1
|
Seatamanoch N, Kongdachalert S, Sunantaraporn S, Siriyasatien P, Brownell N. Microsporidia, a Highly Adaptive Organism and Its Host Expansion to Humans. Front Cell Infect Microbiol 2022; 12:924007. [PMID: 35782144 PMCID: PMC9245026 DOI: 10.3389/fcimb.2022.924007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 12/05/2022] Open
Abstract
Emerging infectious disease has become the center of attention since the outbreak of COVID-19. For the coronavirus, bats are suspected to be the origin of the pandemic. Consequently, the spotlight has fallen on zoonotic diseases, and the focus now expands to organisms other than viruses. Microsporidia is a single-cell organism that can infect a wide range of hosts such as insects, mammals, and humans. Its pathogenicity differs among species, and host immunological status plays an important role in infectivity and disease severity. Disseminated disease from microsporidiosis can be fatal, especially among patients with a defective immune system. Recently, there were two Trachipleistophora hominis, a microsporidia species which can survive in insects, case reports in Thailand, one patient had disseminated microsporidiosis. This review gathered data of disseminated microsporidiosis and T. hominis infections in humans covering the biological and clinical aspects. There was a total of 22 cases of disseminated microsporidiosis reports worldwide. Ten microsporidia species were identified. Maximum likelihood tree results showed some possible correlations with zoonotic transmissions. For T. hominis, there are currently eight case reports in humans, seven of which had Human Immunodeficiency Virus (HIV) infection. It is observed that risks are higher for the immunocompromised to acquire such infections, however, future studies should look into the entire life cycle, to identify the route of transmission and establish preventive measures, especially among the high-risk groups.
Collapse
Affiliation(s)
- Nirin Seatamanoch
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Vector Biology and Vector Borne Disease Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Switt Kongdachalert
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Vector Biology and Vector Borne Disease Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sakone Sunantaraporn
- Vector Biology and Vector Borne Disease Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Padet Siriyasatien
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Vector Biology and Vector Borne Disease Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Narisa Brownell
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Vector Biology and Vector Borne Disease Research Unit, Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- *Correspondence: Narisa Brownell,
| |
Collapse
|
2
|
Encephalitozoon spp. as a potential human pathogen. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Encephalitzoon spp. are microsporidia, and intracellular opportunistic pathogens. The hosts of these pathogens include vertebrates, invertebrates, and certain protozoa. In people microsporidia may be opportunistic pathogens for immunocompromised patients (with AIDS or after organ transplantation). Infection with these microorganisms was also described in persons with diarrhea and corneal diseases.
The species causing rare infections in humans, Encephalitozooncuniculi, had previously been described from animal hosts. However, several new microsporidial species, including E. intestinalis and E. hellem, have been discovered in humans, raising the question of their natural origin. Vertebrate animals are now identified as hosts for all three microsporidial species infecting humans, implying a zoonotic nature of these microorganisms. Molecular studies have identified phenotypic and/or genetic variability within these species, indicating that they are not uniform, and have allowed the question of their zoonotic potential to be addressed. The focus of this review is to present the zoonotic potential of E. intestinalis, E. cuniculi, and E. hellem.
Collapse
|
3
|
The Brief Case: Sister Fungi in a Patient with AIDS. J Clin Microbiol 2022; 60:e0114421. [PMID: 35442074 DOI: 10.1128/jcm.01144-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
4
|
Taghipour A, Bahadory S, Khazaei S, Zaki L, Ghaderinezhad S, Sherafati J, Abdoli A. Global molecular epidemiology of microsporidia in pigs and wild boars with emphasis on Enterocytozoon bieneusi: A systematic review and meta-analysis. Vet Med Sci 2022; 8:1126-1136. [PMID: 35113502 PMCID: PMC9122395 DOI: 10.1002/vms3.751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Microsporidia are spore‐forming intracellular pathogens with worldwide prevalence, causing emerging infections in humans and animals. Enterocytozoon bieneusi is a zoonotic species of microsporidia and is responsible for more than 90% of cases of microsporidiosis in humans and animals. Pigs and wild boars are important animal reservoirs of microsporidia. Hence, we aimed to estimate the global prevalence of microsporidia and genetic diversity of E. bieneusi in pigs and wild boars through a set of systematic review and meta‐analysis (PRISMA) guidelines. Methods Four databases (Web of Science, PubMed, Scopus and Google Scholar) were searched between January 1, 2000 and April 30, 2021. Regarding meta‐analysis, the random‐effect model was employed by forest plot with 95% confidence interval (CI). Results After exclusion of irrelevant articles and duplication removal, 33 papers, including 34 datasets (30 datasets for domestic pigs and 4 for wild boars) finally meet the inclusion criteria to undergo meta‐analysis. The pooled prevalence rates of microsporidia infection in domestic pigs and wild boars were 37.6% (95% CI: 30.8–44.9%) and 8.1% (95% CI: 2.1–26.8%), respectively. While, the pooled prevalence rates of E. bieneusi were 35% (95% CI: 28.4–42.2%) in domestic pigs and 10.1% (95% CI: 1.7–42.4%) in wild boars. The genotypes EbpA was the most reported genotype in domestic pigs and wild boars. Male animals had higher prevalence rates of microsporidia infection than females (27 vs. 17.4%, OR = 1.91; 95% CI, 0.77–4.71%). Conclusion This study indicates the important role of domestic pigs and wild boars as animal reservoir hosts of microsporidia. Thereby, strategies for control and prevention of these zoonotic pathogens should be designed in pigs and wild boars.
