Primer diagnóstico de microsporidiosis humana en Uruguay
Palabras clave:
MICROSPORIDIOSIS, DIARREA, SÍNDROME DE INMUNODEFICIENCIA ADQUIRIDA
Resumen
Los microsporidios son protozoarios conocidos desde hace mucho tiempo como causantes de plagas en invertebrados y vertebrados. En la década de 1980 se les reconoce como agentes etiológicos de diarrea en VIH-sida y posteriormente en trasplantados renales así como en personas inmunocompetentes (diarrea del viajero).
El objetivo de este trabajo es comunicar el primer hallazgo de estos agentes en un paciente VIH-sida y contribuir al conocimiento de las características patogénicas y diagnósticas más importantes de los microsporidios.
En 1998 en el Departamento de Parasitología se implementaron las técnicas de coloración para microsporidios, gram-cromotrope y tricrómica.
El primer hallazgo se observó en un paciente VIH-sida, con diarrea de nueve meses de evolución; no se realizó tratamiento específico ya que concomitantemente presentaba una meningoencefalitis criptococócica, la que precipitó su fallecimiento.
El reconocimiento de estos agentes oportunistas como causa de diarrea en Uruguay, contribuye al diagnóstico etiológico de la diarrea crónica en pacientes VIH-sida.
En adelante, las coloraciones específicas de microsporidios deberían ser incluidas en el algoritmo diagnóstico para enteroparasitosis en grupos de riesgo.
Citas
1) Martínez R. Microsporidios: protistas parásitos, nuevos patógenos humanos. Publicación académica. Madrid: Real Academia de Farmacia-Instituto de España, 1994: 1-19.
2) Atias A. Microsporidiosis. In: Parasitología Médica. 3ª ed, Santiago de Chile: Mediterráneo, 1991: 291-5.
3) Weiss LM, Edlind TD, Vossbrink CR, Hashimoto T. Microsporidian molecular phylogeny: the fungal conection. J Eukaryot Microbiol 1999; 46(5): 17S-8S.
4) Mathis A. Microsporidia: emerging advances in understanding the basic biology of these unique organisms. Int J Parasitol 2000; 30(7): 795-804.
5) Weiss LM. Microsporidia: emerging pathogenic protists. Acta Trop 2001; 78(2): 89-102.
6) Gannon J. A survey of Encephalitozoon cuniculi in laboratory animals colonies in the United Kingdom. Lab Anim 1980; 14(2): 91-4.
7) Cox JC. Altered immune responsiveness associated Encephalitozoon cuniculi infection in rabbits. Infect Immun 1977; 15(2): 392-5.
8) Escobedo AA, Núñez FA. Prevalence of intestinal parasites in Cuban acquired immunodeficiency syndrome (AIDS) patients. Acta Trop 1999; 72(1): 125-30.
9) Chinchilla M, Reyes L, Guerrero OM, Frajan M, Morales MT. Enterocytozoon bieneusi (orden microsporidia, familia enterocytozoonidae) in Costa Rica: report of the first human case in Central America. Parasitol Día 1997; 21(3/4): 119-22.
10) Weber R, Schwartz DA, Bryan RT. Microsporidia. In: Mandell GL, Bennett JE, Dolan R. Principles and practice of infectious diseases. 5ª ed. New York: 2000 (versión electrónica).
11) Matsubayashi H, Koike T, Mikata M, Hagiwara S. A case of Encephalitozoon-like body infection in man. Arch Pathol 1959; 67: 181-7.
12) Pol S, Romana CA, Richard S, Amouyal P, Desportes-Livage I, Carnot F, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328(2): 95-9.
13) Metge S, Van Nhieu JT, Dahmane D, Grimbert P, Foulet F, Sarfati C, et al. A case of Enterocytozoon bieneusi infection in an HIV-negative renal transplant recipient. Eur J Clin Microbiol Infect Dis 2000; 19(3): 221-3.
