Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization.
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Date
2015-07
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Abstract
Purpose: Intestinal microsporidiosis, which occurs in immunocompromised states such as acquired immunodeficiency
syndrome, has rarely been studied in patients with renal transplantation (RT) on immunosuppressive therapy.
Materials and Methods: Three hundred and twenty‑four consecutive RT recipients on immunosuppressive treatment
and 170 healthy subjects were evaluated for intestinal microsporidiosis and other parasites by modified trichrome
staining, wet mount using normal saline, iodine and polymerase chain reaction (PCR). Clinical, demographic and
laboratory parameters associated with occurrence of intestinal microsporidiosis were studied using univariate
and multivariate analysis. The species of microsporidia were studied using PCR‑restriction fragment length
polymorphism (RFLP). Patients were treated with albendazole (400 mg twice daily for 2 weeks). Results: Of 324 RT
recipients initially screened, 52 were excluded from final analysis due to incomplete data. Patients with RT [n = 272,
age 42 ± 12.54 years, 222 (81.6%) male] more often had microsporidiosis than healthy subjects by modified trichrome
stain and PCR [n = 170, age 33.8 ± 6.7 years, 123 (72.3%) male] [16/272 (5.8%) vs. 0/170 (0%), P < 0.001]. Patients
with intestinal microsporidiosis were younger (33.9 ± 8.3 years vs. 42.3 ± 12.6 years; P = 0.009), had diarrhoea more
often (13/16, 81% vs. 123/256, 48%; P = 0.02), which was longer in duration (60, 32.5-105 days vs. 12, 6.2-18 days;
P < 0.001) and had associated giardiasis (2/16, 12.5% vs. 2/256, 0.8%; P = 0.018). Younger age, presence of diarrhoea
and associated giardiasis were significant on multivariate analysis. Enterocytozoon bieneusi was detected in 15/16 (93%)
patients with intestinal microsporidiosis. Conclusion: Intestinal microsporidiosis occurs frequently in patients with RT
on immunosuppressive treatment, particularly among younger patients with longer diarrhoea duration and associated
giardiasis. E. bieneusi is the major species identified among these patients.
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Keywords
Diarrhoea, microsporidia, renal transplant
Citation
Ghoshal U, Khanduja S, Pant P, Prasad K N, Dhole T N, Sharma R K, Ghoshal U C. Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization. Indian Journal of Medical Microbiology. 2015 Jul-Sept; 33 (3): 357-363.