https://ir.library.oregonstate.edu/downloads/4m90dx352

Microsporidia – Emergent Pathogens in the Global Food Chain

This Practical Guidance for Clinical Microbiology document on the laboratory diagnosis of parasites from the gastrointestinal tract provides practical information for the recovery and identification of relevant human parasites. The document is based on a comprehensive literature review and expert consensus on relevant diagnostic methods. However, it does not include didactic information on human parasite life cycles, organism morphology, clinical disease, pathogenesis, treatment, or epidemiology and prevention. As greater emphasis is placed on neglected tropical diseases, it becomes highly probable that patients with gastrointestinal parasitic infections will become more widely recognized in areas where parasites are endemic and not endemic. Generally, these methods are nonautomated and require extensive bench experience for accurate performance and interpretation.

Practical Guidance for Clinical Microbiology Laboratories: Laboratory Diagnosis of Parasites from the Gastrointestinal Tract

The use of albendazole and mebendazole, i.e., benzimidazole broad-spectrum anthelmintics, in treatment of parasitic infections, as well as cancers, is briefly reviewed. These drugs are known to block the microtubule systems of parasites and mammalian cells leading to inhibition of glucose uptake and transport and finally cell death. Eventually they exhibit ovicidal, larvicidal, and vermicidal effects on parasites, and tumoricidal effects on hosts. Albendazole and mebendazole are most frequently prescribed for treatment of intestinal nematode infections (ascariasis, hookworm infections, trichuriasis, strongyloidiasis, and enterobiasis) and can also be used for intestinal tapeworm infections (taeniases and hymenolepiasis). However, these drugs also exhibit considerable therapeutic effects against tissue nematode/cestode infections (visceral, ocular, neural, and cutaneous larva migrans, anisakiasis, trichinosis, hepatic and intestinal capillariasis, angiostrongyliasis, gnathostomiasis, gongylonemiasis, thelaziasis, dracunculiasis, cerebral and subcutaneous cysticercosis, and echinococcosis). Albendazole is also used for treatment of filarial infections (lymphatic filariasis, onchocerciasis, loiasis, mansonellosis, and dirofilariasis) alone or in combination with other drugs, such as ivermectin or diethylcarbamazine. Albendazole was tried even for treatment of trematode (fascioliasis, clonorchiasis, opisthorchiasis, and intestinal fluke infections) and protozoan infections (giardiasis, vaginal trichomoniasis, cryptosporidiosis, and microsporidiosis). These drugs are generally safe with few side effects; however, when they are used for prolonged time (>14-28 days) or even only 1 time, liver toxicity and other side reactions may occur. In hookworms, Trichuris trichiura, possibly Ascaris lumbricoides, Wuchereria bancrofti, and Giardia sp., there are emerging issues of drug resistance. It is of particular note that albendazole and mebendazole have been repositioned as promising anti-cancer drugs. These drugs have been shown to be active in vitro and in vivo (animals) against liver, lung, ovary, prostate, colorectal, breast, head and neck cancers, and melanoma. Two clinical reports for albendazole and 2 case reports for mebendazole have revealed promising effects of these drugs in human patients having variable types of cancers. However, because of the toxicity of albendazole, for example, neutropenia due to myelosuppression, if high doses are used for a prolonged time, mebendazole is currently more popularly used than albendazole in anti-cancer clinical trials.

/pdf/albendazole-and-mebendazole-as-anti-parasitic-and-anti-3jl0exb0el.pdf

Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update

Microsporidia are obligate intracellular pathogens identified ∼150 years ago as the cause of pebrine, an economically important infection in silkworms. There are about 220 genera and 1,700 species of microsporidia, which are classified based on their ultrastructural features, developmental cycle, host-parasite relationship, and molecular analysis. Phylogenetic analysis suggests that microsporidia are related to the fungi, being grouped with the Cryptomycota as a basal branch or sister group to the fungi. Microsporidia can be transmitted by food and water and are likely zoonotic, as they parasitize a wide range of invertebrate and vertebrate hosts. Infection in humans occurs in both immunocompetent and immunodeficient hosts, e.g., in patients with organ transplantation, patients with advanced human immunodeficiency virus (HIV) infection, and patients receiving immune modulatory therapy such as anti-tumor necrosis factor alpha antibody. Clusters of infections due to latent infection in transplanted organs have also been demonstrated. Gastrointestinal infection is the most common manifestation; however, microsporidia can infect virtually any organ system, and infection has resulted in keratitis, myositis, cholecystitis, sinusitis, and encephalitis. Both albendazole and fumagillin have efficacy for the treatment of various species of microsporidia; however, albendazole has limited efficacy for the treatment of Enterocytozoon bieneusi. In addition, immune restoration can lead to resolution of infection. While the prevalence rate of microsporidiosis in patients with AIDS has fallen in the United States, due to the widespread use of combination antiretroviral therapy (cART), infection continues to occur throughout the world and is still seen in the United States in the setting of cART if a low CD4 count persists.

Microsporidiosis in Humans

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre‐ and post‐transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid‐organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post‐transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor‐derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid‐organ transplant recipients are unmet needs.

Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Microsporidia are spore-forming, obligately intracellular organisms related to fungi. Enterocytozoon bieneusi and 3 Encephalitozoon species (Encephalitozoon cuniculi, Encephalitozoon hellem, and Encephalitozoon intestinalis) are the most common microsporidia identified as pathogens of humans (1, 2). Studies indicate that asymptomatic microsporidial disease occurs in humans, and seroprevalence data suggest that humans may be frequently exposed to these organisms (3–5). Microsporidia cause a spectrum of disease, from self-limiting diarrhea to disseminated, life-threatening infections. Microsporidiosis is recognized predominantly among HIV-infected patients but has more recently been noted in non–HIV-infected individuals as an emerging pathogen (6, 7). Several reports describe microsporidial infections involving organ transplant recipients, but to our knowledge, these infections have not been proved to be transplant-transmitted (8–11).

In February 2012, the Centers for Disease Control and Prevention (CDC) was notified of a cluster of 3 transplant recipients with febrile illness onset 7 to 10 weeks after receiving organs from a common donor. Initial evaluation included serologic, molecular, and culture-based assays against a broad range of bacterial, fungal, and viral pathogens. Concomitant illnesses, such as urinary tract infection and organ rejection, were appropriately treated, yet recipients remained ill. Subsequent diagnostic evaluation of recipients suggested infections with a Brucella species that were presumed to be donor-derived. However, despite directed therapy for brucellosis and continued empirical treatment for other infectious etiologies, the patients did not improve, and assistance was requested from public health authorities in determining a common cause for the illness cluster. Kidney biopsy samples sent to CDC from 1 recipient confirmed the diagnosis as microsporidiosis with Encephalitozoon cuniculi, and a public health investigation was initiated to confirm the diagnosis in the other recipients, assess donor and recipient risk factors, and provide therapy recommendations for ill recipients.

/pdf/microsporidiosis-acquired-through-solid-organ-24r3qw4qge.pdf

Microsporidiosis Acquired Through Solid Organ Transplantation: A Public Health Investigation

Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as t...

Microsporidiosis Acquired Through Solid Organ Transplantation

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Microsporidiosis Acquired Through Solid Organ Transplantation: A Public Health Investigation

Microsporidiosis Acquired Through Solid Organ Transplantation