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Enterocytozoon Bieneusi Infection

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Enterocytozoon Bieneusi Infection Microsporidiosis: Enterocytozoon bieneusi infection Dr. Ujjala Ghoshal Professor & Incharge Parasitology Department of Microbiology Sanjay Gandhi Postgraduate Institute of Medical ESCMIDSciences, Lucknow,eLibrary India E mail: [email protected] © by author Microsporidiosis Microsporidiosis is an opportunistic infection caused by a group of obligate intracellular eukaryotic pathogens, which is phylogenetically related to Fungi It is increasingly common pathology in humans due to growing number of persons with immunodepressive states About 1300 species of 150 genera known to infect vertebrates as well as invertebrates Fourteen species are implicated in human pathology, including Enterocytozoon bieneusi and Encephalitozoon intestinalis ESCMID eLibrary E. bieneusi known ©to cause by90 %authorof human infections Enterocytozoon bieneusi In 1985, E. bieneusi was first recognized as opportunistic pathogen in AIDS patient E. bieneusi has been increasingly reported in treatment induced immunosuppression Renal transplant (common) Bone marrow transplant Stem cell transplant and, Liver transplant recipients Cancer patients Patient with Inflammatory bowel disease (IBD) EESCMID. bieneusi has been reported eLibraryamong traveler's, children and elderly as well Lopez-Velez R et al. 1999 © by author Enterocytozoon bieneusi contd.. E. bieneusi has been identified in Pets and farm animals (dog, cat, pig, goat, donkey, cattle, rabbit) Wild animals (fox, otter, raccoon, nutria) Birds (industrial poultry, urban pigeons) Desportes livage I et al. 2005; Anane S et al. 2010 Spores of E. bieneusi have been detected in surface water and also certain fruits, vegetables and milk ESCMID eLibrary © by author E. bieneusi in HIV-infected patients Country Patients with No. of Prevalence diarrhea patients Weber et al. 1992 USA Mixed 134 4.5% Kotler et al. 1994 USA Mixed 194 28.9% Van Gool et al. Zimbabw Yes 129 10.1% 1995 e Anwar-Bruni et USA Mixed 371 5.9% al. 1996 Coyle et al. 1996 USA Mixed 111 27.9% Maiga et al. 1997 Mali Mixed 77 32.5% Mathewson et al. USA Yes 83 6% 1998 Mwachari et al. Kenya Yes 36 2.8% 1998 CegielskiESCMID et al. Tanzania Yes eLibrary86 3.5% 1999 Brandonisio et al. Italy Mixed 154 4.5% 1999 © by author E. bieneusi in HIV-infected patients contd.. Country Patients with No. of Prevalence diarrhea patients Gumbo et al. Zimbabw Yes 55 50.9% 1999 e Wanachiwanawin Thailand Yes 66 33.3% et al. 1998 Wanachiwanawin Thailand Yes 91 28.6% et al. 1999 Ferreira et al. Portugal Yes 215 42.8% 2001 Waywa et al. Thailand Yes 288 9.7% 2001 Chokephaibulkit Thailand Yes 82 19.5% et al. 2001 Wanachiwanawin Thailand Yes 95 25.3% et al. 2002 Florez et al. 2003 Colombia Mixed 115 3.5% ESCMIDSulaiman et al. Peru Mixed eLibrary2672 3.9% 2003 Endeshaw et al. Ethiopia Yes 80 22.5% 2005 © by author E. bieneusi in HIV-infected patients contd.. Country Patients with No. of Prevalence diarrhea patients Tumwine et al. Uganda Yes 91 76.9% 2005 Endeshaw et al. Ethiopia Yes 214 18.2% 2006 Sarfati Et al. 2006 Cameroon Yes 152 5% Chacin Bonilla et Venezuela Mixed 103 13.6% al. 2006 Kulkarni et al. India Yes 137 1.5% 2009 Viriyavejakul et al. Thailand Mixed 64 81.3% 2009 Kucerova et al. Russia na 46 13% 2011 Wang et al. 2013 China 683 