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Disseminated microsporidiosis in an immunosuppressed patient.

Meissner EG, Bennett JE, Qvarnstrom Y, da Silva A, Chu EY, Tsokos M, Gea-Banacloche J - Emerging Infect. Dis. (2012)

Bottom Line: We report a case of disseminated microsporidiosis in a patient with multiple myeloma who had received an allogeneic stem cell transplant requiring substantial immunosuppression.The causative organism was identified as Tubulinosema acridophagus, confirming this genus of microsporidia as a novel human pathogen.

View Article: PubMed Central - PubMed

Affiliation: National Institutes of Health, Bethesda, Maryland 20892, USA. eric.meissner@nih.gov

ABSTRACT
We report a case of disseminated microsporidiosis in a patient with multiple myeloma who had received an allogeneic stem cell transplant requiring substantial immunosuppression. The causative organism was identified as Tubulinosema acridophagus, confirming this genus of microsporidia as a novel human pathogen.

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Related in: MedlinePlus

Microsporidium detected in clinical specimens from a stem cell transplant patient who had undergone substantial immunosuppression. A) Calcofluor white–stained ascitic fluid (original magnification ×500). B) Hematoxylin and eosin–stained skin biopsy sample (original magnification ×400). The arrow indicates clusters of spores. C) Warthin-Starry–stained skin biopsy sample (original magnification ×400). The arrows indicate clusters of spores. D) Modified trichrome–stained material from bronchoalveolar lavage. Scare bar = 5.0 μm. E) Transmission electron micrograph depicting 1 of the microsporidian spores identified in a skin biopsy sample. The image shows the polar filament (PF), containing 13 to 14 coils, in a single layer with anisofilar arrangement (An); the plasma membrane (PM); the exospore (Ex); the endospore (En); and polyribosomes (P). Scale bar = 1 μm.
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Figure 1: Microsporidium detected in clinical specimens from a stem cell transplant patient who had undergone substantial immunosuppression. A) Calcofluor white–stained ascitic fluid (original magnification ×500). B) Hematoxylin and eosin–stained skin biopsy sample (original magnification ×400). The arrow indicates clusters of spores. C) Warthin-Starry–stained skin biopsy sample (original magnification ×400). The arrows indicate clusters of spores. D) Modified trichrome–stained material from bronchoalveolar lavage. Scare bar = 5.0 μm. E) Transmission electron micrograph depicting 1 of the microsporidian spores identified in a skin biopsy sample. The image shows the polar filament (PF), containing 13 to 14 coils, in a single layer with anisofilar arrangement (An); the plasma membrane (PM); the exospore (Ex); the endospore (En); and polyribosomes (P). Scale bar = 1 μm.

Mentions: At this time, the patient also had increasing hyperbilirubinemia and elevation of liver aminotransferases, together with diarrhea, abdominal distension, and new ascites. Graft-versus-host disease of the gut and liver was suspected. A colonoscopy on day 79 showed that, with the exception of 1 ulcer, the colonic mucosa appeared normal; biopsy samples showed nonspecific inflammation and a few apoptotic bodies. A liver biopsy and paracentesis were performed on day 85. Samples were stained with calcofluor white, which revealed yeast-like organisms 2–3 μm in diameter (Figure 1, panel A; Figure A1, panels A and B). The samples were also cultured for the presence of fungi, but results were negative.


Disseminated microsporidiosis in an immunosuppressed patient.

Meissner EG, Bennett JE, Qvarnstrom Y, da Silva A, Chu EY, Tsokos M, Gea-Banacloche J - Emerging Infect. Dis. (2012)

Microsporidium detected in clinical specimens from a stem cell transplant patient who had undergone substantial immunosuppression. A) Calcofluor white–stained ascitic fluid (original magnification ×500). B) Hematoxylin and eosin–stained skin biopsy sample (original magnification ×400). The arrow indicates clusters of spores. C) Warthin-Starry–stained skin biopsy sample (original magnification ×400). The arrows indicate clusters of spores. D) Modified trichrome–stained material from bronchoalveolar lavage. Scare bar = 5.0 μm. E) Transmission electron micrograph depicting 1 of the microsporidian spores identified in a skin biopsy sample. The image shows the polar filament (PF), containing 13 to 14 coils, in a single layer with anisofilar arrangement (An); the plasma membrane (PM); the exospore (Ex); the endospore (En); and polyribosomes (P). Scale bar = 1 μm.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376806&req=5

Figure 1: Microsporidium detected in clinical specimens from a stem cell transplant patient who had undergone substantial immunosuppression. A) Calcofluor white–stained ascitic fluid (original magnification ×500). B) Hematoxylin and eosin–stained skin biopsy sample (original magnification ×400). The arrow indicates clusters of spores. C) Warthin-Starry–stained skin biopsy sample (original magnification ×400). The arrows indicate clusters of spores. D) Modified trichrome–stained material from bronchoalveolar lavage. Scare bar = 5.0 μm. E) Transmission electron micrograph depicting 1 of the microsporidian spores identified in a skin biopsy sample. The image shows the polar filament (PF), containing 13 to 14 coils, in a single layer with anisofilar arrangement (An); the plasma membrane (PM); the exospore (Ex); the endospore (En); and polyribosomes (P). Scale bar = 1 μm.
Mentions: At this time, the patient also had increasing hyperbilirubinemia and elevation of liver aminotransferases, together with diarrhea, abdominal distension, and new ascites. Graft-versus-host disease of the gut and liver was suspected. A colonoscopy on day 79 showed that, with the exception of 1 ulcer, the colonic mucosa appeared normal; biopsy samples showed nonspecific inflammation and a few apoptotic bodies. A liver biopsy and paracentesis were performed on day 85. Samples were stained with calcofluor white, which revealed yeast-like organisms 2–3 μm in diameter (Figure 1, panel A; Figure A1, panels A and B). The samples were also cultured for the presence of fungi, but results were negative.

Bottom Line: We report a case of disseminated microsporidiosis in a patient with multiple myeloma who had received an allogeneic stem cell transplant requiring substantial immunosuppression.The causative organism was identified as Tubulinosema acridophagus, confirming this genus of microsporidia as a novel human pathogen.

View Article: PubMed Central - PubMed

Affiliation: National Institutes of Health, Bethesda, Maryland 20892, USA. eric.meissner@nih.gov

ABSTRACT
We report a case of disseminated microsporidiosis in a patient with multiple myeloma who had received an allogeneic stem cell transplant requiring substantial immunosuppression. The causative organism was identified as Tubulinosema acridophagus, confirming this genus of microsporidia as a novel human pathogen.

Show MeSH
Related in: MedlinePlus