14) Wanke CA, DeGirolami P, Federman M. Enterocytozoon bieneusi infection and diarrheal disease in patients who were not infected with human immunodeficiency virus: case report and review. Clin Infect Dis 1996; 23(4): 816-8.
15) Canning EU, Hollister WS. Human infections with mi-crosporidia. Rev Med Microbiol 1992; 3: 35-42.
16) Atias A. Actualizaciones sobre microsporidios en el hombre. Rev Med Chile 1995; 123: 762-72.
17) Sandfort J, Hannemann A, Gelderblom H, Stark K, Owen RL, Ruf B. Enterocytozoon bieneusi infection in an inmunocompetent patient who had acute diarrhea and who was not infected with the human inmunodeficiency virus. Clin Infect Dis 1994; 19(3): 514-6.
18) Raynaud L, Delbac F, Broussolle V, Rabodonirina M, Girault V, Wallon M, et al. Identification of Encephalitozoon intestinalis in travelers with chronic diarrhea by specific PCR Amplification. J Clin Microbiol 1998; 36(1): 37-40.
19) Sing A, Tybus K, Heesemann J, Mathis A. Molecular diagnosis of an Enterocytozoon bieneusi human genotype C infection in a moderately immunosuppressed human immunodeficiency virus-seronegative liver-transplant recipient with severe chronic diarrhea. J Clin Microbiol 2001; 39(6): 2371-2.
20) Deportes I, Le Charpentier A, Galian F, Bernard B, Cochand-Priollet A, Lavergne P, et al. Ocurrence of a new microsporidian, Enterocytozoon bieneusi n.g., n.sp., in the enterocytes of a human patient with AIDS. J Protozool 1985; 32: 245-50.
21) Cali A, Kotler DP, Orensteien JM. Septata intestinalis n g, n sp., an intestinal microsporidian associated with chronic diarrhea and dissemination in AIDS patients. J Protozool 1993; 40(1): 101-12.
22) Franzen C, Müller A, Hartmann P, Kochanek M, Diehl V, Fätkenheuer G. Disseminated Encephalitozoon (Septata) intestinalis infection in a patient with AIDS. N Engl J Med 1996; 335(21): 1610-1.
23) Canning EU, Hollister WS, Caun IG, Barrison RPH, Logan JR, Polson SM, et al. Microsporidian infection due to Enterocytozoon bieneusi: relationship with immunosuppression and HIV. Trans R Soc Trop Med Hyg 1988; 82: 661.
24) Weber R, Bryan RT, Schwartz DA, Owen RL. Human Microsporidial Infections. Clin Microbiol Rev 1994; 7(4): 426-61.
25) Cali A, Meisler DM, Rutherford I, Lowder CY, McMahon JT, Longworth DL, et al. Corneal microsporidiosis in a patient with AIDS. Am J Trop Med Hyg 1991; 44(5): 463-8.
26) Schwartz DA, Bryan RT, Hewan-Lowe KO, Visvesvara GS, Weber R, Cali A, et al. Disseminated microsporidiosis (Encephalitozoon hellem) and acquired immunodeficiency syndrome. Autopsy evidence for respiratory acquisition. Arch Pathol Lab Med 1992; 116(6): 660-8.
27) Weber R, Kuster H, Keller R, Bachi T, Spycher MA, Briner J, et al. Pulmonary and intestinal microsporidiosis in a patient with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1992; 146(6): 1603-5.
28) Schwartz DA, Sobottka I, Leitch GJ, Cali A, Visvesvara GS. Pathology of microsporidiosis: emerging parasitic infection in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med 1996; 120(2): 173-88.
29) Candida A, López-Vélez ME, Pérez MJ, Guerrero A, Moreira V, Redondo C. Enterocytozoon bieneusi infection in an AIDS patient in Spain. Res Rev Parasitol 1994; 54: 269-71.
