Cases reported "Encephalitozoonosis"

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1/35. Resolution of microsporidial sinusitis and keratoconjunctivitis by itraconazole treatment.

    PURPOSE: To report successful treatment of ocular infection caused by the microsporidium encephalitozoon cuniculi in a person with acquired immunodeficiency syndrome (AIDS) and nasal and paranasal sinus infection. METHOD: Case report. RESULTS: Microsporidial infection in a person with AIDS and with chronic sinusitis and keratoconjunctivitis was diagnosed by Weber modified trichrome stain and transmission electron microscopy. Symptoms completely resolved with itraconazole treatment (200 mg/day for 8 weeks) after albendazole therapy (400 mg/day for 6 weeks) was unsuccessful. CONCLUSION: itraconazole can be recommended in ocular, nasal, and paranasal sinus infection caused by E. cuniculi parasites when treatment with albendazole fails. ( info)

2/35. Encephalitozoon intestinale infection in an AIDS patient--a case report.

    The first case of one of the most frequent intestinal microsporidians, Encephalitozoon intestinale, is reported from an AIDS patient in the czech republic. The patient experienced diarrhoea and was found to have microsporidia spores in stool. Species determination by electron microscopy confirmed the diagnosis of the microsporidian, E. intestinale. The CD4-count at the time of the diagnosis was 73 cells/mm3, IRI = 0.21. Only after symptomatic therapy and rehydration the patient stopped the complaining, and although he refused an antimicrosporidial therapy, the CD4-count one month later increased to 200 cells/mm3 and patient didn't suffered from diarrhoea. Six months after the first finding of microsporidia, the patient was admitted to the hospital care for progressive encephalopathy and developing wasting syndrome again with the intermittent diarrhoea. The patient was treated with albendazole at that time. Nevertheless, after 14 days of albendazole therapy, he still remained positive for E. intestinale spores in the stool (urine specimens remained negative for all the time). The patient died after a two-month hospitalisation and the apparent cause of death was purulent bronchopneumonia, wasting syndrome with microsporidiosis, and hiv encephalopathy. Generalised mycobacteriosis (MAC) was also found from the autopsy material. ( info)

3/35. Microsporidial AIDS cholangiopathy due to Encephalitozoon intestinalis: case report and review.

    microsporidia are increasingly recognized as opportunistic infections in immunodeficient patients, predominantly patients with AIDS. The two microsporidia most commonly associated with disease in AIDS patients are enterocytozoon bieneusi and Encephalitozoon intestinalis (previously known as Septata intestinalis). The most common clinical presentation of microsporidiosis in AIDS patients is diarrhea, most commonly caused by the enterocytozoon bieneusi species. Encephalitozoon intestinalis is a recently described species that has been reported to cause disseminated human infection including cholangitis. We report a case of AIDS cholangiopathy that presented with abdominal pain and cholestatic liver tests. Ultrasound examination and ERCP revealed a picture of sclerosing cholangitis. Bile samples obtained at ERCP were negative for microsporidia; stool studies for microsporidia and cryptosporidia were also negative. No organisms were identified on routine light microscopy of the biopsy specimens from the duodenum, ampulla, and bile duct. E. intestinalis spores were demonstrated in the bile duct biopsies, by methylene blue and azure 11 staining and confirmed by electron microscopy. albendazole therapy was successful in eradicating E. intestinalis with clinical improvement and improvement in CD4 count. However, the cholangiographic picture did not improve and repeat cholangiography revealed progressive bile duct injury. albendazole therapy was delayed and may have been too late to prevent bile duct damage; the drug had to be approved by the US food and Drug Administration for compassionate use. This is an unusual case of sclerosing cholangitis caused by an unusual organism and requiring biliary sphincterotomy and stent placement for progressive stricturing despite eradication of the infection. ( info)

4/35. in vitro culture, ultrastructure, antigenic, and molecular characterization of encephalitozoon cuniculi isolated from urine and sputum samples from a Spanish patient with AIDS.

    In this report we describe the cultivation of two isolates of microsporidia, one from urine and the other from sputum samples from a Spanish AIDS patient. We identified them as encephalitozoon cuniculi, type strain III (the dog genotype), based on ultrastructure, antigenic characteristics, PCR, and the sequence of the ribosomal dna internal transcribed spacer region. ( info)

5/35. microsporidiosis in the graft of a renal transplant recipient.

    microsporidia are intracellular protozoa that are emerging as significant opportunistic infections in AIDS patients. Although there are numerous published reports of intestinal and disseminated infections in patients with AIDS, there have been only two previous reports in transplantation medicine, both on intestinal microsporidiosis. We report here the first documented case of extra-intestinal microsporidiosis in a transplant recipient. A 39-year-old renal transplant recipient presented with a pyrexia and deteriorating graft function. light microscopic examination of a renal allograft biopsy revealed numerous microsporidian spores within the renal tubular epithelium. Transmission electron microscopy confirmed the presence of an Encephalitozoon infection and was highly suggestive of Encephalitozoon intestinalis. Therapy with albendazole was extremely effective and resulted in recovery of renal function. Although a rare cause of renal allograft dysfunction, microsporidiosis is curable. It may be underdiagnosed, and should be considered in the differential diagnosis of transplant recipients presenting with opportunistic infections. ( info)

6/35. Dual microsporidial infection with encephalitozoon cuniculi and enterocytozoon bieneusi in an hiv-positive patient.

