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[Intestinal Microspora infections in a patient with acquired immunodeficiency syndrome]
1Departamento de Anatomía Patológica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile.
Abstract:
A 24 year old man with AIDS diagnosed in 1989 and a history of several episodes of pulmonary pneumocystosis developed chronic diarrhea and severe epigastric pain. Endoscopy revealed a granular intestinal mucosa. There was atrophy of villi and Giemsa, Ziehl-Nielsen and Gram staining identified 1.5 to 2 u spores in the cytoplasm of intestinal cells. Transmission electron microscopy of the spores revealed a thick wall, a sporoplasm with a nucleus, ribosomes, a posterior vacuole and a polar filament with multiple coils; no mitochondria were seen. Thus, the patient had intestinal microsporidiosis caused by Enterocytozoon bieneusi. This is a rare pathogen recently identified in man.
Insights
A patient with AIDS experienced chronic diarrhea and abdominal pain due to intestinal microsporidiosis. This rare infection was caused by Enterocytozoon bieneusi, identified by spore analysis in intestinal cells.
Area of Science:
- Medical Mycology
- Gastroenterology
- Infectious Diseases
Background:
- A 24-year-old male patient with a history of Acquired Immunodeficiency Syndrome (AIDS) and recurrent pulmonary pneumocystosis presented with severe gastrointestinal symptoms.
- The patient reported chronic diarrhea and significant epigastric pain, indicating a potential enteric complication.
Observation:
- Endoscopic examination revealed a granular intestinal mucosa with evidence of villous atrophy.
- Microscopic analysis of intestinal cells using Giemsa, Ziehl-Nielsen, and Gram staining identified 1.5 to 2 µm spores within the cytoplasm.
- Transmission electron microscopy confirmed the presence of spores with characteristic structures, including a thick wall, sporoplasm, nucleus, ribosomes, posterior vacuole, and a coiled polar filament, but notably lacked mitochondria.
Findings:
- The observed spores and clinical presentation were consistent with intestinal microsporidiosis.
- The causative agent was identified as Enterocytozoon bieneusi, a recently recognized human pathogen.
Implications:
- This case highlights Enterocytozoon bieneusi as a significant cause of chronic diarrhea in immunocompromised individuals, particularly those with AIDS.
- The findings underscore the importance of considering microsporidiosis in the differential diagnosis of unexplained gastrointestinal symptoms in patients with advanced HIV infection.
- Accurate identification of Enterocytozoon bieneusi through specialized staining and microscopy is crucial for appropriate patient management and treatment strategies.