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Microsporidiosis - Causes, Symptoms and Treatment

Definition:

Microsporidiosis is present mainly in immunocompromised individuals; it gained momentum as a cause of disease during the onset of the acquired immunodeficiency syndrome (AIDS) epidemic. The prevalence of microsporidiosis in human immunodeficiency virus (HIV)-positive patients is difficult to measure because it is hard to diagnosis and is not usually the first AIDS-defining illness present. Intestinal microsporidiosis is the most common microsporidial disease in people with AIDS. Infections of the eye and other organs may also occur.

Researchers speculate that treatment with antiretroviral therapy, including protease inhibitors, has helped to alleviate microsporidiosis in the HIV population Two small studies in 1997 suggest this possibility. One study treated microsporidial diarrhea with combination antiretroviral therapy, including a protease inhibitor. The diarrhea improved after 12 weeks. The other study evaluated 15 patients with chronic microsporidiosis who had been taking triple antiretroviral therapy, including either indinavir (Crixivan) or ritonavir (Norvir). Four out of six patients revealed no identifiable evidence of parasites in several stool examinations. In 12 of the 15 patients, diarrhea was resolved.

Causes of Microsporidiosis

Microsporidiosis is caused by microsporidia, small intercellular spore-forming protozoan parasites (such as Enterocytozoon intestinalis, Nosema ocularum, and Vittaforma corneae). When the parasites are present in the lumen of the GI tract, they uncoil and infect a host cell. The resulting intercellular division produces sporoblasts. These sporoblasts mature into spores and pass to other cells, or leave the body via urine, feces, or skin. Not much is known about the routes of transmission. In healthy persons, microsporidia is a common cause of subclinical illness. Fifty percent of healthy persons, especially individuals in tropical environments, present with antibodies to the microsporidium Enterocytozoon cuniculi. Only a few cases of infection were reported prior to the AIDS era. These pathogens are opportunistic to people with HIV and the immunocompromised; 30% of AIDS patients with chronic diarrhea have intestinal microsporidiosis. Others develop infections in sites other than the GI tract.

Signs and Symptoms of Microsporidiosis

The extent of the clinical disease depends on the parasite species and the patient's immune status. In AIDS patients, the most common presentation is profuse, watery, non-bloody diarrhea. Abdominal pain, cramping, nausea, vomiting, and weight loss may also be present. Microsporidia can also cause cholangitis, or inflammation of the bile ducts, hepatitis, peritonitis, or inflammation of the membrane lining in the abdomen, keratoconjunctivitis, and inflammation of the cornea and conjunctiva. Additional symptoms may include kidney, liver, lung, muscle, and brain infections.

Diagnosis for Microsporidiosis

Microsporidial spores in humans are small (1 to 2u in diameter) and are difficult to detect. Biopsy or corneal scrapings are necessary to detect organisms present in the infected tissue. Staining with Giemsa, PAS, Gram or acid-fast stains can help identify microsporidia in stools and duodenal fluids. A polymerase chain reaction is also useful for microsporidia detection in stools and in gut biopsies.

Treatment for Microsporidiosis

Currently there is no FDA-approved therapy or standard of care. Albendazole (400 mg P.O. b.i.d.) is given to control the intestinal infection with Septala intestinalis. A reduction of E. bieneusi may be noted in small bowel biopsies, but this does not indicate elimination of the infection. There is currently no treatment for ocular or disseminated microsporidiosis; however, there has been some success with fumagillin eyedrops and imidazole compounds (fluconazole, itraconazo1e).

Special Considerations and Prevention Tips for Microsporidiosis

1. Wash hands between patient contact, after touching infected material, and before touching open wounds or performing invasive procedures.

2. Dispose of soiled linens appropriately.

3. Change bed linens regularly.

4. Dispose of feces and urine appropriately.

5. Assist patient in maintaining good personal hygiene.

6. Wear gloves when handling infectious secretions and performing patient care.

7. Handle bedpans carefully.

8. Maintain the integrity of the patient's skin.

9. Promote a healthy diet.

10. Patients should practice careful hand-washing techniques.

11. Infected bed linens and other items should be contained in the appropriate receptacles.

12. Reinforce use of universal precaution methods to patients, families, and visitors.

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