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Chapter 8 : Clinical Syndromes Associated with Microsporidiosis

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Abstract:

This chapter describes the clinical and pathogenic features of microsporidiosis. It mainly focuses on intestinal disease. Most reports of intestinal microsporidiosis have involved human immunodeficiency virus (HIV)-infected individuals. Although the majority of cases have been diagnosed in homosexual males, diagnoses also have been made in heterosexual women and in children. has been identified in patients with other immune deficiencies, as well as in immuno competent individuals who are asymptomatic or have a self-limited diarrheal illness. Microsporidia were originally believed to cause intestinal disease on the basis of their identification in abnormal small intestinal mucosa of severely immunosuppressed AIDS patients with chronic diarrhea and weight loss. The cardinal feature of intestinal microsporidiosis is injury to the small intestinal epithelium, leading to malabsorption. The various stages in the life cycle of and have been characterized by transmission electron microscopy (TEM) in several laboratories. Intestinal microsporidiosis affects the topography of the small intestinal surface. is most often observed in the upper third of the villus and not in the crypt. There is no acute inflammation. Two agents, fumagillin and albendazole, have been shown to have activity against microsporidia both in vitro and in vivo. In contrast to , has a uniformly excellent response to albendazole therapy.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8

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Simian immunodeficiency virus
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Transmission Electron Microscopy
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Image of FIGURE1
FIGURE1

Transmision electron micrograph of a jejunal biopsy from a patient with infection, demonstrating the plasmodial stage of development. Note their locat i on in the supranuclear Golgi region, the nuclear cupping, and the intraepithelial lymphocytes. Magnification, ×4,525.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 2
FIGURE 2

Transmission electron micrograph of a single meront with a developing nucleus. Magnification, ×10,000.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 3
FIGURE 3

Transmision electron micrograph of a jejunal biopsy from a patient with infection, demonstrating a degenerating (vesiculated) enterocyte containing many mature spores and one sporogonial plasmodium. Magnification, ×9,813.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 4
FIGURE 4

A spore of , demonstrating the characteristic six turns of the polar tubule, which are organized into two tiers of three turns each and which are out of register bu 45°. Magnification, ×83,000.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 5
FIGURE 5

Transmission electron micrograph of a jejunal biopsy from a patient with infection, demonstrating cells containing spores that have sloughed or are in the process of sloughing from the epithelial surface. Magnification, ×3,423.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 6
FIGURE 6

(A) Transmission electron micrograph of a jejunal biopsy, demonstrating numerous septated parasitophorous vacuoles of , which are located in the Golgi-rich supranuclear cytoplasm. Note the intraepithelial lymphocytes. Magnification, ×3,270. (B) From meronts to mature spores, development in a septated parasitophorous vacuole. Magnification, ×10,584.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 7
FIGURE 7

A spore of , demonstrating the characteristic six to seven turns of the polar tubule. Magnification, ×25,000.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 8
FIGURE 8

(A) Endoscopic photograph of jejunal mucosa from a patient with infection, demonstating villus fusion.This photograph was obtained after immersing the intestinal lumen in saline. (B) Endoscopic photograph of jejunal mucosa from an uninfected subject, demonstrating normal jejunal villi.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 9
FIGURE 9

Low magnification of small bowel, showing partial villus atrophy and crypt hyperplasia.These changes are typical of microsporidial infection, although they can also be seen with cryptosporidiosis. The sample was stained with hematoxylin and eosin. Magnification, ×125.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 10
FIGURE 10

Light microscopy showing supranuclear plasmodia of E. bieneusi and shedding enterocytes containing mature spores.The sample was stained with hematoxylin and eosin. Magnification, ×250.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 11
FIGURE 11

Light micrograph of villus tip in a plastic section of a patient with infection demonstrating spores in nearly every epithelial cell near the villus tip. the sample was stained with methylene blue-azure II-fuchsin. Magnification, ×250.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 12
FIGURE 12

Urine sediment stained with Diff-Quik, demonstating spores of within epithelial cells. Magnification, ×250.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE13
FIGURE13

An area of ulcerated small bowel due to infection. The sample was stained with hematoxylin and eosin. Magnification, ×125.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 14
FIGURE 14

(A) Gram stain of a jejunal villus tip from a patient with infection demonstrating grampositive spores. Magnification, ×125. (B) Acid-fast stain of a jejunal biopsy, showing spores of Magnification, ×400. (C) Giemsa stain of a villus tip from a patient with infection, showing multiple intracellular forms of Magnification, ×125.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 15
FIGURE 15

Endoscopic retrograde cholangiogram from a patient with E. bieneusi infection, demonstrating diffuse dilatation of the common bile duct with irregular walls, plus areas of narrowing and dilatation of the intrahepatic bile ducts.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 16
FIGURE 16

Renal tubular epithelium infected with lyse and shed in the lumen to be subsequendy found in the urinary sediment.The sample was stained with hematoxylin and eosin. Magnification, ×400.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 17
FIGURE 17

(A) Gross picture of a brain from a patient with infection demonstrating multiple necrotic lesions in the gray matter. (B) Light microscopic section from the brain shown in panel A, demonstrating spores in astrocytes and other cells.The sample was stained with Gomori methenamine-silver. Magnification, ×400.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Image of FIGURE 18
FIGURE 18

Light micrograph, under polarized light, of cardiac muscle from a patient with Trachipleistophora infection, demonstrating atrophy and fibrosis of the cardiac myocytes. the spores of the organism are birefringent. The sample was stained with hematoxylin and eosin. Magnification, ×250.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
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Tables

Generic image for table
TABLE 1

Microsporidia identified as pathogenic to humans

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8
Generic image for table
TABLE 2

Therapy for microsporidiosis

BID, twice a day; QD, once a day.

Antiretroviral treatment, which results in improvement of immune function, can result in the resolution of symptoms and spontaneous elimination of this organism by the host.

Citation: Kotler D, Orenstein J. 1999. Clinical Syndromes Associated with Microsporidiosis, p 258-292. In Wittner M, Weiss L (ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC. doi: 10.1128/9781555818227.ch8

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