andreu-Ballester JC, Garcia-Ballesteros C, Amigo V, Ballester F, Gil-Borrás R, Catalán-Serra I, Magnet A, Fenoy S, del Aguila C, Ferrando-Marco J, Cuéllar C. Microsporidia and its relation to Crohn's disease. A retrospective study. PLoS One 2013; 8:e62107. [PMID: 23637975 PMCID: PMC3630148 DOI: 10.1371/journal.pone.0062107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The cause of Crohn's Disease (CD) remains unknown. Recently a decrease in the global lymphocyte population in the peripheral blood of CD patients has been reported. This decrease was more evident in γδ T lymphocytes, especially γδ CD8+T subsets. Furthermore, a decrease of IL-7 was also observed in these patients. We propose the hypothesis that microsporidia, an obligate intracellular opportunistic parasite recently related to fungi, in CD patients can take advantage of the lymphocytes and IL-7 deficits to proliferate and to contribute to the pathophysiology of this disease. METHODS AND FINDINGS In this case-control study, serum samples were collected from 36 CD patients and from 36 healthy individuals (controls), IgE and IgG anti-Encephalitozoon antibodies were determined by ELISA; and forty-four intestinal tissue samples were analyzed through real time Polymerase Chain Reaction (PCR), twenty CD patients, nine with others diseases and 15 healthy subjects. We observed that IgE anti-Encephalitozoon levels were significantly higher in patients with CD: 0.386(±0.256) vs control group, 0.201(±0.147), P<0.001. However, IgG anti-Encephalitozoon values were significantly lower in CD patients: 0.361(±0.256) vs control group, 0.876(±0.380), P<0.001. In the group of CD patients, 6/20 (30%) were positive by real time PCR for microsporidia and, all the patients of the control group were negative by real time PCR. CONCLUSIONS These results suggest that CD patients are a group at risk for microsporidiasis and, moreover that microsporidia may be involved as a possible etiologic factor of CD.
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Affiliation(s)
| | - Carlos Garcia-Ballesteros
- Research Department, Arnau de Vilanova Hospital, Valencia, Spain
- Hematology Department, Arnau de Vilanova Hospital, Valencia, Spain
| | - Victoria Amigo
- Hematology Department, Arnau de Vilanova Hospital, Valencia, Spain
| | - Ferran Ballester
- Center of Research in Public Health, Valencia, Spanish Consortium for Research in Epidemiology and Public Health, Barcelona, University of Valencia, Valencia, Spain
| | | | | | - Angela Magnet
- Laboratory of Parasitology, San Pablo Centro de Estudios Universitarios University, Madrid, Spain
| | - Soledad Fenoy
- Laboratory of Parasitology, San Pablo Centro de Estudios Universitarios University, Madrid, Spain
| | - Carmen del Aguila
- Laboratory of Parasitology, San Pablo Centro de Estudios Universitarios University, Madrid, Spain
| | - Jose Ferrando-Marco
- Anatomical Pathology Department, Arnau de Vilanova Hospital, Valencia, Spain
| | - Carmen Cuéllar
- Department of Parasitology, Faculty of Pharmacy, Complutense University, Madrid, Spain
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Microsporidia and coccidia as causes of persistence diarrhea among liver transplant children: incidence rate and species/genotypes. Pediatr Infect Dis J 2013; 32:185-7. [PMID: 22982981 DOI: 10.1097/inf.0b013e318273d95f] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We determined species/genotype(s) of enteric microsporidia and coccidia causing diarrhea among 44 liver transplant children in Shiraz Nemazee hospital using acid-fast-trichrome staining and polymerase chain reaction-sequencing techniques. Enterocytozoon bieneusi (genotype D), Cryptosporidium (parvum and meleagridis) were detected in 6.81% and 11.36% of the children, respectively.
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George B, Coates T, McDonald S, Russ G, Cherian S, Nolan J, Brealey J. Disseminated microsporidiosis with Encephalitozoon species in a renal transplant recipient. Nephrology (Carlton) 2012; 17 Suppl 1:5-8. [PMID: 22497646 DOI: 10.1111/j.1440-1797.2012.01580.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To our knowledge, 5 cases of disseminated microsporidiosis with Encephalitozoon species have been reported worldwide in transplant recipients. George et al. present the first such case in Australia, to be reported and treated with good clinical recovery.
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Affiliation(s)
- Bibin George
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, South Australia.