Collapse
Affiliation(s)
- Ali Taghipour
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Saeed Bahadory
- Department of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sasan Khazaei
- Department of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Leila Zaki
- Department of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sheida Ghaderinezhad
- Department of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Jila Sherafati
- Department of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.,Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
| |
Collapse
|
5
|
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.
Collapse
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
| | -
- Department of Nephrology, 3iHP, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Nadelman DA, Bradt AR, Qvarnstrom Y, Goldsmith CS, Zaki SR, Wang F, Smith EH, Fullen DR. Cutaneous microsporidiosis in an immunosuppressed patient. J Cutan Pathol 2020; 47:659-663. [PMID: 32125011 DOI: 10.1111/cup.13674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
Microsporidia are a group of obligate intracellular parasites that naturally infect domestic and wild animals. Human microsporidiosis is an increasingly recognized multisystem opportunistic infection. The clinical manifestations are diverse with diarrhea being the most common presenting symptom. We present a 52-year-old woman with a history of amyopathic dermatomyositis complicated by interstitial lung disease managed with mycophenolate mofetil and hydroxychloroquine who presented with a 7-month history of recurrent subcutaneous nodules as well as intermittent diarrhea and chronic sinusitis. A punch biopsy showed superficial and deep lymphocytic and granulomatous dermatitis with focal necrosis. Tissue stains for microorganisms revealed oval 1 to 3 μm spores within the necrotic areas in multiple tissue stains. Additional studies at the Centers for Disease Control and Prevention confirmed cutaneous microsporidiosis. This case is one of very few confirmed examples of cutaneous microsporidiosis reported in the literature.
Collapse
Affiliation(s)
| | - Ashley R Bradt
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yvonne Qvarnstrom
- Centers for Global Health, Division of Parasitic Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Cynthia S Goldsmith
- National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Sherif R Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Frank Wang
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily H Smith
- Department of Dermatology, University of Missouri, Columbia, Missouri, USA
| | - Douglas R Fullen
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
Shah S, Jacob SS, Mani R, Parameswaran A, Kumar S, Annigeri RA, Mahesh R, Uppuluri R. Renal Microsporidiosis in Pediatric Bone Marrow Transplant Recipients: A Case Series. Turk Patoloji Derg 2020; 36:68-72. [PMID: 29630083 PMCID: PMC10512666 DOI: 10.5146/tjpath.2017.01416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
Microsporidiosis is a rare, but emerging opportunistic infection in solid organ transplant and stem cell transplant recipients. Renal involvement in microsporidiosis is very rarely seen in these recipients. We describe two cases of pediatric renal microsporidiosis, diagnosed on renal biopsies, following bone marrow transplantation presenting as severe acute kidney injury. The first patient died, whereas the second survived due to early diagnosis based on high index of suspicion and prompt treatment with Albendazole. We believe these are the first such reported cases of renal microsporidiosis in pediatric bone marrow transplant recipients.
Collapse
Affiliation(s)
- Saloni Shah
- Department of Histopathology, Apollo Hospitals, CHENNAI, TAMIL NADU, INDIA
| | | | | | | | | | | | | | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Smith RM, Muehlenbachs A, Schaenmann J, Baxi S, Koo S, Blau D, Chin-Hong P, Thorner AR, Kuehnert MJ, Wheeler K, Liakos A, Jackson JW, Benedict T, da Silva AJ, Ritter JM, Rollin D, Metcalfe M, Goldsmith CS, Visvesvara GS, Basavaraju SV, Zaki S. Three Cases of Neurologic Syndrome Caused by Donor-Derived Microsporidiosis. Emerg Infect Dis 2018; 23:387-395. [PMID: 28220747 PMCID: PMC5382757 DOI: 10.3201/eid2303.161580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Encephalitozoon cuniculi was transmitted from an infected donor to 3 solid organ recipients, 1 of whom died. In April 2014, a kidney transplant recipient in the United States experienced headache, diplopia, and confusion, followed by neurologic decline and death. An investigation to evaluate the possibility of donor-derived infection determined that 3 patients had received 4 organs (kidney, liver, heart/kidney) from the same donor. The liver recipient experienced tremor and gait instability; the heart/kidney and contralateral kidney recipients were hospitalized with encephalitis. None experienced gastrointestinal symptoms. Encephalitozoon cuniculi was detected by tissue PCR in the central nervous system of the deceased kidney recipient and in renal allograft tissue from both kidney recipients. Urine PCR was positive for E. cuniculi in the 2 surviving recipients. Donor serum was positive for E. cuniculi antibodies. E. cuniculi was transmitted to 3 recipients from 1 donor. This rare presentation of disseminated disease resulted in diagnostic delays. Clinicians should consider donor-derived microsporidial infection in organ recipients with unexplained encephalitis, even when gastrointestinal manifestations are absent.
