Volume 3, Issue 1 (March 2017)                   Curr Med Mycol 2017, 3(1): 30-36 | Back to browse issues page

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Nooshadokht M, Sharifi I, Mohammadi M A, Pirestani M, Afgar A, Mahootchi A, et al . Intestinal Microsporidiosis in Iran (Kerman): Comparison in immune-compromised patients and immune competent people with diarrhea. Curr Med Mycol. 2017; 3 (1) :30-36
URL: http://cmm.mazums.ac.ir/article-1-147-en.html
Abstract:   (1564 Views)
Background and Purpose: Gastroenteritis and the clinical profile caused by Microsporidia, an opportunistic pathogen, may be severe in immunocompromised individuals, especially in AIDS patients. Conventionally, it is necessary to detect the small infective spores in stained smears. However, due to the limitations of the microscopy-based methods, several DNA-based methods such as polymerase chain reaction (PCR) have recently been developed to enhance diagnosis sensitivity. Therefore,we sought to evaluate the rate of infection in immunocompromised patients as compared with immunocompetent patients in Kerman, Iran.
Materials and Methods: We collected stool samples of 199 human subjects (116 males and 83 females), aged 1 to 69 years old. They were divided into immunocompromised (i.e., AIDS [n=72] and cancer-positive patients [n=59]) and immunocompetent (n=68) groups. We comparatively examined the fecal materials using the microscopy and PCR methods.
Results: The overall prevalence rate of Microsporidia infection was 10.05% (20/199). Entrocytozoon bieneusi was the only species within the Microsporidia genus that was identified in 14.5% (19/131) of the immunocompromised patients and 1.47% (1/68) of the immunocompetent individuals.
Conclusion: Considering the higher prevalence rate of microsporidiosis in patients with immunodeficiency (10.03%), we suggest performing sensitive and specific techniques such as PCR for the detection of these parasites in immunocompromised patients.

Full-Text [PDF 564 kb]   (542 Downloads)    
Type of Study: Original Articles | Subject: Medical Mycology
Received: 2017/07/29 | Accepted: 2017/11/6 | Published: 2017/12/13

1. 1. Lee SC, Corradi N, Doan S, Dietrich FS, Keeling PJ, Heitman J. Evolution of the sex-related locus and genomic features shared in microsporidia and fungi. PLoS One. 2010;5(5):e10539. [DOI:10.1371/journal.pone.0010539]
2. Lee SC, Corradi N, Byrnes EJ, Torres-Martinez S, Dietrich FS, Keeling PJ, et al. Microsporidia evolved from ancestral sexual fungi. Current Biology. 2008;18(21):1675-9. [DOI:10.1016/j.cub.2008.09.030]
3. Capella-Gutiérrez S, Marcet-Houben M, Gabaldón T. Phylogenomics supports microsporidia as the earliest diverging clade of sequenced fungi. BMC biology. 2012;10(1):47. [DOI:10.1186/1741-7007-10-47]
4. Zainudin N, Nasarudin S, Periyasamy P, Moktar N, Noordin R, Osman E. Diagnosis of disseminated microsporidiosis: detection of circulating Enterocytozoon bieneusi DNA in blood of HIV/AIDS patients. Tropical Biomedicine. 2016;33(4):761-70.
5. Sak B, Kváč M, Kučerová Z, Květoňová D, Saková K. Latent microsporidial infection in immunocompetent individuals–a longitudinal study. PLoS neglected tropical diseases. 2011;5(5):e1162. [DOI:10.1371/journal.pntd.0001162]
6. Mirjalali H, Mohebali M, Mirhendi H, Gholami R, Keshavarz H, Meamar AR, et al. Emerging intestinal microsporidia infection in HIV+/AIDS patients in Iran: microscopic and molecular detection. Iranian journal of parasitology. 2014;9(2):149.
7. Waywa D, Kongkriengdaj S, Chaidatch S, Tiengrim S, Kowadisaiburana B, Chaikachonpat S, et al. Protozoan enteric infection in AIDS related diarrhea in Thailand. Southeast Asian Journal of Tropical Medicine and Public Health. 2001;32:151-5.