30) Giang TT, Kotler DP, Garro ML, Orenstein JM. Tissue diagnosis of intestinal microsporidiosis using the chromotrope-2R modified trichrome stain. Arch Pathol Lab Med 1993; 117(12): 1249-51.
31) Peacock CS, Blanshard C, Tovey DG, Ellis DS, Gazzard BG. Histological diagnosis of intestinal microsporidiosis in patients with AIDS. J Clin Pathol 1991; 44(7): 558-63.
32) van Gool T, Snijders F, Reiss P, Eeftinck Schattenkerk JK, van den Bergh Weerman MA, Bartelsman JF, et al. Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique. J Clin Pathol 1993; 46(8): 694-9.
33) Conteas CN, Sowerby T, Berlin GW, Dahlan F, Nguyen A, Porschen R, et al. Fluorescence techniques diagnosis intestinal microsporidiosis in stool, enteric fluid, and biopsy specimens from acquired immunodeficiency syndrome patients with chronic diarrhea. Arch Pathol Lab Med 1996; 120(9): 847-53.
34) Rijpstra AC, Canning EU, Van Ketel RJ, Eeftinck Schattenkerk JK, Laarman JJ. Use of light microscopy to diagnose small-intestinal microsporidiosis in patients with AIDS. J Infect Dis 1988; 157(4): 827-31.
35) Weber R, Bryan RT, Owen RL, Wilcox CM, Gorelkin L, Visvesvara GS. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group. N Engl J Med 1992; 326(3): 161-2.
36) Moura H, Schawartz DA, Bornay-Llinares F, Sodre FC, Wallace S, Visvesvara GS. A new improved "quick-hot Gram-chromotrope" technique that differentially stains microsporidian spores in clinical samples, including paraffin-embedded tissue sections. Arch Pathol Lab Med 1997; 121(8): 888-93.
37) Visvesvara GS, Leitch GJ, Moura H, Wallace S, Weber R, Bryan RT. Culture, electron microscopy, and immunoblot studies on a microsporidian parasite isolated from the urine of a patient with AIDS. J Protozool 1991; 38(6): 105S-111S.
38) Weiss LM, Cali A, Levee E, LaPlace D, Tanowitz H, Simon D, et al. Diagnosis of Encephalitozoon cuniculi infection by Western blot and the use of cross-reactive antigens for the possible detection of microsporidiosis in humans. Am J Trop Med Hyg 1992; 47(4): 456-62.
39) Bornay-Llinares FJ, Acosta B, Peman J, Moura H, Schwartz DA, Da Silva AJ, et al. Mantenimiento en cultivo y caracterización de un microsporidio (Encephalitozoon hellem) aislado en un paciente con sida y neumonía. Parasitol Día 2000; 24: 69-78.
40) Visvesvara GS, Leitch GJ, da Silva AJ, Croppo AJ, Moura H, Wallace S, et al. Polyclonal and monoclonal antibody and PCR-amplified small-subunit rRNA identification of a microsporidian, Encephalitozoon hellem, isolated from an AIDS patient with disseminated infection. J Clin Microbiol 1994; 32(11): 2760-8.
41) Da Silva AJ, Bornay-Llinares FJ, Del Aguila de la Puente C del A, Moura H, Peralta JM, Sobottka I, et al. Diagnosis of Enterocytozoon bieneusi (microsporidia) infections by polymerase chain reaction in stool samples using primers based on the region coding for small-subunit ribosomal RNA. Arch Pathol Lab Med 1997; 121: 874-9.
42) Coyle CM, Wittner M, Kotler, DP, Noyer C, Orenstein JM, Tanowitz HB, et al. Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene. Clin Infect Dis 1996; 23: 1002-6.
43) Bornay-Llinares FJ, Da Silva AJ, Moura H, Schawartz DA, Visvesvara GS, Pieniazek NJ, et al. Immunologic, microscopic, and molecular evidence of Encephalitozoon intestinalis (Septata intestinalis) infection in mammals other than humans. J Infect Dis 1998; 178(3): 820-6.