Collapse
|
12
|
Gillett AK, Ploeg R, O’Donoghue PJ, Chapman PA, Webb RI, Flint M, Mills PC. Ultrastructural and Molecular Characterisation of an Heterosporis-Like Microsporidian in Australian Sea Snakes (Hydrophiinae). PLoS One 2016; 11:e0150724. [PMID: 27007116 PMCID: PMC4805256 DOI: 10.1371/journal.pone.0150724] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
Four sea snakes (two Hydrophis major, one Hydrophis platurus, one Hydrophis elegans) were found washed ashore on different beaches in the Sunshine Coast region and Fraser Island in Queensland, Australia between 2007–2013. Each snake had multiple granulomas and locally extensive regions of pallor evident in the hypaxial and intercostal musculature along the body. Lesions in two individuals were also associated with vertebral and rib fractures. Histological examination revealed granulomas scattered throughout skeletal muscle, subcutaneous adipose tissue and fractured bone. These were composed of dense aggregates of microsporidian spores surrounded by a mantle of macrophages. Sequences (ssrRNA) were obtained from lesions in three sea snakes and all revealed 99% similarity with Heterosporis anguillarum from the Japanese eel (Anguillarum japonica). However, ultrastructural characteristics of the organism were not consistent with those of previous descriptions. Electron microscopic examination of skeletal muscle revealed large cysts (not xenomas) bound by walls of fibrillar material (Heterosporis-like sporophorocyst walls were not detected). The cysts contained numerous mature microsporidian spores arranged in small clusters, sometimes apparently within sporophorous vesicles. The microspores were monomorphic, oval and measured 2.5–3.0 μm by 1.6–1.8 μm. They contained isofilar polar filaments with 11 (infrequently 9–12) coils arranged in two ranks. This is the first published report of a microsporidian infection in hydrophiid sea snakes. This discovery shows microsporidia with molecular affinities to Heterosporis anguillarum but ultrastructural characters most consistent with the genus Pleistophora (but no hitherto described species). Further studies are required to determine whether the microsporidian presented here belongs to the genus Heterosporis, or to a polymorphic species group as suggested by the recognition of a robust Pleistophora/Heterosporis clade by molecular studies. The gross and histological pathology associated with these infections are described.
Collapse
Affiliation(s)
- Amber K. Gillett
- Vet-MARTI, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
- Australia Zoo Wildlife Hospital, Beerwah, Queensland, Australia
- * E-mail:
| | - Richard Ploeg
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Peter J. O’Donoghue
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Phoebe A. Chapman
- Vet-MARTI, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Richard I. Webb
- Centre for Microscopy and Microanalysis, The University of Queensland, St Lucia, Queensland, Australia
| | - Mark Flint
- Vet-MARTI, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
- School of Forest Resources and Conservation, University of Florida, The Florida Aquarium’s Centre for Conservation, Apollo Beach, Florida, United States of America
| | - Paul C. Mills
- Vet-MARTI, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| |
Collapse
|
13
|
Abstract
Microsporidia are highly specialized obligate intracellular organisms that are closely related to fungi. Although traditionally associated with diarrheal illness in patients with AIDS, extraintestinal infections involving various organs have been reported with increasing frequency in the past decade, particularly in immunocompromised hosts. Diagnosis is usually accomplished by light microscopic identification of spores in body fluids and tissues, using a variety of stains. Transmission electron microscopy, immunofluorescence assays, or molecular methods are necessary for identification to the genus and species level. Early diagnosis is essential for preventing the significant associated morbidity and mortality of extraintestinal microsporidiosis.
Collapse
|
14
|
Concurrent infection of the urinary tract with Encephalitozoon cuniculi and Enterocytozoon bieneusi in a renal transplant recipient. J Clin Microbiol 2014; 52:1780-2. [PMID: 24523472 DOI: 10.1128/jcm.03328-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A urinary tract coinfection, caused by Encephalitozoon cuniculi genotype II and Enterocytozoon bieneusi genotype D, was identified in an HIV-seronegative renal transplant recipient kept under lifelong immunosuppression. To our knowledge, this is the first report describing concurrent infection with these two microsporidia species in organ transplant recipients.
Collapse
|