微孢子虫病研究进展

随着艾滋病的流行 ,有关微孢子虫病的报道逐渐增多。本文从检测诊断、免疫学、细胞培养、动物模型、分子生物学及治疗等方面对感染人的微孢子虫进行综述     

微孢子虫病研究进展

随着艾滋病的流行，有关微孢子虫病的报道逐渐增多。本文从检测诊断、免疫学、细胞培养、动物模型、分子生物学及治疗等方面对感染人的微孢子虫进行综述。     

艾滋病合并常见原虫感染的诊断治疗

原虫感染是艾滋病患者重要的机会性感染之一。为了提高临床医生对艾滋病合并原虫感染的认识,本文对艾滋病合并弓形虫脑炎、隐孢子虫病、微孢子虫病及等孢球虫病的诊断治疗现状进行综述。     

微孢子虫病研究现状

微孢子虫病是一种新兴的机会致病性传染病,过去认为该虫通常感染免疫缺陷患者,但近年来微孢子虫感染健康者的报道越来越多,引起了研究者们的广泛关注.该文对肠脑炎微孢子虫(Encephalitozoon intestinalis)、兔脑炎微孢子虫(Encephalitozoon cuniculi)、比氏肠微孢子虫(Enterocytozoon bieneusi)等多种感染人的微孢子虫的临床症状、分子生物学、流行病学及治疗预防等方面进行综述.     

几种新现人体隐孢子虫种和基因型流行现状

隐孢子虫是一种寄生于宿主胃肠道上皮细胞内的原虫。人感染后,免疫功能正常者,常引起自限性腹泻;但在高危人群(如儿童、老人和免疫缺陷者等)中可发生严重腹泻和肠外感染,尤其是艾滋病患者。目前,隐孢子虫的分子流行病学研究已鉴定了30个有效种和40多种基因型,其中21个隐孢子虫种和基因型在人体发现。人体隐孢子虫病多数由人隐孢子虫(C.hominis)和微小隐孢子虫(C.parvum)引起。火鸡隐孢子虫(C.meleagridis)、泛在隐孢子虫(C.ubiquitum)、猫隐孢子虫(C.felis)和犬隐孢子虫(C.canis)引起的隐孢子虫病例也逐渐增多。除此之外,随着人体隐孢子虫病分子流行病学数据的增加,在人体内鉴定到一些新的隐孢子虫和基因型。特对上述新现的人体隐孢子虫种和基因型的流行现状进行综述。     

微孢子虫及微孢子虫病

微孢子虫及微孢子虫病黄松如，黄敏君微孢子虫（Ｍｉｃｒｏｓｐｏｒｉｄｉｕｍ）是一群专性细胞内生长的寄生原虫，常见于节肢动物和鱼类，但也可感染人类和其它哺乳动物￣［１，２］。虽然早在１９２７年及１９５９年就已有人报道感染微孢子虫的小儿病例￣［３，４］，但...     

艾滋病合并隐孢子虫感染的研究进展

随着艾滋病的流行,合并隐孢子虫感染的病例逐渐增多,世界卫生组织（WHO）已将人的隐孢子虫病列为艾滋病的怀疑指标之一,被公认为艾滋病患者合并感染的重要机会性致病病原之一。在一些地区,隐孢子虫病甚至成了艾滋病患者的主要致死因素之一。文章就隐孢子虫病在艾滋病病人中的流行特点、病原学特征、临床表现及治疗等方面进行综述。     

人体隐孢子虫病流行病学及临床研究进展

人对隐孢子虫普遍易感,艾滋病患者和免疫力低下人群隐孢子虫感染率较高,是艾滋病患者的主要致死因素之一。近年来,人们对隐孢子虫病作了大量的研究,本文主要对人体隐孢子虫病的病原体特征、临床表现、流行病学以及治疗研究进展作了综述。     

微孢子虫检测技术的研究进展

微孢子虫是专性细胞内寄生的真核生物,其作为人类新发病原越来越受到重视,故快速、准确的检测技术对于微孢子虫病的防治显得尤为重要。本文简要综述了以染色技术、免疫组化技术和分子生物学技术等为主的微孢子虫识别方法的研究进展,以期为有效防治微孢子虫病提供参考。     

