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Encephalitozoon intestinale infection in an AIDS patient--a case report
Z Kucerová-Pospísilová1, M Stanková, O Ditrich
1Institute of Parasitology, Academy of Sciences of the Czech Republic, Ceské Budĕjovice, Czech Republic.
Abstract:
The first case of one of the most frequent intestinal microsporidians, Encephalitozoon intestinale, is reported from an AIDS patient in the Czech Republic. The patient experienced diarrhoea and was found to have microsporidia spores in stool. Species determination by electron microscopy confirmed the diagnosis of the microsporidian, E. intestinale. The CD4-count at the time of the diagnosis was 73 cells/mm3, IRI = 0.21. Only after symptomatic therapy and rehydration the patient stopped the complaining, and although he refused an antimicrosporidial therapy, the CD4-count one month later increased to 200 cells/mm3 and patient didn't suffered from diarrhoea. Six months after the first finding of microsporidia, the patient was admitted to the hospital care for progressive encephalopathy and developing wasting syndrome again with the intermittent diarrhoea. The patient was treated with albendazole at that time. Nevertheless, after 14 days of albendazole therapy, he still remained positive for E. intestinale spores in the stool (urine specimens remained negative for all the time). The patient died after a two-month hospitalisation and the apparent cause of death was purulent bronchopneumonia, wasting syndrome with microsporidiosis, and HIV encephalopathy. Generalised mycobacteriosis (MAC) was also found from the autopsy material.
Insights
This case report details the first Encephalitozoon intestinale infection in an AIDS patient in the Czech Republic. Despite treatment, the patient experienced severe symptoms and opportunistic infections, highlighting challenges in managing microsporidiosis in immunocompromised individuals.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Immunology
Background:
- Encephalitozoon intestinale is a common intestinal microsporidian pathogen.
- Microsporidiosis is an opportunistic infection frequently seen in patients with Acquired Immunodeficiency Syndrome (AIDS).
- Early diagnosis and management are crucial for improving outcomes in immunocompromised patients.
Observation:
- A case of Encephalitozoon intestinale infection is reported in an AIDS patient in the Czech Republic presenting with diarrhea.
- The patient had a low CD4 count (73 cells/mm3) at diagnosis.
- Despite symptomatic treatment and rehydration, the patient later developed progressive encephalopathy, wasting syndrome, and intermittent diarrhea.
Findings:
- Species identification confirmed Encephalitozoon intestinale via electron microscopy.
- The patient initially improved with symptomatic therapy, with CD4 count rising to 200 cells/mm3.
- Albendazole treatment was ineffective in clearing E. intestinale spores from stool, and the patient experienced opportunistic infections including generalized mycobacteriosis.
Implications:
- This case underscores the challenges in treating intestinal microsporidiosis in advanced HIV infection.
- The study highlights the potential for severe opportunistic infections and disease progression despite standard care.
- Further research into effective therapeutic strategies for microsporidiosis in immunocompromised populations is warranted.