Limits...
Microsporidium infection and perforation peritonitis: A rare association.

Tanveer N, Barman S - Indian J Sex Transm Dis (2015 Jul-Dec)

Bottom Line: Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis.The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months.The association of perforation peritonitis and microsporidium is rare.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University College of Medical Sciences, New Delhi, India.

ABSTRACT
Enteric protozoan infections are a well-documented cause of diarrhea in immunocompromised patients. Special stains on stool specimens are routinely performed in such patients to diagnose these protozoa namely cryptosporidium, microsporidium, and isospora. Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis. We report a case of microsporidium enteritis diagnosed on histopathological examination of small bowel resection specimen in a case of perforation peritonitis. The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months. This case report highlights the importance of carefully screening the resection specimens for protozoal infections in immunocompromised individuals. The association of perforation peritonitis and microsporidium is rare. Hence, the possibility that untreated microsporidium infection can lead to perforation cannot be ruled out.

No MeSH data available.


Related in: MedlinePlus

Silver Methenamine stain (×4) shows severe infection – the cytoplasmic vacuoles are studded with silver stain positive organisms
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4660563&req=5

Figure 4: Silver Methenamine stain (×4) shows severe infection – the cytoplasmic vacuoles are studded with silver stain positive organisms

Mentions: On gross examination, the ileal segment was 11.5 cm long with an exudate covered discolored serosa. Two 0.5 cm × 0.5 cm perforations were identified at a distance of 2.5 cm from one resected end and 3.5 cm from the other resected end. Both resected ends were viable. No lymph nodes were found. Multiple sections were examined from the perforation sites and from the rest of the specimen. There was only mild villous blunting with mild increase in lymphocytes in the lamina propria. There was no increase in intraepithelial lymphocytes. No granulomas or necrosis were identified. Sections from the perforation site showed heavy infestation of enterocytes by poorly staining variably refractile 2-5 μ size bluish bodies seen in the apical supranuclear cytoplasm [Figure 1]. In few areas characteristic molding of the enterocyte nuclei by the vacuole containing the spores was also seen [Figures 1 and 2]. The organisms were confirmed by Giemsa [Figure 2], Periodic Acid Schiff [Figure 3], and Silver Methenamine stains [Figure 4]. Based on these findings, the diagnosis of microsporidium infection was made. Ziehl-Neelsen and modified Ziehl-Neelsen stains did not show any acid fast Bacilli.


Microsporidium infection and perforation peritonitis: A rare association.

Tanveer N, Barman S - Indian J Sex Transm Dis (2015 Jul-Dec)

Silver Methenamine stain (×4) shows severe infection – the cytoplasmic vacuoles are studded with silver stain positive organisms
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660563&req=5

Figure 4: Silver Methenamine stain (×4) shows severe infection – the cytoplasmic vacuoles are studded with silver stain positive organisms
Mentions: On gross examination, the ileal segment was 11.5 cm long with an exudate covered discolored serosa. Two 0.5 cm × 0.5 cm perforations were identified at a distance of 2.5 cm from one resected end and 3.5 cm from the other resected end. Both resected ends were viable. No lymph nodes were found. Multiple sections were examined from the perforation sites and from the rest of the specimen. There was only mild villous blunting with mild increase in lymphocytes in the lamina propria. There was no increase in intraepithelial lymphocytes. No granulomas or necrosis were identified. Sections from the perforation site showed heavy infestation of enterocytes by poorly staining variably refractile 2-5 μ size bluish bodies seen in the apical supranuclear cytoplasm [Figure 1]. In few areas characteristic molding of the enterocyte nuclei by the vacuole containing the spores was also seen [Figures 1 and 2]. The organisms were confirmed by Giemsa [Figure 2], Periodic Acid Schiff [Figure 3], and Silver Methenamine stains [Figure 4]. Based on these findings, the diagnosis of microsporidium infection was made. Ziehl-Neelsen and modified Ziehl-Neelsen stains did not show any acid fast Bacilli.

Bottom Line: Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis.The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months.The association of perforation peritonitis and microsporidium is rare.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University College of Medical Sciences, New Delhi, India.

ABSTRACT
Enteric protozoan infections are a well-documented cause of diarrhea in immunocompromised patients. Special stains on stool specimens are routinely performed in such patients to diagnose these protozoa namely cryptosporidium, microsporidium, and isospora. Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis. We report a case of microsporidium enteritis diagnosed on histopathological examination of small bowel resection specimen in a case of perforation peritonitis. The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months. This case report highlights the importance of carefully screening the resection specimens for protozoal infections in immunocompromised individuals. The association of perforation peritonitis and microsporidium is rare. Hence, the possibility that untreated microsporidium infection can lead to perforation cannot be ruled out.

No MeSH data available.


Related in: MedlinePlus