同时检测4种肠道原虫的多重PCR方法的建立及应用北大核心CSCD

目的建立一种同时检测隐孢子虫、贾第鞭毛虫、微孢子虫和环孢子虫4种原虫的多重PCR体系。方法基于隐孢子虫18S rRNA基因、贾第鞭毛虫TPI基因、微孢子虫SSU rRNA基因、环孢子虫18S rRNA基因保守序列设计特异引物,建立和优化一种同时检测隐孢子虫、贾第鞭毛虫、微孢子虫和环孢子虫的多重PCR方法,测序验证阳性结果,并进行该方法的敏感性和特异性试验。结果成功建立一种同时检测隐孢子虫、贾第鞭毛虫、微孢子虫和环孢子虫的多重PCR方法,在同一个PCR反应体系中稳定扩增获得大小分别为314、113、179和242 bp的产物,检出限为≥10拷贝的原虫DNA克隆质粒。该方法与单病原PCR检测的结果一致性较好。结论本研究建立的4种原虫的多重PCR检测技术操作简单、快速、成本效益高,可用于人体、动物和环境中隐孢子虫、贾第鞭毛虫、微孢子虫和环孢子虫感染和污染的筛查。     

Prevalence of intestinal microsporidiosis in human immunodeficiency virus-infected patients with diarrhea in major United States cities

To determine the prevalence of intestinal microsporidiosis in HIV-infected patients, we performed a prospective study of HIV-infected patients with diarrheal illnesses in three US hospitals and examined an observational database of HIV-infected patients in 10 US cities. Among 737 specimens from the three hospitals, results were positive for 11 (prevalence 1.5%); seven (64%) acquired HIV through male-to-male sexual contact, two (18%) through male-to-male sexual contact and injection drug use, and one (9%) through heterosexual contact; one (9%) had an undetermined mode of transmission. Median CD4 count within six months of diagnosis of microsporidiosis was 33 cells/microL (range 3 to 319 cells/microL). For the national observational database (n = 24,098), the overall prevalence of microsporidiosis was 0.16%. Prevalence of microsporidiosis among HIV-infected patients with diarrheal disease is low, and microsporidiosis is most often diagnosed in patients with very low CD4+ cell counts. Testing for microsporidia appears to be indicated, especially for patients with very low CD4+ cell counts.     

Human microsporidioses

Recent developments in microsporidiosis research include the increased utilization of molecular techniques for the investigation of clinical specimens as well as for epidemiological and phylogenetic studies. Special attention is given to studies reporting severe disseminated microsporidioses involving most organs in AIDS patients, and the increased number of HIV-seronegative and immunocompetent individuals with microsporidiosis. The potential efficacy of fumagillin (Sanofi Recherche, Gentilly, France) in infections caused by Enterocytozoon bieneusi, and the remission of intestinal microsporidiosis in HIV infected patients with antiretroviral therapy are also highlighted.     

Intestinal microsporidiosis in HIV-infected children with diarrhea

Intestinal microsporidiosis is a common opportunistic disease associated with diarrhea in adult AIDS patients in Thailand; the data regarding this infection in children are scarce. The present study was designed to investigate the prevalence and clinical features of intestinal microsporidiosis in hospitalized HIV-infected and uninfected (free of HIV) children with diarrhea. Of the 95 HIV-infected children and 87 uninfected children, 24 (25.3%) and 13 (14.9%) respectively were diagnosed with intestinal microsporidiosis. Species identification of microsporidia spores, by transmission electron microscopy, demonstrated Enterocytozoon bieneusi in 5 cases. Cryptosporidium parvum was a common coinfective parasite; pneumonia was the most frequent concurrent disease found in children with intestinal microsporidiosis. Malnutrition was commoner in the HIV-infected group (79.2% vs 23.1%; p = 0.003). This study indicates that intestinal microsporidiosis is an important disease in both HIV-infected and uninfected Thai children with diarrhea.     

眼部微孢子虫病研究进展

由微孢子虫所引起的眼部疾患具有两种不同的临床类型：一种是角膜基质型,常见于免疫功能正常的健康人;另一种为上皮型点状角膜结膜炎,多发生于免疫功能低下的患者。这两种不同的临床表现与病原体的种属及患者的免疫状况有关。本文就眼部微孢子虫病的研究进展进行综述。     

Microsporidiosis in solid organ transplant recipients: two Enterocytozoon bieneusi cases and review

Abstract: Microsporidiosis first came to prominence as an opportunistic infection in patients with acquired immunodeficiency syndrome. Microsporidia are now emerging pathogens responsible for severe diarrhea during solid organ transplantation. Two main clinical entities can be identified: infection by Enterocytozoon bieneusi , causing diarrhea with limited treatment options; and infection by Encephalitozoon intestinalis , which may disseminate and usually responds to albendazole treatment. We describe here 2 cases of microsporidiosis caused by E. bieneusi in a renal and a liver transplant recipient, respectively, in whom complete clinical efficacy of a short course of fumagillin therapy was obtained. Long-term microbiological eradication was assessed using classical methods and monitored using a real-time quantitative polymerase chain reaction-based method. Both patients experienced drug-induced thrombocytopenia, which resolved after withdrawal of the treatment. We also review the 18 other previously reported cases of microsporidiosis in transplant recipients. In case of persistent diarrhea in solid organ transplant patients, microsporidiosis should be considered. Based on the present experience, treating E. bieneusi infection with 7 days of fumagillin therapy is adequate to eradicate E. bieneusi in this context.     

