Improved Light-Microscopical Detection of Microsporidia Spores in Stool and Duodenal Aspirates

Weber, Rainer; Bryan, Ralph T.; Owen, Robert L.; Wilcox, C. Mel; Gorelkin, Leo; Visvesvara, Govinda S.

doi:10.1056/nejm199201163260304

Cited by 464 publications

(324 citation statements)

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“…The fresh fecal samples were first processed by the Baermann (1917) method. After that, the samples were preserved in 10% formalin and processed by the Lutz (1919) and Ritchie (1948) methods and the Safranin/Methylene Blue (Baxby et al 1984) and Weber's chromotrope modified Trichrome (Weber et al 1992) staining techniques. All samples were submitted to the five parasitological methods cited above.…”

mentioning

confidence: 99%

Detection of Cryptosporidium - specific coproantigen in human immunodeficiency virus/acquired immunodeficiency syndrome patients by using a commercially available immunoenzymatic assay

Silva¹,

Ferreira

Gonçalves-Pires³

et al. 2003

Mem. Inst. Oswaldo Cruz

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mentioning

confidence: 99%

Detection of Cryptosporidium - specific coproantigen in human immunodeficiency virus/acquired immunodeficiency syndrome patients by using a commercially available immunoenzymatic assay

Silva¹,

Ferreira

Gonçalves-Pires³

et al. 2003

Mem. Inst. Oswaldo Cruz

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“…The microsporidian protozoan organism Enterocytozoon bieneusi, first reported in 1985 [1,2], has been recognized as a human immunodeficiency virus (HIV)-associated intestinal opportunistic pathogen [1][2][3][4][5][6][7][8][9]. Preliminary epidemiological studies have indicated that it may be present in 10%-30% of severely immunodeficient HIV-infected adults with chronic diarrhea [3][4][5][6]9].…”

mentioning

confidence: 99%

Intestinal Coinfection with Enterocytozoon bieneusi and Cryptosporidium in a Human Immunodeficiency Virus-Infected Child with Chronic Diarrhea

Weber

Sauer²,

Lüthy³

et al. 1993

Clinical Infectious Diseases

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The microsporidian Enterocytozoon bieneusi has been recognized as an important cause of chronic diarrhea in severely immunodeficient adults infected with human immunodeficiency virus (HIV). We report the first case of intestinal E. bieneusi infection in a child. The 9-year-old boy with connatal HIV infection presented with failure to thrive, chronic diarrhea, and intermittent abdominal pain. His CD4 lymphocyte count was 0.05 X 109/L and dropped to 0.01 X 109/L. No HIV-associated opportunistic infection other than oral hairy leukoplakia and oral candidiasis had been found before microsporidia were detected. Treatment of microsporidiosis with albendazole was of no benefit. During follow-up, the boy also developed intestinal cryptosporidiosis. Evaluation of chronic diarrhea in severely immunodeficient HIV-infected children should include examination for intestinal microsporidia. We recommend the use of a new coprodiagnostic technique that allows detection of microsporidial spores in stool specimens. Furthermore, consideration of dual or even multiple parasitic infections in the differential diagnosis of chronic diarrhea may have both important clinical and epidemiological implications.The microsporidian protozoan organism Enterocytozoon bieneusi, first reported in 1985 [1, 2], has been recognized as a human immunodeficiency virus (HIV)-associated intestinal opportunistic pathogen [1][2][3][4][5][6][7][8][9]. Preliminary epidemiological studies have indicated that it may be present in 10%-30% of severely immunodeficient HIV-infected adults with chronic diarrhea [3][4][5][6]9].We report the first case in which an HIV-infected pediatric patient with chronic diarrhea was found to have E. bieneusi spores in stool specimens by light-microscopic and electronmicroscopic examination. During follow-up, the child also developed intestinal cryptosporidiosis. Case ReportThe patient, a 9-year-old boy, was born in Switzerland to an HIV-seropositive Swiss mother with a history of intravenous drug use. Between the ages of 3 and 8 years, the boy lived with his mother in Ecuador before his return to Switzerland. His mother died of AIDS-related complications in February 1992. She did not have diarrhea. The boy developed normally and was healthy until summer 1991, when he expe- rienced intermittent diarrhea, abdominal pain, and mild dry cough without fever.In September 1991, he was referred to the University Children's Hospital in Zurich because of persistent gastrointestinal symptoms. He had three to six watery stools per day and intermittent nonspecific diffuse abdominal pain. His weight (19.3 kg) and height (118 cm) were below the third percentile. Physical examination was normal apart from oral hairy leukoplakia and oral candidiasis. He was found to be positive for antibody to HIV-1, and the results of HIV-1 culture also were positive. The hematocrit was 0.31, the leukocyte count was 4.6 X 109/L with a CD4 + count of 0.05 X 109/L and a CD8 + lymphocyte count of 2.03 X 10 9/L. Tests of functional immune status disclosed antibody def...

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“…In summary, mean ages were similar for both groups. Weight loss and cachexia were significantly more important in patients with microsporidiosis, either 303 staining, or the new gram-chromotrope were sufficient to establish a diagnosis 27,37 . Besides reducing the necessity of invasive procedures, it has special interest in developing countries such as Brazil, since the costs of more sophisticated methods like biopsy or PCR were reduced as well.…”

Section: Discussionmentioning

confidence: 99%

“…Our negative findings using these methods in specimens from two patients in whom microsporidia spores were detected in stool samples using either light microscopy or PCR, suggests that tissue examination using LM may also fail to detect microsporidia in small-bowel tissue. The variable sensitivity of LM may be due to the focal distribution of infected enterocytes, the selected biopsy site, the small amount of tissue obtained with biopsies or the lack of utilization of Warthin-Starry or Gram-chromothrope, more specific stainning for microsporidia in tissues 17,28,37 .…”

Section: Discussionmentioning

confidence: 99%

“…Detection of microsporidia spores was accomplished after processing stool samples in thin smears using the modified chromotrope stain along with the recently described Gram-chromotrope staining method 27,28,37 . The criteria used to define microsporidia-positive patients was the presence of one or more pinkish (chromotrope) or pinkish-violet (Gramchromotrope) ovoid structures with a spore wall and a belt-like stripe, over an examination of at least 100 field /100x, confirmed by 2 examiners.…”

Section: Detection Of Intestinal Pathogens In Stoolsmentioning

confidence: 99%

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Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil

Brasil

Lima

Paiva

et al. 2000

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThe objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5%) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.

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Improved Light-Microscopical Detection of Microsporidia Spores in Stool and Duodenal Aspirates

Abstract: E. bieneusi is an important cause of chronic diarrhea in HIV-infected persons. This new diagnostic technique serves as a practical, noninvasive means to detect microsporidia spores in stool specimens and is also applicable to the examination of duodenal aspirates.

Cited by 464 publications

References 29 publications

Detection of Cryptosporidium - specific coproantigen in human immunodeficiency virus/acquired immunodeficiency syndrome patients by using a commercially available immunoenzymatic assay

Detection of Cryptosporidium - specific coproantigen in human immunodeficiency virus/acquired immunodeficiency syndrome patients by using a commercially available immunoenzymatic assay

Intestinal Coinfection with Enterocytozoon bieneusi and Cryptosporidium in a Human Immunodeficiency Virus-Infected Child with Chronic Diarrhea

Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil

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