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46
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A new and highly divergent Enterocytozoon bieneusi genotype isolated from a renal transplant recipient. J Clin Microbiol 2012; 50:2176-8. [PMID: 22442321 DOI: 10.1128/jcm.06791-11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 49-year-old renal transplant recipient was admitted to our hospital due to abundant liquid diarrhea and dehydration. Parasitological investigations, including genotyping, led to the diagnosis of intestinal microsporidiosis due to a new and highly divergent internal transcribed spacer (ITS) genotype of Enterocytozoon bieneusi. The potential route of transmission through horse stools is discussed.
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Field A, Paik J, Stark D, Qiu M, Morey A, Plit M, Canning E, Glanville A. Myositis due to the microsporidianAnncaliia (Brachiola) algeraein a lung transplant recipient. Transpl Infect Dis 2012; 14:169-76. [DOI: 10.1111/j.1399-3062.2012.00724.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 01/12/2012] [Accepted: 01/16/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A.S. Field
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - J.Y. Paik
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - D. Stark
- Division of Microbiology; St Vincent's Hospital; Sydney NSW Australia
| | - M.R. Qiu
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - A. Morey
- Division of Anatomical Pathology; St Vincent's Hospital; Sydney NSW Australia
| | - M.L. Plit
- Department of Thoracic Medicine; St Vincent's Hospital; Sydney NSW Australia
| | | | - A.R. Glanville
- Department of Thoracic Medicine; St Vincent's Hospital; Sydney NSW Australia
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48
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Lobo ML, Xiao L, Antunes F, Matos O. Microsporidia as emerging pathogens and the implication for public health: a 10-year study on HIV-positive and -negative patients. Int J Parasitol 2012; 42:197-205. [PMID: 22265899 DOI: 10.1016/j.ijpara.2011.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/02/2011] [Accepted: 12/08/2011] [Indexed: 11/29/2022]
Abstract
Despite recent advances in the understanding and diagnosis of emerging microsporidian pathogens, more research is necessary to elucidate their complex epidemiology. In fact, studies that reflect true human-infecting microsporidian prevalence are still inadequate. The present 10-year study was undertaken to examine the occurrence of Microsporidia in 1989 stools, 69 urine and 200 pulmonary specimens from HIV-positive and HIV-negative patients using PCR and DNA sequencing. In stools, 12.0% were Microsporidia-positive. Prevalences of 13.9% and 8.5% were observed for HIV+ and HIV- samples, respectively. The percentage of children that were Microsporidia-positive (18.8%) was significantly higher than that of adults (10.2%). In stools, Enterocytozoon bieneusi (6.3%) and Vittaforma-like parasites (6.8%) were identified. Based on the internal transcribed spacer (ITS) region of E. bieneusi, Type IV (37.5%), Peru 6 (29.2%), D (12.5%), A (8.3%), C (6.3%) and PtEb II (6.3%) genotypes were identified. Microsporidia were detected in 1.5% and 1.0% of urine and pulmonary specimens, respectively. Encephalitozoonintestinalis was detected in urine. In pulmonary specimens, Encephalitozoon cuniculi and Vittaforma-like parasites were identified. An immunosuppressive condition and youth (children) appear to be risk factors for microsporidian infection. Microsporidia seems to have an important impact on public health in Portugal, highlighting the need to implement routine diagnosis.
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Affiliation(s)
- Maria Luísa Lobo
- Grupo de Protozoários Oportunistas/VIH e Outras Protozooses/Unidade de Parasitologia Médica, CMDT, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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49
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Microsporidia infection in a mexican kidney transplant recipient. Case Rep Nephrol 2012; 2012:928083. [PMID: 24558617 PMCID: PMC3914178 DOI: 10.1155/2012/928083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022] Open
Abstract
Microorganisms of the microsporidia group are obligated intracellular protozoa that belong to the phylum Microspora; currently they are considered to be related or belong to the fungi reign. It is considered an opportunistic infection in humans, and 14 species belonging to 8 different genera have been described. Immunocompromized patients such as those infected with human immunodeficiency virus (HIV), also HIV serum-negative asymptomatic patients, with poor hygienic conditions, and recipients of bone marrow or solid organ transplantation are susceptible to develop deinfection. Sixty transplanted patients with renal microsporidia infection have been reported worldwide. The aim of this paper is to inform about the 2nd case of kidney transplant and microsporidia infection documented in Mexico.
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50
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Mishra BB, Tiwari VK. Natural products: An evolving role in future drug discovery. Eur J Med Chem 2011; 46:4769-807. [DOI: 10.1016/j.ejmech.2011.07.057] [Citation(s) in RCA: 565] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 07/29/2011] [Accepted: 07/30/2011] [Indexed: 11/16/2022]
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