    This report describes the first dual microsporidial infection with encephalitozoon cuniculi and enterocytozoon bieneusi in an hiv-positive patient. In view of clinical and epidemiological findings, our E. cuniculi isolate was deduced to be of the dog strain. The patient's occupational involvement with dogs indicates that canines should be considered as a reservoir of human infections for both microsporidial species. Furthermore, our report provides detailed clinical and radiological information on a rare case of a symptomatic pulmonary infection by E. cuniculi and its improvement after treatment with albendazole. ( info)

7/35. Disseminated infection due to encephalitozoon cuniculi in a patient with AIDS: case report and review.

    OBJECTIVE AND methods: Infections due to microsporidia are increasingly recognized as opportunistic infections in patients with AIDS. We describe here a case of disseminated infection due to encephalitozoon cuniculi and review the literature on this microsporidial infection. RESULTS: All 12 patients reported in the literature had AIDS and nine presented with disseminated infection involving the kidneys, sinuses, lungs, brain and conjunctiva. Asymptomatic infection was seen in three patients. microsporidia were detected by light microscopy examination of urine samples in all the cases. Species identification was performed by various genotypic methods or transmission electron microscopy. Eight of 12 patients who received albendazole therapy experienced clinical improvement with documented clearance of spores in five of these eight patients. Two patients relapsed. CONCLUSIONS: E. cuniculi infection should be considered in severely immunocompromised hiv-infected patients with multi-organ involvement and fever, especially when renal failure is present. Microsporidial spores are usually seen in urine samples and in the involved organ. albendazole therapy seems to be effective. ( info)

8/35. Disseminated microsporidiosis caused by encephalitozoon cuniculi III (dog type) in an Italian AIDS patient: a retrospective study.

    We report a case of disseminated microsporidiosis in an Italian woman with AIDS. This study was done retrospectively using formalin-fixed, paraffin-embedded tissue specimens obtained at autopsy. microsporidia spores were found in the necrotic lesions of the liver, kidney, and adrenal gland and in ovary, brain, heart, spleen, lung, and lymph nodes. The infecting agent was identified as belonging to the genus Encephalitozoon based on transmission electron microscopy and indirect immunofluorescence. Additional molecular studies, including sequence of the rDNA internal transcribed spacer region, identified the agent as E. cuniculi, genotype III. We believe that this is the first report of a human case of disseminated microsporidial infection involving the ovary. ( info)

9/35. Disseminated infection with encephalitozoon intestinalis in AIDS patients: report of 2 cases.

    microsporidiosis must be regarded as a late opportunistic infection when hiv is advanced. In this article we describe 2 cases of disseminated infection with Encephalitozoon intestinalis. The first case had a local intestinal infection for > 1 y before it disseminated and microsporidia were found intracellularly in sputum. In the second case, spores were initially found in conjunctival cells, sinus lavage, sputum and urine. This patient had clinical symptoms and radiological findings from the central nervous system. Signs of cerebral lymphoma developed after treatment of the opportunistic microsporidial infection. ( info)

10/35. Disseminated encephalitozoon cuniculi infection in a Mexican kidney transplant recipient.

    BACKGROUND: No cases of encephalitozoon cuniculi infection have been reported in transplant patients. methods: A 42-year-old man received a renal transplant 8 months earlier because of terminal glomerulonephritis and was admitted with cough, fever, diarrhea, abdominal pain, and colon wall thickening. While under rapamycin (2 g/day), cyclosporine A (4.4 mg/kg/day), and prednisone (100 mg/day) therapy, he developed Banff grade IB graft rejection and was treated with methylprednisolone (1 g/day) for 3 days and oral prednisone (60 mg/d). RESULTS: Microbiologic studies were inconclusive, and biopsy specimens of ileum, colon, liver, and the grafted kidney revealed numerous gram-positive microsporidia spores. Parasitophorous vacuoles containing various developing stages of Encephalitozoon were seen. Immunofluorescence studies identified the etiologic agent as E. cuniculi. albendazole therapy resulted in clinical improvement but no eradication after 10 months of follow-up. CONCLUSIONS: This report describes what is, to the authors' knowledge, the first case of disseminated E. cuniculi infection in a kidney transplant human immunodeficiency virus-negative patient from mexico. ( info)
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