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. 1993 Aug;46(8):694–699. doi: 10.1136/jcp.46.8.694

Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique.

T van Gool 1, F Snijders 1, P Reiss 1, J K Eeftinck Schattenkerk 1, M A van den Bergh Weerman 1, J F Bartelsman 1, J J Bruins 1, E U Canning 1, J Dankert 1
PMCID: PMC501450  PMID: 8408691

Abstract

AIMS--To assess the value of a new rapid fluorescence method for the diagnosis of microsporidiosis in HIV seropositive patients. METHODS--Microsporidian spores in stools were demonstrated by using the fluorochrome stain Uvitex 2B. The new technique was evaluated in three groups of HIV seropositive patients with diarrhoea. Group 1: 19 patients with biopsy confirmed E bieneusi infection (186 stool samples); group 2: 143 consecutive patients from whom faeces were submitted for routine investigation of diarrhoea (318 samples); group 3: 16 patients with small intestinal biopsy specimens negative for microsporidia (55 samples). The new method was used to monitor spore shedding during experimental treatment with paromomycin and albendazole in four patients. RESULTS--Brightly fluorescent spores were detected in all stool samples of patients in group 1. In group 2 16 (11%) patients had spores in their stool samples. E bieneusi was found in 11 patients; in the other five another genus of microsporidia, Encephalitozoon, was recognised. Encephalitozoon spores were also found in the urine of three of these patients and in the maxillary sinus aspirate of two of them, suggesting disseminated infection. The results were confirmed by electron microscopic examination. In group 3 negative biopsy specimens were confirmed by negative stool samples in all cases. Treatment with albendazole and paromomycin did not affect the spore shedding in three patients with E bieneusi infection. By contrast, in a patient with Encephalitozoon sp infection albendazole treatment resulted in clinical improvement together with complete cessation of spore excretion in the stool. CONCLUSION--The Uvitex 2B fluorescence method combines speed, sensitivity, and specificity for the diagnosis and treatment evaluation of intestinal and disseminated microsporidiosis.

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Selected References

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  1. Blanshard C., Ellis D. S., Tovey D. G., Dowell S., Gazzard B. G. Treatment of intestinal microsporidiosis with albendazole in patients with AIDS. AIDS. 1992 Mar;6(3):311–313. doi: 10.1097/00002030-199203000-00009. [DOI] [PubMed] [Google Scholar]
  2. Desportes I., Le Charpentier Y., Galian A., Bernard F., Cochand-Priollet B., Lavergne A., Ravisse P., Modigliani R. Occurrence of a new microsporidan: Enterocytozoon bieneusi n.g., n. sp., in the enterocytes of a human patient with AIDS. J Protozool. 1985 May;32(2):250–254. doi: 10.1111/j.1550-7408.1985.tb03046.x. [DOI] [PubMed] [Google Scholar]
  3. Didier E. S., Didier P. J., Friedberg D. N., Stenson S. M., Orenstein J. M., Yee R. W., Tio F. O., Davis R. M., Vossbrinck C., Millichamp N. Isolation and characterization of a new human microsporidian, Encephalitozoon hellem (n. sp.), from three AIDS patients with keratoconjunctivitis. J Infect Dis. 1991 Mar;163(3):617–621. doi: 10.1093/infdis/163.3.617. [DOI] [PubMed] [Google Scholar]
  4. Eeftinck Schattenkerk J. K., van Gool T., van Ketel R. J., Bartelsman J. F., Kuiken C. L., Terpstra W. J., Reiss P. Clinical significance of small-intestinal microsporidiosis in HIV-1-infected individuals. Lancet. 1991 Apr 13;337(8746):895–898. doi: 10.1016/0140-6736(91)90215-b. [DOI] [PubMed] [Google Scholar]
  5. Hollister W. S., Canning E. U., Willcox A. Evidence for widespread occurrence of antibodies to Encephalitozoon cuniculi (Microspora) in man provided by ELISA and other serological tests. Parasitology. 1991 Feb;102(Pt 1):33–43. doi: 10.1017/s0031182000060315. [DOI] [PubMed] [Google Scholar]
  6. McWhinney P. H., Nathwani D., Green S. T., Boyd J. F., Forrest J. A. Microsporidiosis detected in association with AIDS-related sclerosing cholangitis. AIDS. 1991 Nov;5(11):1394–1395. doi: 10.1097/00002030-199111000-00024. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Orenstein J. M., Dieterich D. T., Kotler D. P. Systemic dissemination by a newly recognized intestinal microsporidia species in AIDS. AIDS. 1992 Oct;6(10):1143–1150. doi: 10.1097/00002030-199210000-00013. [DOI] [PubMed] [Google Scholar]
  9. Orenstein J. M., Zierdt W., Zierdt C., Kotler D. P. Identification of spores of Enterocytozoon bieneusi in stool and duodenal fluid from AIDS patients. Lancet. 1990 Nov 3;336(8723):1127–1128. doi: 10.1016/0140-6736(90)92600-m. [DOI] [PubMed] [Google Scholar]
  10. Peacock C. S., Blanshard C., Tovey D. G., Ellis D. S., Gazzard B. G. Histological diagnosis of intestinal microsporidiosis in patients with AIDS. J Clin Pathol. 1991 Jul;44(7):558–563. doi: 10.1136/jcp.44.7.558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. 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]
  12. 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]
  13. 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]
  14. van Gool T., Hollister W. S., Schattenkerk W. E., Van den Bergh Weerman M. A., Terpstra W. J., van Ketel R. J., Reiss P., Canning E. U. Diagnosis of Enterocytozoon bieneusi microsporidiosis in AIDS patients by recovery of spores from faeces. Lancet. 1990 Sep 15;336(8716):697–698. doi: 10.1016/0140-6736(90)92198-q. [DOI] [PubMed] [Google Scholar]

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