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Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species.
Med J Aust. 1993 Mar 15; 158(6):390-4.MJ

Abstract

OBJECTIVES

To determine whether microsporidian infections occur in Australian patients infected with human immunodeficiency virus (HIV), to assess the incidence, and to discuss microscopic detection methods.

DESIGN AND PATIENTS

180 consecutive HIV-infected patients (109 with chronic diarrhoea and 71 with other indications) underwent upper gastrointestinal tract endoscopy and pinch biopsies of the second part of the duodenum. The biopsies were handled by a protocol: four levels, with haematoxylin and eosin stain (H&E) at each level, periodic acid Schiff reagent after diastase (DiPAS) and auramine stain at the second level, and Warthin-Starry (WS) stain and cytomegalovirus early antigen immunoperoxidase study at the third level. Electron microscopy was carried out on samples from the first 95 patients, and thereafter from selected patients.

SETTING

The patients came from the HIV Medicine Unit of a teaching hospital and from the practice of a gastroenterologist.

MAIN OUTCOME MEASURES

Diagnosis of microsporidia was to based on the H&E stain, with electron microscopy as the definitive test because the microsporidia are often difficult to see with H&E. Empirically, the WS stain was found to stain the microorganisms and it replaced electron microscopy during the study as the screening diagnostic test.

RESULTS

Microsporidia were present in 36 of the 109 patients with diarrhoea (33%) and one of 71 patients without diarrhoea. The WS stain in all cases showed developing spores in the enterocytes and in four cases in macrophages as well. The H&E stain showed non-specific duodenitis and was not diagnostic in some cases. Electron microscopy on samples from the first 95 consecutive patients showed 100% concordance with the WS stain. In 33 cases, electron microscopy showed the multinucleated plasmodia and the spores of Enterocytozoon bieneusi and in the four cases confirmed the spores in macrophages and showed a new Encephalitozoon-like species with a septate parasitophorous vacuole. Other causes of duodenal infection were cytomegalovirus (11 cases), mycobacteria (8), cryptosporidia (8) and Giardia lamblia (5).

CONCLUSION

E. bieneusi was the commonest microorganism found in our series of 180 consecutive patients. The actual prevalence of the two microsporidia species within the HIV-positive population and general community awaits further study. The WS stain provides a sensitive diagnostic test for the presence of E. bieneusi and the new Encephalitozoon-like species, avoiding the cost and potential sampling error of electron microscopy. The detailed ultrastructure and taxonomy of the new species requires further study.

Authors+Show Affiliations

St Vincent's Hospital, Darlinghurst, NSW.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7683076

Citation

Field, A S., et al. "Microsporidia in the Small Intestine of HIV-infected Patients. a New Diagnostic Technique and a New Species." The Medical Journal of Australia, vol. 158, no. 6, 1993, pp. 390-4.
Field AS, Hing MC, Milliken ST, et al. Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. Med J Aust. 1993;158(6):390-4.
Field, A. S., Hing, M. C., Milliken, S. T., & Marriott, D. J. (1993). Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. The Medical Journal of Australia, 158(6), 390-4.
Field AS, et al. Microsporidia in the Small Intestine of HIV-infected Patients. a New Diagnostic Technique and a New Species. Med J Aust. 1993 Mar 15;158(6):390-4. PubMed PMID: 7683076.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. AU - Field,A S, AU - Hing,M C, AU - Milliken,S T, AU - Marriott,D J, PY - 1993/3/15/pubmed PY - 1993/3/15/medline PY - 1993/3/15/entrez SP - 390 EP - 4 JF - The Medical journal of Australia JO - Med. J. Aust. VL - 158 IS - 6 N2 - OBJECTIVES: To determine whether microsporidian infections occur in Australian patients infected with human immunodeficiency virus (HIV), to assess the incidence, and to discuss microscopic detection methods. DESIGN AND PATIENTS: 180 consecutive HIV-infected patients (109 with chronic diarrhoea and 71 with other indications) underwent upper gastrointestinal tract endoscopy and pinch biopsies of the second part of the duodenum. The biopsies were handled by a protocol: four levels, with haematoxylin and eosin stain (H&E) at each level, periodic acid Schiff reagent after diastase (DiPAS) and auramine stain at the second level, and Warthin-Starry (WS) stain and cytomegalovirus early antigen immunoperoxidase study at the third level. Electron microscopy was carried out on samples from the first 95 patients, and thereafter from selected patients. SETTING: The patients came from the HIV Medicine Unit of a teaching hospital and from the practice of a gastroenterologist. MAIN OUTCOME MEASURES: Diagnosis of microsporidia was to based on the H&E stain, with electron microscopy as the definitive test because the microsporidia are often difficult to see with H&E. Empirically, the WS stain was found to stain the microorganisms and it replaced electron microscopy during the study as the screening diagnostic test. RESULTS: Microsporidia were present in 36 of the 109 patients with diarrhoea (33%) and one of 71 patients without diarrhoea. The WS stain in all cases showed developing spores in the enterocytes and in four cases in macrophages as well. The H&E stain showed non-specific duodenitis and was not diagnostic in some cases. Electron microscopy on samples from the first 95 consecutive patients showed 100% concordance with the WS stain. In 33 cases, electron microscopy showed the multinucleated plasmodia and the spores of Enterocytozoon bieneusi and in the four cases confirmed the spores in macrophages and showed a new Encephalitozoon-like species with a septate parasitophorous vacuole. Other causes of duodenal infection were cytomegalovirus (11 cases), mycobacteria (8), cryptosporidia (8) and Giardia lamblia (5). CONCLUSION: E. bieneusi was the commonest microorganism found in our series of 180 consecutive patients. The actual prevalence of the two microsporidia species within the HIV-positive population and general community awaits further study. The WS stain provides a sensitive diagnostic test for the presence of E. bieneusi and the new Encephalitozoon-like species, avoiding the cost and potential sampling error of electron microscopy. The detailed ultrastructure and taxonomy of the new species requires further study. SN - 0025-729X UR - https://www.unboundmedicine.com/medline/citation/7683076/Microsporidia_in_the_small_intestine_of_HIV_infected_patients__A_new_diagnostic_technique_and_a_new_species_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0025-729X&date=1993&volume=158&issue=6&spage=390 DB - PRIME DP - Unbound Medicine ER -