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. 1996 Nov;34(11):2803–2811. doi: 10.1128/jcm.34.11.2803-2811.1996

Myositis associated with a newly described microsporidian, Trachipleistophora hominis, in a patient with AIDS.

A S Field 1, D J Marriott 1, S T Milliken 1, B J Brew 1, E U Canning 1, J G Kench 1, P Darveniza 1, J L Harkness 1
PMCID: PMC229407  PMID: 8897186

Abstract

Microsporidia are zoonotic protozoa which were rare human pathogens prior to 1985, when Enterocytozoon bieneusi was described in human immunodeficiency virus-infected patients with chronic diarrhea. Another species, Encephalitozoon (Septata) intestinalis, is associated with diarrhea and chronic sinusitis, and approximately 25 cases have been reported in the literature. However, other microsporidial infections in human immunodeficiency virus-infected patients remain extremely rare. We report the first case of a Pleistophora sp.-like microsporidian infection presenting as a progressive severe myosotis associated with fever and weight loss. The organism was demonstrated by light microscopy and electron microscopy in corneal scrapings, skeletal muscle, and nasal discharge. Electron microscopy showed an electron-dense surface coat with "sunflare"-like projections surrounding all stages of development of meronts (two to four nuclei, dividing by binary fission), sporonts, and sporoblasts. Division of sporonts, in which sporonts separate from the thick outer coat, creating a sporophorous vesicle, is by binary fission, differentiating this organism from Pleistophora sp. The spore measures 4.0 by 2.5 microns and has a rugose exospore. A new genus and species, Trachipleistophora hominis, has been established for this parasite. The patient was treated with albendazole, sulfadiazine, and pyrimethamine, and the clinical symptoms resolved.