44) Van Gool T, Dankert J. Human microsporidiosis: Clinical, diagnostic and therapeutic aspects of an increasing infection. Clin Microbiol Infect 1995; 1(2): 75-85.
45) Fernández N, Combol A, Acuña AM, Zanetta E. Microsporidios: primer hallazgo en Uruguay de Enterocytozoon bieneusi. Rev Urug Pat Clín 2000; 33: 55.
46) Combol A, Fernández N, Acuña AM, Zanetta E. Diagnóstico de Microsporidios en pacientes VIH-SIDA. Lab Día 2001; 10: 29.
2) Atias A. Microsporidiosis. In: Parasitología Médica. 3ª ed, Santiago de Chile: Mediterráneo, 1991: 291-5.
3) Weiss LM, Edlind TD, Vossbrink CR, Hashimoto T. Microsporidian molecular phylogeny: the fungal conection. J Eukaryot Microbiol 1999; 46(5): 17S-8S.
4) Mathis A. Microsporidia: emerging advances in understanding the basic biology of these unique organisms. Int J Parasitol 2000; 30(7): 795-804.
5) Weiss LM. Microsporidia: emerging pathogenic protists. Acta Trop 2001; 78(2): 89-102.
6) Gannon J. A survey of Encephalitozoon cuniculi in laboratory animals colonies in the United Kingdom. Lab Anim 1980; 14(2): 91-4.
7) Cox JC. Altered immune responsiveness associated Encephalitozoon cuniculi infection in rabbits. Infect Immun 1977; 15(2): 392-5.
8) Escobedo AA, Núñez FA. Prevalence of intestinal parasites in Cuban acquired immunodeficiency syndrome (AIDS) patients. Acta Trop 1999; 72(1): 125-30.
9) Chinchilla M, Reyes L, Guerrero OM, Frajan M, Morales MT. Enterocytozoon bieneusi (orden microsporidia, familia enterocytozoonidae) in Costa Rica: report of the first human case in Central America. Parasitol Día 1997; 21(3/4): 119-22.
10) Weber R, Schwartz DA, Bryan RT. Microsporidia. In: Mandell GL, Bennett JE, Dolan R. Principles and practice of infectious diseases. 5ª ed. New York: 2000 (versión electrónica).
11) Matsubayashi H, Koike T, Mikata M, Hagiwara S. A case of Encephalitozoon-like body infection in man. Arch Pathol 1959; 67: 181-7.
12) Pol S, Romana CA, Richard S, Amouyal P, Desportes-Livage I, Carnot F, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328(2): 95-9.
13) Metge S, Van Nhieu JT, Dahmane D, Grimbert P, Foulet F, Sarfati C, et al. A case of Enterocytozoon bieneusi infection in an HIV-negative renal transplant recipient. Eur J Clin Microbiol Infect Dis 2000; 19(3): 221-3.
14) Wanke CA, DeGirolami P, Federman M. Enterocytozoon bieneusi infection and diarrheal disease in patients who were not infected with human immunodeficiency virus: case report and review. Clin Infect Dis 1996; 23(4): 816-8.
15) Canning EU, Hollister WS. Human infections with mi-crosporidia. Rev Med Microbiol 1992; 3: 35-42.
16) Atias A. Actualizaciones sobre microsporidios en el hombre. Rev Med Chile 1995; 123: 762-72.
17) Sandfort J, Hannemann A, Gelderblom H, Stark K, Owen RL, Ruf B. Enterocytozoon bieneusi infection in an inmunocompetent patient who had acute diarrhea and who was not infected with the human inmunodeficiency virus. Clin Infect Dis 1994; 19(3): 514-6.
18) Raynaud L, Delbac F, Broussolle V, Rabodonirina M, Girault V, Wallon M, et al. Identification of Encephalitozoon intestinalis in travelers with chronic diarrhea by specific PCR Amplification. J Clin Microbiol 1998; 36(1): 37-40.
