1/19. Intestinal microsporidiosis occurring in two renal transplant recipients treated with mycophenolate mofetil.BACKGROUND: Intestinal microsporidiosis is a major cause of chronic diarrhea and malabsorption in patients with human immunodeficiency virus. Its occurrence in transplant recipients has exceptionally been reported to date. methods: We report what we believe are the first two cases of intestinal microsporidiosis in renal transplant recipients. The patients were treated with mycophenolate mofetil. RESULTS: The clinical presentation was chronic diarrhea with massive weight loss. Stool analysis revealed microsporidian spores, identified as enterocytozoon bieneusi spores by polymerase chain reaction. The onset of this opportunistic infection in these two patients is believed to be secondary to an increase in immunosuppression after azathioprine replacement by mycophenolate mofetil. The withdrawal of mycophenolate mofetil led to clinical recovery. CONCLUSION: The incidence of microsporidiosis will probably increase in transplant recipients treated with powerful immunosuppressants. Therefore, we recommend a systematic search for microsporidian spores in stool specimens in cases of unexplained diarrhea in these patients.- - - - - - - - - - ranking = 1keywords = immunodeficiency (Clic here for more details about this article) |
2/19. myxobolus sp., another opportunistic parasite in immunosuppressed patients?During a study of intestinal parasitic infections in human immunodeficiency virus-positive patients, a parasite belonging to the phylum myxozoa, recently described from human samples, was identified in one sample. When this parasite was stained by the modified Ziehl-Neelsen staining method, the features of the spores were identified: they were pyriform in shape, had thick walls, and had one suture and two polar capsules, with each one having four or five coils. The suture and two polar capsules were observed with the chromotrope-modified stain. The number of stools passed was more than 30 per day, but oocysts of isospora belli were also found. Upon reexamination of some formalin- or merthiolate-iodine-formaldehyde-preserved samples an identical parasite was found in another sample from a patient presenting with diarrhea. strongyloides stercoralis larvae and eggs of hymenolepis nana and ascaris lumbricoides were also found in this sample. Given that both patients were also infected with other pathogens that cause diarrhea, the possible pathogenic role of this parasite could not be established. The probable route of infection also could not be established.- - - - - - - - - - ranking = 1keywords = immunodeficiency (Clic here for more details about this article) |
3/19. Disseminated microsporidiosis (Encephalitozoon hellem) and acquired immunodeficiency syndrome. autopsy evidence for respiratory acquisition.microsporidia are obligate intracellular protozoal parasites that infect a variety of cell types in a broad range of invertebrates and vertebrates. They have recently come to medical attention due to the increased frequency with which members of two microsporidian genera, enterocytozoon and Encephalitozoon, are being diagnosed in patients with the acquired immunodeficiency syndrome (AIDS). The majority of published reports of human microsporidiosis describe enterocytozoon infection of small intestinal enterocytes. In addition, a growing number of AIDS patients have been identified with infection due to the two species of Encephalitozoon-encephalitozoon cuniculi and Encephalitozoon hellem, observed in conjunctival, corneal, and, recently, sinonasal tissues. However, there are scant data regarding the systemic pathology and epidemiology of these infections. This article describes a patient with AIDS who died with systemic Encephalitozoon infection. The etiologic microsporidian was found to be E hellem by using antemortem biochemical and antigenic analyses. A complete autopsy, the first to be reported in a patient with this infection, revealed organisms in the eyes, urinary tract, and respiratory tract. A surprising observation was the occurrence of numerous organisms within the lining epithelium of almost the entire length of the tracheobronchial tree, suggestive of respiratory acquisition. Detailed light and electron microscopic findings and the biological and diagnostic features of microsporidiosis are discussed.- - - - - - - - - - ranking = 45.290494402035keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
4/19. Resolution of microsporidial epithelial keratopathy in a patient with AIDS.A patient with a positive human immunodeficiency virus (hiv) titer and cryptococcal meningitis suffered bilateral epithelial keratopathy caused by Encephalitozoon, which did not respond to sulfas, erythromycin, bacitracin, tobramycin, neomycin, polymyxin b, or fluconazole. Eventual administration of itraconazole for the meningitis apparently produced resolution of the long-lasting (2-month) ocular infection. This new oral triazole antifungal may be valuable against the increasingly prevalent microsporidial infections in patients with acquired immune deficiency syndrome. Debulking of the infection by corneal scraping may have contributed to the authors' success.- - - - - - - - - - ranking = 1keywords = immunodeficiency (Clic here for more details about this article) |