5.7% AgholiESCMID et al. 2013 Iran Mixed eLibrary356 2.2% Khanduja et al. India Mixed 222 1.8% 2016 © by author E. bieneusi in renal transplant recipients Country Patients with No. of patients Prevalence/ no. diarrhea of cases Guerard A et al. France Yes 2 2 (E. bieneusi) 1999 Metge S et al. France Yes 1 1 (E. bieneusi) 2000 Mohindra AR et USA urine 1 1 (E. cuniculi) al. 2002 Gamboa- Mexico Yes 1 1 (E. cuniculi) Dominguez A et al. 2003 Lanternier F et France Yes 1 1 (E. bieneusi) al. 2009 Champion L et France Yes 10 10 (E. bieneusi) al. 2010 ESCMID eLibrary Talabani H et al. France Urine sample 1 1 (E. cuniculi) 2010 © by author E. bieneusi in renal transplant recipients contd.. Country Patients with No. of patients Prevalence/ no. diarrhea of cases Galvan AL et al. 2011 Spain Yes 2 2 (E. bieneusi) Pomares C et al. 2012 France Yes 1 1 (E. bieneusi) Visvesvara GS et al. USA Yes 1 1 (E. bieneusi) 2013 Godron A et al. 2013 France Yes 1 1 (E. bieneusi) Ladapo TA et al. 2014 Nigeria yes 2 2 (E. cuniculi) Brown M et al. 2018 Australia Yes 1 1 (E. bieneusi) Ghoshal U et al. 2015 India Mixed 272 E. bieneusi 5.8% In diarrhea: 9.6% Tabatabiae ESCMID F et al. Iran Urine eLibrary sample 38 E. bieneusi 2015 5.26% Kicia M et al. 2016 Poland Mixed 86 32% © by author E. bieneusi 23% E. bieneusi in malignancy patients Country Patients with No. of patients Prevalence/ no. of diarrhea cases Nevez G et al. 2015 France - 5 CD4 T cell 5 cases (E. hellem) prolymphocytic leukemia patients Hamamci B et al. 2015 Turkey Yes 93 patients 9.7% (9/93) (E. bieneusi) Jimenez GB et al. 2012 Mexico Yes 13 leukemia & 4 (E. bieneusi) lymphoma patients Yakub J et al. 2012 Pakistan Mixed 13 Hepatocellular 3 cases carcinoma (E. bieneusi) Baiomy A et al. 2010 Egypt Mixed 40 malignancy 2% (1/40) patients Microsporidia Lono AR et al. 2008 Malaysia Mixed 311 cancer 3 cases patients (Breast, (Encephalitozoon ESCMID eLibraryCervical, lung) spp.) Chabchoub N et al. Tunisia Mixed 35 haematological 8.6% 2009 malignancy E. bieneusi patients Encephalitozoon © by author spp. E. bieneusi in children Country Patients with No. of patients Prevalence diarrhea Del Aguila C et al. Spain Mixed 83 1.2% (1/83) 1997 Tumwine JK et al. Uganda Mixed 1779 17.4% (310/1779) 2002 Tumwine JK et al. Uganda Mixed 243 32.9% (80/243) 2002 Samie A et al. 2007 South Africa Mixed 67 4.5% (3/67) Ayinmode AB et al. Nigeria Mixed 43 9.3% (4/43) 2011 Yang J et al. 2014 China Mixed 255 7.5%(19/255) Wang ESCMIDT et al. 2017 China Mixed eLibrary500 0.2%(1/500) Ding S et al. 2018 China Mixed 93 11.82%(11/93) © by author Other groups may be at risk Bone marrow transplant (BMT) patients: 4% (8/200) of BMT patients had E. bieneusi Cetinkaya U et al. 2015 Stem cell transplant: 2 cases of allogeneic haematopoietic stem cell transplant recipients had E. bieneusi Bukreyeva I et al. 2017 Liver transplant: 6.8% (3/44) of liver transplant recipients had E. bieneusi A paediatric patient with liver kidney transplant had E.bieneusi Agholi M et al. 2013; Desobeaux G et al. 2013 InflammatoryESCMID bowel disease eLibrary (IBD): 12.7% (9/71) of IBD patients had E. bieneusi © by authorHasani Z et al. 2017 Modes of Transmission Human to human transmission: Spores of E. bieneusi are excreted into the environment via • Fecal matter (most common) • Pulmonary secretions (three case reports) • Urine Del aguila C et al. 1997; Weber R et al. 1992; Botterel F et al. 