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Year : 2014  |  Volume : 7  |  Issue : 2  |  Page : 116-121

Microsporidia in diarrheic patients: detection and evaluation of intestinal inflammation and malabsorption

Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt

Correspondence Address:
Hend A El-Taweel
91 Ahmed Shawky Street (7/13), Moustafa Kamel, 21523, Alexandria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1687-7942.149563

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Background Early reports on microsporidial diarrhea involved mainly HIV-immunodeficient patients. More recent studies indicate that microsporidial spores may also be detected in immunocompromised persons not infected with HIV as well as in immunocompetent individuals. However, the exact mechanism of microsporidial diarrhea is not clearly defined. Objectives The aims of this study were to evaluate the contribution of microsporidia toward the burden of diarrheal diseases and to investigate the occurrence of associated intestinal inflammation and malabsorption. Patients and methods Stool samples of 237 patients with diarrhea were examined for microsporidial spores using modified trichrome stain. Microsporidia-positive samples were examined for concomitant parasitic infections. Intestinal inflammation was evaluated in patients infected solely with microsporidia ( n = 30) by comparing the fecal lactoferrin level measured by an enzyme immunoassay with that of a control group of healthy, age and sex matched, parasite-free nondiarrheic individuals ( n = 15). Fecal pH and assessment of fecal fat using oil red O stain were used as indictors of carbohydrate and fat malabsorption, respectively. Results Microsporidian spores were detected in 15.6% of diarrheic patients. Considering the median and range values, microsporidia-infected patients showed significantly higher fecal lactoferrin levels (median 49.75, range 2.8-220 μg/g, respectively) and lower fecal pH (median 5.82, range 5.12-6.98, respectively) compared with the control group (median 4.1, range 2.4-31 μg/g and median 6.7, range 6.3-7.16 μg/g, respectively). A significantly greater proportion of microsporidia-infected patients had elevated lactoferrin levels (>7.4 μg/g stool), markedly acidic stool (pH < 6), or increased fecal fat compared with the control group. Conclusion Infection with microsporidia is present in a considerable proportion of diarrheic patients and results in an intestinal inflammatory response as well as carbohydrate and fat malabsorption. Enteric microsporidiosis should be taken into consideration in the management of diarrheal diseases.

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