Contents
Microsporidiosis is a group of parasitic invasions caused by intracellular protozoa of the Microspora type. Clinical manifestation depends on the species of the parasite, localization in the organism, the immune status of the host, especially the degree of the immunodeficiency.
Microsporidiosis – occurrence and causes
Microsporidiosis are opportunistic invasions. The described clinical cases almost exclusively concern people with congenital or acquired immunodeficiencies. The invasive form is protozoa spores. Infection with microsporidiosis spreads through the faecal-oral route, and the source of the pathogen is contaminated water (tap water, from recreational reservoirs). Invasion may affect many tissues, organs and systems of a human being.
The representatives of 7 types of microsporidia cause infection in humans. The invasions of Enterocytozoon bieneusi and Encephalitozoon intestinalis lead to inflammation of the intestines and bile ducts. Enterocytozoon bieneusi may cause self-limiting traveler’s diarrhea in immunocompetent individuals.
Invasion of microsporidiosis can affect many tissues, organs and systems. Belong to them:
- cornea,
- conjunctiva,
- skeletal muscles,
- marrow,
- central nervous system,
- paranasal sinuses,
- airways and lungs,
- digestive and urinary systems.
Clinical symptoms of microsporidiosis
The invasion of the gastrointestinal tract by microsporidiosis causes malabsorption, triggers chronic diarrhea and leads to cachexia. Intestinal catarrh is often accompanied by inflammation of the bile ducts.
Diagnostics of microsporidiosis
In diagnostics it is used microscopic examination stool smears stained with the chromotrope according to Weber’s method, Giemsa’s method or calcofluor facilitate the identification of microsporidia spores. Used light, fluorescence and electron microscopy. In parenteral or generalized forms, the diagnostic material is diseased tissue obtained by biopsy, urine sediment, swabs and scrapings from the conjunctiva of the eye. Identification of microsporidia in the tested material confirms the diagnosis.
Differentiation
Intestinal microsporidiosis should be differentiated from:
- giardiasis,
- cryptosporidiosis,
- isosporosis,
- cyclosporosis.
In addition, infectious diarrhea of a different etiology, celiac disease and functional disorders of the intestines must be taken into account.
Treatment of microsporidiosis
The drug of choice for the treatment of microsporidiosis is albendazole at a dose of 400 mg twice a day for 2-3 weeks. The therapeutic effect is also obtained after application nitazoksanidu and fumagiliny. Nitroimidazole derivatives (metronidazole, tinidazole, ornidazole, secnidazole) are ineffective. In HIV-infected patients, effective cART and symptomatic treatment may lead to resolution of diarrhea, even without treatment. In severe invasions with multiple sites, a combination therapy is used – albendazole in the above-mentioned dosage with itraconazole (400 mg daily). Symptomatic therapy, consisting of hydration and replenishment of electrolytes, is also necessary.
How to prevent microsporidiosis?
The preventive treatment of microsporidiosis consists in:
- compliance with basic hygiene rules,
- consumption of treated drinking water and food free from contamination with protozoa spores.
- avoiding swimming in recreational reservoirs where the water is not ozonated.
What’s the prognosis?
The prognosis for microsporidiosis depends on the degree of damage to the immune system – uncertain in people with CD4 T cells below 100 cells /mikrol.
Source: J. Cianciara, J. Juszczyk, Infectious and parasitic diseases; Czelej Publishing House