8. Sulżyc-Bielicka V, Kołodziejczyk L, Jaczewska S, Bielicki D, Kładny J, Safranow K. Prevalence of Cryptosporidium sp. in patients with colorectal cancer. Polish Journal of Surgery. 2012;84(7):348-51. [DOI:10.2478/v10035-012-0058-4]
9. Saigal K, Khurana S, Sharma A, Sehgal R, Malla N. Comparison of staining techniques and multiplex nested PCR for diagnosis of intestinal microsporidiosis. Diagnostic microbiology and infectious disease. 2013;77(3):248-9. [DOI:10.1016/j.diagmicrobio.2013.07.004]
10. Ryan U, Cacciò SM. Zoonotic potential of Giardia. International journal for parasitology. 2013;43(12):943-56. [DOI:10.1016/j.ijpara.2013.06.001]
11. Williams DW, Wilson MJ, Lewis M, Potts A. Identification of Candida species by PCR and restriction fragment length polymorphism analysis of intergenic spacer regions of ribosomal DNA. Journal of Clinical Microbiology. 1995;33(9):2476-9.
12. Garcia ls. diagnostic medical parasitology, fourth edition2001.
13. Espern A, Morio F, Miegeville M, Illa H, Abdoulaye M, Meyssonnier V, et al. Molecular study of microsporidiosis due to E. bieneusi and E. intestinalis among HIV-infected patients from two geographical areas: Niamey (Niger) and Hanoi (Vietnam). Journal of Clinical Microbiology. 2007. [DOI:10.1128/JCM.00684-07]
14. Menotti J, Cassinat B, Porcher R, Sarfati C, Derouin F, Molina J-M. Development of a real-time polymerase-chain-reaction assay for quantitative detection of Enterocytozoon bieneusi DNA in stool specimens from immunocompromised patients with intestinal microsporidiosis. The Journal of infectious diseases. 2003;187(9):1469-74. [DOI:10.1086/374620]
15. Genta RM, Miles P, Fields K. Opportunistic Strongyloides stercoralis infection in lymphoma patients. Report of a case and review of the literature. Cancer. 1989;63(7):1407-11. https://doi.org/10.1002/1097-0142(19890401)63:7<1407::AID-CNCR2820630729>3.0.CO;2-I [DOI:10.1002/1097-0142(19890401)63:73.0.CO;2-I]
16. Arbo A, IGNACIO SANTOS J. Diarrheal diseases in the immunocompromised host. The Pediatric infectious disease journal. 1987;6(10):894-906.
17. Galván A, Sánchez AM, Valentín MP, Henriques-Gil N, Izquierdo F, Fenoy S, et al. First cases of microsporidiosis in transplant recipients in Spain and review of the literature. Journal of Clinical Microbiology. 2011;49(4):1301-6. [DOI:10.1128/JCM.01833-10]
18. Lono AR, Kumar S, Chye TT. Incidence of microsporidia in cancer patients. Journal of gastrointestinal cancer. 2008;39(1-4):124-9. [DOI:10.1007/s12029-009-9065-z]
19. Tumwine JK, Kekitiinwa A, Bakeera-Kitaka S, Ndeezi G, Downing R, Feng X, et al. Cryptosporidiosis and microsporidiosis in Ugandan children with persistent diarrhea with and without concurrent infection with the human immunodeficiency virus. The American journal of tropical medicine and hygiene. 2005;73(5):921-5.
20. Kazemi E, Tavalla M, Maraghi S, Yad MJ, Latifi M. Frequency of Microsporidial Infection in Immunocompromised Patients with Staining and Molecular Methods Based on Internal Transcribed Spacer Region Gene in Two Cities of Southwest Iran during 2013-2014. Asian Journal of Pharmaceutical Research and Health Care. 2016;9(1):7-16. [DOI:10.18311/ajprhc/2017/6014]
21. Bern C, Kawai V, Vargas D, Rabke-Verani J, Williamson J, Chavez-Valdez R, et al. The epidemiology of intestinal microsporidiosis in patients with HIV/AIDS in Lima, Peru. Journal of Infectious Diseases. 2005;191(10):1658-64. [DOI:10.1086/429674]
22. Agholi M, Hatam GR, Motazedian MH. HIV/AIDS-associated opportunistic protozoal diarrhea. AIDS research and human retroviruses. 2013;29(1):35-41. [DOI:10.1089/aid.2012.0119]
23. Painter JE, Gargano JW, Collier SA, Yoder JS, Control CfD, Prevention. Giardiasis surveillance–United States, 2011-2012. MMWR Surveill Summ. 2015;64(Suppl 3):15-25.
