Difference between revisions of "Microsporidium"

(ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.))
 
Line 17: Line 17:
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
*Microsporidiosis
 
*Microsporidiosis
*Cryptosporidiosis
+
*[[Cryptosporidiosis]]
*CMV (CD4 < 100)
+
*[[CMV]] (CD4 < 100)
 
*MAC (CD4 < 100)
 
*MAC (CD4 < 100)
*Adenovirus
+
*[[Adenovirus]]
 
*Isospora
 
*Isospora
 
*[[Giardia]]
 
*[[Giardia]]

Latest revision as of 18:22, 27 September 2017

Background

  • Unicellular spore-forming parasitic protozoa that are found pervasively throughout the environment.[1] Microsporidiosis most commonly affects immunosuppressed individuals and seldom has implications for the immunocompetent patient.

Clinical Features

Clinical manifestations are wide ranging and typically affect immunosuppressed hosts (e.g. HIV/AIDS, long-term steroid use, transplant and chemotherapy patients), travelers, children, and the elderly[2]. The most common manifestation is copious diarrhea with volume depletion leading to electrolyte derangements.[3]

Immunosuppressed patients:[4]

Immunocompetent patients:[5]

Differential Diagnosis

Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

  • Enterotoxigenic E. coli (most common cause of watery diarrhea)[6]
  • Norovirus (often has prominent vomiting)
  • Campylobacter
  • Non-typhoidal Salmonella
  • Enteroaggregative E. coli (EAEC)
  • Enterotoxigenic Bacteroides fragilis

Traveler's Diarrhea

Evaluation

Work-up

  • CBC
  • Metabolic panel
  • C. difficile toxin EIA
  • Fecal WBC and RBC
  • Lactoferrin
  • Wet mount microscopy
  • Stool culture

Evaluation

Management[7]

Disposition[8]

  • Discharge: immunocompetent or low risk patients with unclear etiology but normal examination findings after rehydration
  • Admission: patients with life-threatening volume loss, failure to improve after resuscitation, electrolyte abnormalities requiring gradual and/or significant correction, toxic or ill-appearing, intolerant of PO intake or significant risk factors (CD4 < 100, chemotherapy, transplant, etc.)
  • Pearl: Obtain contact information for patients PCP and specialist providers (oncology, infectious disease, rheumatology, etc). Consultation and coordination of care is especially important for patients with significant and relevant co-morbidities

External Links

References

  1. Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)
  2. Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.
  3. Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html
  4. Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.
  5. Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html
  6. Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  7. Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)
  8. Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)