Confirmed microsporidial graft infection in a HIV‐negative renal transplant recipient: A case report and review of the literature

Microsporidia are intracellular organisms most commonly known to cause opportunistic infection in patients with human immunodeficiency virus (HIV). There have been several case reports of infection in solid organ and bone marrow transplant recipients. Here, we report a case of a non‐HIV–infected renal transplant patient with microsporidiosis of the renal tract associated with acute graft dysfunction. We also review the literature of 12 previously reported cases of microsporidiosis in patients with renal transplants who had described graft involvement. We review the pattern of illness as well as the common renal biopsy features when microsporidial infection is associated with renal graft infection.     

Intestinal microsporidiosis in diarrheal patients infected with human immunodeficiency virus-1 in Addis Ababa, Ethiopia

Intestinal microsporidiosis is most commonly associated with persistent diarrhea in advanced AIDS cases. To determine the prevalence and clinical manifestations of this infection in HIV/AIDS patients, a single fresh stool sample and blood were collected from 243 (214 HIV-positive and 29 HIV-negative) diarrheal patients. The presence of intestinal microsporidiosis in the stool was determined by Uvitex-2B staining and a PCR-based detection method. HIV screening was done by using ELISA, and reactive samples were confirmed by Western blotting. The CD4+ cell count was analyzed using FACScan. Out of 243 diarrheal patients, 39 (16.0%) cases were positive for intestinal microsporidial infection by either of the methods used. Of the 39, only 18 cases positive by microscopy were also positive by PCR. Based on PCR and microscopic analyses the microsporidial parasites were identified as Enterocytozoon bieneusi (30), Ecephalitozoon intestinalis (6), and double infections (3). All microsporidia-positive cases were HIV-positive, and 92.3% had diarrhea for over 4 weeks. The diarrhea was watery in 79.5% of the patients. Weight loss >10% was recorded in 37 (94.9%) cases. The CD4+ cell count was <100 cells/mm(3) in 84.4% of subjects, and 59.4% of the patients had a CD4+ cell count of < or =50 cells/mm(3), with a mean of 22.8 cells/mm(3). This study revealed that intestinal microsporidiosis is a common cause of chronic diarrhea and severe weight loss in advanced AIDS patients in Ethiopia. This condition is attributable mainly to E. bieneusi. Thus, early diagnosis of intestinal microsporidiosis in HIV/AIDS patients would certainly be helpful in the understanding and management of diarrheal illness.     

Fumagillin‐induced aseptic meningoencephalitis in a kidney transplant recipient with microsporidiosis

Microsporidiosis is an opportunistic infection in organ transplant recipients and patients with other cellular immunodeficiency. Fumagillin is an effective treatment against Enterocytozoon bieneusi, one of the two main species causing the microsporidiosis involved in human diseases. We report the first case, to our knowledge, of a probable drug‐induced aseptic meningoencephalitis, after administration of fumagillin in a kidney transplant recipient with microsporidiosis.     

Changing patterns of disease and treatment of opportunistic parasitic infections in patients with AIDS

In the past 18 months, the significant effect of highly active antiretroviral therapy and immune reconstitution on the incidence of opportunistic protozoan infections, mainly cryptosporidiosis and microsporidiosis, has been demonstrated in HIV-infected patients. The major therapeutic advances of the past 18 months concern microsporidiosis, for which the efficacies of fumagillin and albendazole have been assessed against Enterocytozoon bieneusi and Encephalitozoon infections, respectively. The efficacy of macrolides is still uncertain for the treatment of cryptosporidiosis; however, promising results were obtained with nitazoxanide. The incidence of toxoplasmosis has markedly decreased as a result of the efficacy of specific prophylaxis, and visceral leishmaniasis is still considered as an emerging opportunistic disease during AIDS.     

Treatment of intestinal microsporidiosis with albendazole in patients with AIDS.

OBJECTIVE: To determine the clinical and parasitological response to treatment of intestinal microsporidiosis with albendazole. DESIGN: Open prospective study. SETTING: Hospital-based HIV/genito-urinary medicine unit. PATIENTS, PARTICIPANTS: Six consecutive AIDS patients with small intestinal microsporidiosis as the only identified cause of diarrhoea after intensive gastrointestinal investigations. RESULTS: Diarrhoea resolved completely in all patients within 1 week of starting treatment, and body weight stabilized or increased. Four patients who relapsed at 19-31 days after the cessation of treatment responded to a second course of albendazole. Degenerative changes occurred in the parasites after treatment, which had not been seen either in pre-treatment biopsies or, in four patients, following therapy with other drugs. CONCLUSIONS: Albenazole is a useful palliative treatment for microsporidial diarrhoea.