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Pulmonary microsporidiosis due to Encephalitozoon hellem in a patient with AIDS
M Scaglia1, L Sacchi, G P Croppo
1Laboratory of Clinical Parasitology, University-IRCCS S. Matteo, Pavia, Italy.
Abstract:
The microsporidian Encephalitozoon hellem is being reported with increasing frequency in HIV-positive subjects, as an agent of disseminated microsporidiosis without involving the gastrointestinal tract. We describe a case of pulmonary microsporidiosis in a 27-year-old Italian man with AIDS who developed fever, cough, and dyspnea. A chest X-ray showed multiple bilateral pulmonary opacities and mediastinal lymph-node enlargement. Stained smears of bronchoalveolar lavage sediment showed oval structures consistent with microsporidian spores. Viral, bacterial and fungal cultures were repeatedly negative, whereas microsporidia were successfully cultured in human and bovine fibroblast cell lines. Analysis of electron micrographs indicated that the isolate belonged to the genus Encephalitozoon. Based on further immunological, biochemical and molecular studies it was characterized as E. hellem. Even though a temporary improvement with albendazole therapy was noticed, the patient deteriorated clinically and died of severe respiratory distress.
Insights
Encephalitozoon hellem, a microsporidian parasite, is increasingly causing disseminated infections in HIV-positive individuals. This case highlights pulmonary microsporidiosis as a severe, non-gastrointestinal manifestation in an AIDS patient.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host Pathogens
Background:
- Disseminated microsporidiosis is an emerging opportunistic infection in human immunodeficiency virus (HIV)-positive individuals.
- Encephalitozoon hellem is a microsporidian species increasingly identified as a cause of systemic disease, often without gastrointestinal involvement.
Observation:
- A case of pulmonary microsporidiosis is presented in a 27-year-old Italian man with acquired immunodeficiency syndrome (AIDS).
- The patient presented with fever, cough, dyspnea, bilateral pulmonary opacities, and mediastinal lymphadenopathy on chest X-ray.
- Bronchoalveolar lavage revealed microsporidian spores; cultures were positive for microsporidia, while viral, bacterial, and fungal cultures were negative.
Findings:
- Electron microscopy, immunological, biochemical, and molecular analyses confirmed the isolate as Encephalitozoon hellem.
- The pulmonary microsporidiosis was characterized as a disseminated, non-gastrointestinal form of the disease.
- Albendazole therapy provided only temporary clinical improvement.
Implications:
- This case underscores the importance of considering Encephalitozoon hellem in the differential diagnosis of pulmonary infections in advanced HIV/AIDS.
- Pulmonary microsporidiosis can lead to severe respiratory distress and mortality, even with treatment.
- Further research into effective therapeutic strategies for disseminated microsporidiosis is warranted.