19) Sing A, Tybus K, Heesemann J, Mathis A. Molecular diagnosis of an Enterocytozoon bieneusi human genotype C infection in a moderately immunosuppressed human immunodeficiency virus-seronegative liver-transplant recipient with severe chronic diarrhea. J Clin Microbiol 2001; 39(6): 2371-2.
20) Deportes I, Le Charpentier A, Galian F, Bernard B, Cochand-Priollet A, Lavergne P, et al. Ocurrence of a new microsporidian, Enterocytozoon bieneusi n.g., n.sp., in the enterocytes of a human patient with AIDS. J Protozool 1985; 32: 245-50.
21) Cali A, Kotler DP, Orensteien JM. Septata intestinalis n g, n sp., an intestinal microsporidian associated with chronic diarrhea and dissemination in AIDS patients. J Protozool 1993; 40(1): 101-12.
22) Franzen C, Müller A, Hartmann P, Kochanek M, Diehl V, Fätkenheuer G. Disseminated Encephalitozoon (Septata) intestinalis infection in a patient with AIDS. N Engl J Med 1996; 335(21): 1610-1.
23) Canning EU, Hollister WS, Caun IG, Barrison RPH, Logan JR, Polson SM, et al. Microsporidian infection due to Enterocytozoon bieneusi: relationship with immunosuppression and HIV. Trans R Soc Trop Med Hyg 1988; 82: 661.
24) Weber R, Bryan RT, Schwartz DA, Owen RL. Human Microsporidial Infections. Clin Microbiol Rev 1994; 7(4): 426-61.
25) Cali A, Meisler DM, Rutherford I, Lowder CY, McMahon JT, Longworth DL, et al. Corneal microsporidiosis in a patient with AIDS. Am J Trop Med Hyg 1991; 44(5): 463-8.
26) Schwartz DA, Bryan RT, Hewan-Lowe KO, Visvesvara GS, Weber R, Cali A, et al. Disseminated microsporidiosis (Encephalitozoon hellem) and acquired immunodeficiency syndrome. Autopsy evidence for respiratory acquisition. Arch Pathol Lab Med 1992; 116(6): 660-8.
27) Weber R, Kuster H, Keller R, Bachi T, Spycher MA, Briner J, et al. Pulmonary and intestinal microsporidiosis in a patient with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1992; 146(6): 1603-5.
28) Schwartz DA, Sobottka I, Leitch GJ, Cali A, Visvesvara GS. Pathology of microsporidiosis: emerging parasitic infection in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med 1996; 120(2): 173-88.
29) Candida A, López-Vélez ME, Pérez MJ, Guerrero A, Moreira V, Redondo C. Enterocytozoon bieneusi infection in an AIDS patient in Spain. Res Rev Parasitol 1994; 54: 269-71.
30) Giang TT, Kotler DP, Garro ML, Orenstein JM. Tissue diagnosis of intestinal microsporidiosis using the chromotrope-2R modified trichrome stain. Arch Pathol Lab Med 1993; 117(12): 1249-51.
31) Peacock CS, Blanshard C, Tovey DG, Ellis DS, Gazzard BG. Histological diagnosis of intestinal microsporidiosis in patients with AIDS. J Clin Pathol 1991; 44(7): 558-63.
32) van Gool T, Snijders F, Reiss P, Eeftinck Schattenkerk JK, van den Bergh Weerman MA, Bartelsman JF, et al. Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique. J Clin Pathol 1993; 46(8): 694-9.
33) Conteas CN, Sowerby T, Berlin GW, Dahlan F, Nguyen A, Porschen R, et al. Fluorescence techniques diagnosis intestinal microsporidiosis in stool, enteric fluid, and biopsy specimens from acquired immunodeficiency syndrome patients with chronic diarrhea. Arch Pathol Lab Med 1996; 120(9): 847-53.