24. Wumba R, Longo-Mbenza B, Menotti J, Mandina M, Kintoki F, Situakibanza NH, et al. Epidemiology, clinical, immune, and molecular profiles of microsporidiosis and cryptosporidiosis among HIV/AIDS patients. International journal of general medicine. 2012;5:603.
25. Assefa S, Erko B, Medhin G, Assefa Z, Shimelis T. Intestinal parasitic infections in relation to HIV/AIDS status, diarrhea and CD4 T-cell count. BMC infectious diseases. 2009;9(1):155. [DOI:10.1186/1471-2334-9-155]
26. Samie A, Obi C, Tzipori S, Weiss L, Guerrant R. Microsporidiosis in South Africa: PCR detection in stool samples of HIV-positive and HIV-negative individuals and school children in Vhembe district, Limpopo Province. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007;101(6):547-54. [DOI:10.1016/j.trstmh.2007.02.005]
27. Coyle CM, Wittner M, Kotler DP, Noyer C, Orenstein JM, Tanowitz HB, et al. Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon (Septata) intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene. Clinical infectious diseases. 1996;23(5):1002-6. [DOI:10.1093/clinids/23.5.1002]
28. Endeshaw T, Kebede A, Verweij JJ, Zewide A, Tsige K, Abraham Y, et al. Intestinal microsporidiosis in diarrheal patients infected with human immunodeficiency virus-1 in Addis Ababa, Ethiopia. Japanese journal of infectious diseases. 2006;59(5):306.
29. Ojuromi OT, Izquierdo F, Fenoy S, Fagbenro-Beyioku A, Oyibo W, Akanmu A, et al. Identification and characterization of microsporidia from fecal samples of HIV-positive patients from Lagos, Nigeria. PLoS One. 2012;7(4):e35239. [DOI:10.1371/journal.pone.0035239]
30. Ungar B. Enzyme-linked immunoassay for detection of Cryptosporidium antigens in fecal specimens. Journal of Clinical Microbiology. 1990;28(11):2491-5.
31. Omoruyi BE, Nwodo UU, Udem CS, Okonkwo FO. Comparative diagnostic techniques for Cryptosporidium infection. Molecules. 2014;19(2):2674-83. [DOI:10.3390/molecules19022674]
32. Laude A, Valot S, Desoubeaux G, Argy N, Nourrisson C, Pomares C, et al. Is real-time PCR-based diagnosis similar in performance to routine parasitological examination for the identification of Giardia intestinalis, Cryptosporidium parvum/Cryptosporidium hominis and Entamoeba histolytica from stool samples? Evaluation of a new commercial multiplex PCR assay and literature review. Clinical Microbiology and Infection. 2016;22(2):190. e1-. e8.
33. Tuli L, Singh DK, Gulati AK, Sundar S, Mohapatra TM. A multiattribute utility evaluation of different methods for the detection of enteric protozoa causing diarrhea in AIDS patients. BMC microbiology. 2010;10(1):11. [DOI:10.1186/1471-2180-10-11]
34. Ghoshal U, Dey A, Ranjan P, Khanduja S, Agarwal V, Ghoshal U. Identification of opportunistic enteric parasites among immunocompetent patients with diarrhoea from Northern India and genetic characterisation of Cryptosporidium and Microsporidia. Indian journal of medical microbiology. 2016;34(1):60. [DOI:10.4103/0255-0857.174114]
35. Elgun G, Koltas IS. Investigation of Cryptosporidium spp. antigen by ELISA method in stool specimens obtained from patients with diarrhea. Parasitology research. 2011;108(2):395-7. [DOI:10.1007/s00436-010-2079-4]
36. Arvanitis M, Anagnostou T, Fuchs BB, Caliendo AM, Mylonakis E. Molecular and nonmolecular diagnostic methods for invasive fungal infections. Clinical microbiology reviews. 2014;27(3):490-526. [DOI:10.1128/CMR.00091-13]

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