2002; Kicia M et al. 2014; Anane S et al. 2010 Animal to human transmission: Several studies reported similar genotypes infecting humans and various animals No formal proof of animal to human transmission of ESCMIDmicrosporidiosis, except eLibraryone case of seroconversion in a child in close contact with dog © by authorPrasertbun R et al. 2017; McInnes EF et al. 1991 Modes of transmission contd.. Waterborne transmission: Recent study confirms the presence of E. bieneusi in surface water, E. intestinalis in tertiary sewage effluents, surface and ground water This represents the first confirmation to the species level of human pathogenic microsporidia in water indicating these pathogens may be waterborne Spores eliminated from fecal matter of infected animals in contact with surface water, thus subsequent contamination ESCMIDof water sources eLibrary Jawanmard E et al. 2018; Grackzyk TK et al. 2007; Sorel N et al. ©2003 by author Modes of Transmission contd.. Food-borne transmission: Spores of microsporidia have been identified in irrigation water and certain plants (lettuce, parsley, strawberries) Soft fruits, vegetables and herbs collected from markets in Poland were contaminated with E. bieneusi Jedrzejewski S et al. 2007 Milk contaminated with E. bieneusi has been reported in herds from Korea and China Lee JH 2008; Peng XQ et al. 2016 In 2009, a food borne outbreak of gastrointestinal illness in overESCMID100 people was eLibraryassociated with consumption of E. bieneusi contaminated cucumbers in Sweden © by authorDecraena V et al. 2012 Clinical manifestations Intestinal microsporidiosis in immunocompromised hosts: Chronic intractable diarrhea 4 to 8 bowel movements per day Loose to watery stool Anorexia, weight loss Nausea, vomiting Dehydration with mild hypokalemia and hypomagnesia Fat malabsorption Immunocompromised patients with CD4 count≤ 100 cells/µl are more susceptible Intestinal ESCMIDmicrosporidosis ineLibraryimmunocompetant hosts : Self limiting watery diarrhea resolved within 2 wks May persist as ©an asymptomatic by authorinfection Other clinical manifestations Pulmonary microsporidiosis Persistent cough Nonpurulent sputum Dyspnea Wheezing Botterel F et al. 2002 Biliary microsporidiosis Disseminate to hepotobiliary system leading to cholangitis ESCMID AnaneeLibrary S et al. 2010; Franzen C et al. 1999 © by author Life Cycle Infective form: Spore Spores inhaled / ingested Polar tubule injects sporoplasm into the host cell Spore Sporoplasm develops into meronts and further sporonts Sporonts ESCMID give rise to sporoblasts eLibrary Mature spores are released, excreted with feces© by authorSporoplasm ejected into host cell Laboratory Diagnosis Fluorescent Light Microscopy Microscopy Diagnosis Transmission Molecular ESCMIDElectron Microscopy eLibrarymethods © by author Samples Stool (three samples; most common) Urine Biopsy Sputum Bronchoalveolar lavage fluid ESCMID eLibrary © by author Diagnosis: Light Microscopy Weber’s trichrome stain is widely used to identify spores of Microsporidia Spores appear as rose ovoid elements presenting a colorless posterior vacuole against green background Spores of Microsporidia under Important points: light microscopy 1.In Smearsome shouldcases be verystain thinuptake 2.is Pretreatmentstronger ofat fecalthe specimenequator, with 10% KOH may improve quality of smear 3.
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