34) Rijpstra AC, Canning EU, Van Ketel RJ, Eeftinck Schattenkerk JK, Laarman JJ. Use of light microscopy to diagnose small-intestinal microsporidiosis in patients with AIDS. J Infect Dis 1988; 157(4): 827-31.
35) Weber R, Bryan RT, Owen RL, Wilcox CM, Gorelkin L, Visvesvara GS. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group. N Engl J Med 1992; 326(3): 161-2.
36) Moura H, Schawartz DA, Bornay-Llinares F, Sodre FC, Wallace S, Visvesvara GS. A new improved "quick-hot Gram-chromotrope" technique that differentially stains microsporidian spores in clinical samples, including paraffin-embedded tissue sections. Arch Pathol Lab Med 1997; 121(8): 888-93.
37) Visvesvara GS, Leitch GJ, Moura H, Wallace S, Weber R, Bryan RT. Culture, electron microscopy, and immunoblot studies on a microsporidian parasite isolated from the urine of a patient with AIDS. J Protozool 1991; 38(6): 105S-111S.
38) Weiss LM, Cali A, Levee E, LaPlace D, Tanowitz H, Simon D, et al. Diagnosis of Encephalitozoon cuniculi infection by Western blot and the use of cross-reactive antigens for the possible detection of microsporidiosis in humans. Am J Trop Med Hyg 1992; 47(4): 456-62.
39) Bornay-Llinares FJ, Acosta B, Peman J, Moura H, Schwartz DA, Da Silva AJ, et al. Mantenimiento en cultivo y caracterización de un microsporidio (Encephalitozoon hellem) aislado en un paciente con sida y neumonía. Parasitol Día 2000; 24: 69-78.
40) Visvesvara GS, Leitch GJ, da Silva AJ, Croppo AJ, Moura H, Wallace S, et al. Polyclonal and monoclonal antibody and PCR-amplified small-subunit rRNA identification of a microsporidian, Encephalitozoon hellem, isolated from an AIDS patient with disseminated infection. J Clin Microbiol 1994; 32(11): 2760-8.
41) Da Silva AJ, Bornay-Llinares FJ, Del Aguila de la Puente C del A, Moura H, Peralta JM, Sobottka I, et al. Diagnosis of Enterocytozoon bieneusi (microsporidia) infections by polymerase chain reaction in stool samples using primers based on the region coding for small-subunit ribosomal RNA. Arch Pathol Lab Med 1997; 121: 874-9.
42) Coyle CM, Wittner M, Kotler, DP, Noyer C, Orenstein JM, Tanowitz HB, et al. Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene. Clin Infect Dis 1996; 23: 1002-6.
43) Bornay-Llinares FJ, Da Silva AJ, Moura H, Schawartz DA, Visvesvara GS, Pieniazek NJ, et al. Immunologic, microscopic, and molecular evidence of Encephalitozoon intestinalis (Septata intestinalis) infection in mammals other than humans. J Infect Dis 1998; 178(3): 820-6.
44) Van Gool T, Dankert J. Human microsporidiosis: Clinical, diagnostic and therapeutic aspects of an increasing infection. Clin Microbiol Infect 1995; 1(2): 75-85.
45) Fernández N, Combol A, Acuña AM, Zanetta E. Microsporidios: primer hallazgo en Uruguay de Enterocytozoon bieneusi. Rev Urug Pat Clín 2000; 33: 55.
46) Combol A, Fernández N, Acuña AM, Zanetta E. Diagnóstico de Microsporidios en pacientes VIH-SIDA. Lab Día 2001; 10: 29.
Publicado
2002-12-31
Cómo citar
1.
Fernández N, Combol A, Zanetta E, Acuña AM, Gezuele E. Primer diagnóstico de microsporidiosis humana en Uruguay. Rev. Méd. Urug. [Internet]. 31 de diciembre de 2002 [citado 17 de noviembre de 2024];18(3):251-5. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/968
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