5/19. Microsporidial keratoconjunctivitis in acquired immunodeficiency syndrome.We describe three patients with acquired immunodeficiency syndrome who presented with a bilateral coarse superficial epithelial keratitis due to infection with the protozoal parasite Microspora, encephalitozoon cuniculi. Despite the extent of the corneal surface disease, conjunctival inflammation was minimal. visual acuity ranged from 20/20 to 20/200. In one patient, the keratitis was complicated by the development of a surface defect with secondary pseudomonas species infection. All patients had a history of exposure to household pets. Standard cultures were negative. diagnosis was established in two of the three cases based on characteristic appearance of the protozoan in conjunctival scrapings. Electron microscopy of a conjunctival biopsy specimen in one patient confirmed the species. No recognized effective treatment is available for this infection.- - - - - - - - - - ranking = 45.290494402035keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
6/19. enterocytozoon bieneusi (Microspora): prevalence and pathogenicity in AIDS patients.microsporidia are unicellular organisms, which lack mitochondria. They have prokaryotic-like ribosomes and characteristic spores containing an extrusible polar tube which serves as a passage for inoculation of the infectious agent (sporoplasm) into host cells. Clinically apparent infections in man appear to be limited to immunoprivileged sites or immunocompromised patients. One species, encephalitozoon cuniculi, has been reported several times in patients with neurological disorders and once causing a fatal hepatitis in an AIDS patient. The most recently discovered species, enterocytozoon bieneusi, is known only from the small intestinal enterocytes of patients with the acquired immunodeficiency syndrome, and is easily differentiated from other microsporidia by the precocious development of spore organelles in the sporont and by the poor development of the endospore layer of the spore wall. Although only about 40 cases have been reported, circumstantial evidence suggests that E. bieneusi may be the cause of a severe watery diarrhoea, which responds only temporarily to treatment with metronidazole.- - - - - - - - - - ranking = 9.0580988804069keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
7/19. pneumocystis carinii choroidopathy. A new clinical entity.A 43-year-old black woman with acquired immunodeficiency syndrome developed bilateral multifocal choroidopathy characterized by slowly enlarging round to oval lesions in the posterior pole and midperiphery. Systemic evaluation revealed no evidence of mycobacterial, fungal, or spirochetal disease. fluorescein angiography of the lesions showed early hypofluorescence with late staining of the lesions, which appeared deep to the retinal circulation. There was no evidence of retinal involvement. Over a 4-month period of observation, the lesions appeared to enlarge slowly, with no evidence of vitreous cells or debris in the overlying retina. A transscleral choroidal biopsy was performed, and electron microscopy showed numerous cystic structures characteristic of pneumocystis carinii within necrotic choroid. The lack of inflammatory changes clinically, by fluorescein angiography, and histopathologically was striking.- - - - - - - - - - ranking = 9.0580988804069keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/19. prevalence of enteric parasites in homosexual patients attending an outpatient clinic.A total of 372 pooled stool specimens from 274 homosexual men with diarrhea were submitted for parasitologic examination over a 2.5-year period. Each two-vial pooled specimen set contained portions of stool from 3 consecutive days in Formalin and polyvinyl alcohol. Of the 274 patients, 133 (48.5%) harbored one or more intestinal protozoa, with 161 (43.3%) of the 372 specimens submitted being positive for one or more organisms. The parasites identified included entamoeba histolytica (71 patients), giardia lamblia (22 patients), endolimax nana (106 patients), Entamoeba coli (39 patients), Entamoeba hartmanni (25 patients), dientamoeba fragilis (3 patients), Iodamoeba butschlii (2 patients), and Chilomastix mesnili (2 patients). cryptosporidium sp. (2 patients) and isospora belli (1 patient) were also detected. Results of this study support the experience of other workers regarding high rates of infection with intestinal parasites in the homosexual population and also indicate that symptomatic individuals belonging to this acquired immunodeficiency syndrome risk group be screened for both common and uncommon intestinal pathogens.- - - - - - - - - - ranking = 9.0580988804069keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/19. Disseminated pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome.A case of disseminated pneumocystosis occurring in a patient with the acquired immunodeficiency syndrome is described. Postmortem examination of this patient, who had three episodes of pneumocystis carinii pneumonia during his 3-year clinical course, revealed clinically unsuspected infiltration of lymph nodes, spleen, adrenal glands, and bone marrow, in addition to persistent pulmonary infection by the organism.- - - - - - - - - - ranking = 45.290494402035keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
10/19. Cutaneous pneumocystosis.A 42-year-old man with the acquired immunodeficiency syndrome (AIDS) presented with a 9-month history of progressive hearing loss and bilateral external auditory canal masses. biopsy of the right ear mass detected pneumocystis carinii. The patient was treated with a 7-day course of intravenous trimethoprim, followed by a 3-week course of oral trimethoprim-sulfamethoxazole, with a marked reduction in the size of his ear masses. This is the first reported case of skin involvement by P. carinii in a patient with AIDS. Because of our patient's documented response to treatment, we stress the importance of biopsy of cutaneous lesions in this group of patients, who may have a potentially treatable condition.- - - - - - - - - - ranking = 9.0580988804069keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
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