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Selected References

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  1. Cali A. General microsporidian features and recent findings on AIDS isolates. J Protozool. 1991 Nov-Dec;38(6):625–630. [PubMed] [Google Scholar]
  2. Cali A., Kotler D. P., Orenstein J. M. Septata intestinalis N. G., N. Sp., an intestinal microsporidian associated with chronic diarrhea and dissemination in AIDS patients. J Eukaryot Microbiol. 1993 Jan-Feb;40(1):101–112. doi: 10.1111/j.1550-7408.1993.tb04889.x. [DOI] [PubMed] [Google Scholar]
  3. Chupp G. L., Alroy J., Adelman L. S., Breen J. C., Skolnik P. R. Myositis due to Pleistophora (Microsporidia) in a patient with AIDS. Clin Infect Dis. 1993 Jan;16(1):15–21. doi: 10.1093/clinids/16.1.15. [DOI] [PubMed] [Google Scholar]
  4. Dieterich D. T., Lew E. A., Kotler D. P., Poles M. A., Orenstein J. M. Treatment with albendazole for intestinal disease due to Enterocytozoon bieneusi in patients with AIDS. J Infect Dis. 1994 Jan;169(1):178–183. doi: 10.1093/infdis/169.1.178. [DOI] [PubMed] [Google Scholar]
  5. Dore G. J., Marriott D. J., Hing M. C., Harkness J. L., Field A. S. Disseminated microsporidiosis due to Septata intestinalis in nine patients infected with the human immunodeficiency virus: response to therapy with albendazole. Clin Infect Dis. 1995 Jul;21(1):70–76. doi: 10.1093/clinids/21.1.70. [DOI] [PubMed] [Google Scholar]
  6. Field A. S., Hing M. C., Milliken S. T., Marriott D. J. Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. Med J Aust. 1993 Mar 15;158(6):390–394. [PubMed] [Google Scholar]
  7. Haque A., Hollister W. S., Willcox A., Canning E. U. The antimicrosporidial activity of albendazole. J Invertebr Pathol. 1993 Sep;62(2):171–177. doi: 10.1006/jipa.1993.1092. [DOI] [PubMed] [Google Scholar]
  8. Hartskeerl R. A., Van Gool T., Schuitema A. R., Didier E. S., Terpstra W. J. Genetic and immunological characterization of the microsporidian Septata intestinalis Cali, Kotler and Orenstein, 1993: reclassification to Encephalitozoon intestinalis. Parasitology. 1995 Apr;110(Pt 3):277–285. doi: 10.1017/s0031182000080860. [DOI] [PubMed] [Google Scholar]
  9. Hollister W. S., Canning E. U., Colbourn N. I. A species of Encephalitozoon isolated from an AIDS patient: criteria for species differentiation. Folia Parasitol (Praha) 1993;40(4):293–295. [PubMed] [Google Scholar]
  10. Hollister W. S., Canning E. U., Colbourn N. I., Aarons E. J. Encephalitozoon cuniculi isolated from the urine of an AIDS patient, which differs from canine and murine isolates. J Eukaryot Microbiol. 1995 Jul-Aug;42(4):367–372. doi: 10.1111/j.1550-7408.1995.tb01595.x. [DOI] [PubMed] [Google Scholar]
  11. Hollister W. S., Canning E. U., Colbourn N. I., Curry A., Lacey C. J. Characterization of Encephalitozoon hellem (Microspora) isolated from the nasal mucosa of a patient with AIDS. Parasitology. 1993 Nov;107(Pt 4):351–358. doi: 10.1017/s003118200006769x. [DOI] [PubMed] [Google Scholar]
  12. Hollister W. S., Canning E. U., Weidner E., Field A. S., Kench J., Marriott D. J. Development and ultrastructure of Trachipleistophora hominis n.g., n.sp. after in vitro isolation from an AIDS patient and inoculation into athymic mice. Parasitology. 1996 Jan;112(Pt 1):143–154. doi: 10.1017/s0031182000065185. [DOI] [PubMed] [Google Scholar]
  13. Lacey C. J., Clarke A. M., Fraser P., Metcalfe T., Bonsor G., Curry A. Chronic microsporidian infection of the nasal mucosae, sinuses and conjunctivae in HIV disease. Genitourin Med. 1992 Jun;68(3):179–181. doi: 10.1136/sti.68.3.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ledford D. K., Overman M. D., Gonzalvo A., Cali A., Mester S. W., Lockey R. F. Microsporidiosis myositis in a patient with the acquired immunodeficiency syndrome. Ann Intern Med. 1985 May;102(5):628–630. doi: 10.7326/0003-4819-102-5-628. [DOI] [PubMed] [Google Scholar]
  15. McDougall R. J., Tandy M. W., Boreham R. E., Stenzel D. J., O'Donoghue P. J. Incidental finding of a microsporidian parasite from an AIDS patient. J Clin Microbiol. 1993 Feb;31(2):436–439. doi: 10.1128/jcm.31.2.436-439.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Modigliani R., Bories C., Le Charpentier Y., Salmeron M., Messing B., Galian A., Rambaud J. C., Lavergne A., Cochand-Priollet B., Desportes I. Diarrhoea and malabsorption in acquired immune deficiency syndrome: a study of four cases with special emphasis on opportunistic protozoan infestations. Gut. 1985 Feb;26(2):179–187. doi: 10.1136/gut.26.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Orenstein J. M., Chiang J., Steinberg W., Smith P. D., Rotterdam H., Kotler D. P. Intestinal microsporidiosis as a cause of diarrhea in human immunodeficiency virus-infected patients: a report of 20 cases. Hum Pathol. 1990 May;21(5):475–481. doi: 10.1016/0046-8177(90)90003-n. [DOI] [PubMed] [Google Scholar]
  18. Pol S., Romana C. A., Richard S., Amouyal P., Desportes-Livage I., Carnot F., Pays J. F., Berthelot P. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med. 1993 Jan 14;328(2):95–99. doi: 10.1056/NEJM199301143280204. [DOI] [PubMed] [Google Scholar]
  19. Schwartz D. A., Bryan R. T., Hewan-Lowe K. O., Visvesvara G. S., Weber R., Cali A., Angritt P. Disseminated microsporidiosis (Encephalitozoon hellem) and acquired immunodeficiency syndrome. Autopsy evidence for respiratory acquisition. Arch Pathol Lab Med. 1992 Jun;116(6):660–668. [PubMed] [Google Scholar]
  20. Terada S., Reddy K. R., Jeffers L. J., Cali A., Schiff E. R. Microsporidan hepatitis in the acquired immunodeficiency syndrome. Ann Intern Med. 1987 Jul;107(1):61–62. doi: 10.7326/0003-4819-107-1-61. [DOI] [PubMed] [Google Scholar]
  21. Weber R., Bryan R. T., Owen R. L., Wilcox C. M., Gorelkin L., Visvesvara G. S. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group. N Engl J Med. 1992 Jan 16;326(3):161–166. doi: 10.1056/NEJM199201163260304. [DOI] [PubMed] [Google Scholar]
  22. Weber R., Kuster H., Visvesvara G. S., Bryan R. T., Schwartz D. A., Lüthy R. Disseminated microsporidiosis due to Encephalitozoon hellem: pulmonary colonization, microhematuria, and mild conjunctivitis in a patient with AIDS. Clin Infect Dis. 1993 Sep;17(3):415–419. doi: 10.1093/clinids/17.3.415. [DOI] [PubMed] [Google Scholar]
  23. Weber R., Sauer B., Spycher M. A., Deplazes P., Keller R., Ammann R., Briner J., Lüthy R. Detection of Septata intestinalis in stool specimens and coprodiagnostic monitoring of successful treatment with albendazole. Clin Infect Dis. 1994 Aug;19(2):342–345. doi: 10.1093/clinids/19.2.342. [DOI] [PubMed] [Google Scholar]
  24. Zender H. O., Arrigoni E., Eckert J., Kapanci Y. A case of Encephalitozoon cuniculi peritonitis in a patient with AIDS. Am J Clin Pathol. 1989 Sep;92(3):352–356. doi: 10.1093/ajcp/92.3.352. [DOI] [PubMed] [Google Scholar]
  25. van Gool T., Snijders F., Reiss P., Eeftinck Schattenkerk J. K., van den Bergh Weerman M. A., Bartelsman J. F., Bruins J. J., Canning E. U., Dankert J. Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique. J Clin Pathol. 1993 Aug;46(8):694–699. doi: 10.1136/jcp.46.8.694. [DOI] [PMC free article] [PubMed] [Google Scholar]

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