Microsporidiosis in pediatric renal transplant patients in Cape Town, South Africa: Two case reports
Autor: | Priya Gajjar, Monica Birkhead, Bhavani Poonsamy, John Frean, Peter Nourse, Komala Pillay, Taiwo Augustina Ladapo |
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Rok vydání: | 2014 |
Předmět: |
Diarrhea
Graft Rejection Ganciclovir medicine.medical_specialty Nephrotic Syndrome Adolescent Fever medicine.medical_treatment Albendazole Microsporidiosis South Africa Postoperative Complications Internal medicine Biopsy medicine Humans Renal Insufficiency Encephalitozoon cuniculi Transplantation Kidney biology medicine.diagnostic_test business.industry Immunosuppression biology.organism_classification medicine.disease Kidney Transplantation medicine.anatomical_structure Cytomegalovirus Infections Pediatrics Perinatology and Child Health Immunology Kidney Failure Chronic Female medicine.symptom business Immunosuppressive Agents medicine.drug |
Zdroj: | Pediatric Transplantation. 18:E220-E226 |
ISSN: | 1397-3142 |
Popis: | Microsporidia are an emerging group of pathogens associated with life-threatening opportunistic infections in immunocompromised hosts, particularly human immunodeficiency virus (HIV)-infected individuals. There have, however, been recent reports of infection in adult solid organ transplant recipients. We report two cases in children, to our knowledge the first in the paediatric literature. Two 13-yr-old, HIV-seronegative females received deceased donor renal transplants from the same donor. Both patients suffered acute cell-mediated rejection and CMV infection reactivation, managed with intensified immunosuppression and ganciclovir. Pyrexia of unknown origin and intermittent diarrhea in both prompted extensive investigations. In both patients, numerous spores of a microsporidial species were demonstrated in renal tissue on biopsy and in the urine, using modified trichrome and quick-hot Gram-chromotrope staining. Electron microscopy and PCR confirmed Encephalitozoon cuniculi infections. Both patients were successfully treated with 400 mg twice daily of albendazole, with sustained clinical improvement. We recommend that microsporidiosis be considered in the differential diagnosis of pyrexia of unknown origin in severely immunocompromised pediatric solid organ transplant recipients, particularly when associated with diarrhea. |
Databáze: | OpenAIRE |
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