Prevalence and genetic characterisation of microsporidia among immunocompromised patients in Malaysia / Nur Amirah Hassan
While information with regards to the bacterial and viral infection is commonly available among clinicians, data on parasitic infection, particularly microsporidia among immunocompromised patient is currently lacking in Malaysia. Most of the epidemiological study of microsporidia has relied on co...
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| Format: | Thesis |
| Published: |
2018
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| Online Access: | http://studentsrepo.um.edu.my/10351/4/amirah.pdf http://studentsrepo.um.edu.my/10351/ |
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| Summary: | While information with regards to the bacterial and viral infection is commonly available
among clinicians, data on parasitic infection, particularly microsporidia among
immunocompromised patient is currently lacking in Malaysia. Most of the epidemiological
study of microsporidia has relied on conventional microscopy technique, which does not
differentiate parasite at the species level. The present study was carried out to identify
microsporidian species in various groups of immunocompromised patients. From March
2016 to March 2017, a total of 342 archived stool samples were examined microscopically
for microsporidian spores using Gram-chromotrope Kinyoun (GCK) staining. Positive stool
samples by microscopy were subjected to polymerase chain reaction (PCR) and sequencing
for species identification. Based on microscopy examination, the overall prevalence of
microsporidian infections was 28.9% (99/342; 95% CI=24.4-34). The prevalence of
microsporidia were significantly higher among males (32.7%; 95% CI=27-39) compared to
females (21.6%; 95% CI=15.1-30) (p=0.031). The highest prevalence was recorded in
autoimmune diseases patients (62.5%; 95% CI=30.6-86.3), followed by end-stage renal
failure (ESRF) patients (52.9%; 95% CI=39.5-66.0), cancer patients (31.9%; 95% CI=22.1-
43.6), human immunodeficiency virus (HIV/AIDS) patient (27.7%; 95% CI=20.5-36.4) and
organ transplant recipients (22.2%; 95% CI=10.6-40.8). Meanwhile, the lowest prevalence
of microsporidian infections was reported in acute gastroenteritis (AGE) patients (11.3%;
95% CI=5.29-22.6). Other intestinal parasites reported among these patients were
Abstract
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Strongyloides stercoralis, Trichuris trichiura, Ascaris lumbricoides and Cryptosporidium
species. Diarrhoea was the most common symptoms among patients with microsporidiosis.
Of these positive stool samples by microscopy, 50 samples were successfully amplified and
confirmed as Enterocytozoon bienuesi. No Encephalitozoon intestinalis was detected. The
highest prevalence of E. bienuesi was recorded in organ transplant recipients (6/6; 100%)
and autoimmune patients (5/5; 100%), followed by AGE patients (5/6; 83.3%), HIV/AIDS
patients (16/33; 48.5%), cancer patients (9/22; 41%), and ESRF patients (9/27; 33.3%),
respectively. Phylogenetic analysis revealed that zoonotic and inter-human transmission
may be a possible route of transmission for microsporidian infections among these patients.
Three different mismatches were reported within the E. bieneusi isolates which speculated
the existence of genetic diversity in the E. bieneusi species. Accurate identification of
species might help clinicians to decide appropriate management strategies as dissemination
risks, and treatment response varies for different species, hence improving the management
of microsporidian infections. |
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