Introduction
Microsporidiosis is an emerging opportunistic infection in renal transplantation (RT) recipients. We aimed to describe its clinical presentation and treatment.
Materials and methods
We ...collected microsporidiosis cases identified in RT recipients between 2005 and 2019 in six French centers from the Crystal, Divat and Astre prospective databases.
Results
We report 68 RT recipients with intestinal microsporidiosis; the patients were predominantly male (61.8%), with a median age of 58 (46–69) years. Infection occurred at a median time of 3 (0.8–6.8) years posttransplant. Only Enterocytozoon bieneusi was found. Microsporidiosis manifested as diarrhea (98.5% of patients) with weight loss (72.1%) and acute renal injury (57.4%) without inflammatory biological parameters. The therapeutic approaches were no treatment (N = 9), reduction of the immunosuppressive regimen (∆IS) (N = 22), fumagillin alone (N = 9), fumagillin and ∆IS (N = 19), and albendazole or nitazoxanide and ∆IS (N = 9). Overall clinical remission was observed in 60 patients (88.2%). We observed no acute kidney rejection, renal transplant failure, or death within 6 months after microsporidiosis.
Conclusion
E. bieneusi is an underestimated opportunistic pathogen in RT recipients, and infection with E. bieneusi leads to diarrhea with important dehydration and acute renal injury. The treatment is based on the reduction of the immunosuppressive regimen and the administration of fumagillin if available.
Intestinal microsporidiosis is most often caused by
, and to a lesser extent by species of the genus
. Until now,
was not clearly known to induce disease restricted to the intestine, or rarely in HIV ...subjects or in tropical countries. We report here 11 cases of delineated intestinal microsporidioses due to
diagnosed in France in non-HIV patients. Briefly, all patients were immunocompromised. They all suffered from diarrhoea, associated in nearly 50% of cases with weight loss. Concerning treatment, 5/11 patients had a discontinuation or a decrease of their immunosuppressive therapy, and 4/11 received albendazole. All patients recovered. Five different genotypes were identified based on the rRNA ITS sequence.
Non-pharmaceutical forms of Artemisia annua (a Chinese plant containing artemisinin) are used by some travellers who believe these products are safer than anti-malarial drugs. We report two cases of ...severe Plasmodium falciparum malaria requiring hospitalization in an Intensive Care Unit following prophylaxis with non-pharmaceutical A. annua in French travellers.
Background
Microsporidiosis has been largely reported in patients with acquired immunodeficiency syndrome, but emerged as a cause of persistent diarrhea in solid organ transplant patients.
Methods
...Through the French Microsporidiosis Network and the Groupe français de recherche en greffe de foie, we collected all microsporidiosis cases identified in liver transplant patients between 1995 and 2020 in France.
Results
We identified 24 liver transplant recipients with microsporidiosis. Sex ratio was balanced and median age was 58.8 (3.5‐83.5) years (there were 4 children). Microsporidiosis occurred at a median time of 3.9 (0.1‐18.9) years post‐transplant. Median duration of diarrhea before diagnosis was 22 days (12‐45). Therapeutic care included immunosuppressive therapy changes in 20 patients, as follows: stop cyclosporine or tacrolimus (n = 2), dose reduction of cyclosporine or tacrolimus (n = 12), stop MMF (n = 5), and dose reduction of corticosteroids (n = 1). In addition, 15 patients received specific therapy against microsporidiosis: fumagillin (n = 11) or albendazole (n = 4). Median duration of treatment was 14 days (8‐45 days). Finally, 7 patients had immunosuppressive treatment tapering only. Microsporidiosis was complicated by renal failure in 15 patients, requiring dialysis in one case. Two patients had infection relapse. No patient presented proven rejection within the 3 months after microsporidiosis. None of the patients died within the 3 months after microsporidiosis.
Conclusions
Microsporidiosis is a very rare infection after liver transplantation but can induce severe dehydration and renal failure. Therefore, it must be systematically sought in any case of persistent diarrhea after first line screening of frequent infectious causes.
Un test de diagnostic un peu trop rapide ? Le Govic, Yohann; Garrivet, Julie; Dubée, Vincent ...
Revue francophone des laboratoires,
January 2019, 2019-01-00, Letnik:
2019, Številka:
508
Journal Article
Les travaux dans les hôpitaux sont une nécessité tant pour l’évolution des structures que pour leur entretien et la maintenance de locaux qualifiés pour le soin. Toutefois leur réalisation se heurte ...à l’obligation de maintenir une activité de soins. Ces travaux génèrent obligatoirement pour les patients un risque fongique lié à la dissémination de la poussière et à la mise en suspension de spores fongiques. Ce risque doit être intégré à la prise en charge des travaux hospitaliers, largement en amont de leur réalisation. Son évaluation doit être faite par une équipe pluridisciplinaire associant hygiéniste, mycologue et service technique.
Works in Healthcare facilities are a necessity both for the development of these structures, their maintenance and upkeep of local qualified to care. However, their implementation is hampered by the requirement to maintain a care activity. These works can generate a risk for patients linked to the spread of dust and suspension of fungal spores. This risk assessment must be integrated into the project of works, well ahead of their realization. Its evaluation should be done by a multidisciplinary team combining infection control practionner, mycologist and construction management.
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