Disseminated microsporidiosis especially infecting the brain, heart, and kidneys: Report of a newly recognized pansporoblastic species in two symptomatic AIDS patients

Anthony T. Yachnis, Johannes Berg, Ariel Martinez-Salazar, Bradley S. Bender, Leslie Diaz, Amyn M. Rojiani, Thomas A. Eskin, Jan M. Orenstein

Research output: Contribution to journalArticle

68 Scopus citations

Abstract

Microsporidia have emerged as important opportunistic AIDS pathogens of the alimentary, respiratory, and urinary tracts. Although nonhuman mammalian microsporidia infections typically include encephalitis, CNS microsporidiosis has not been reported in patients with AIDS. A 33-year-old white male and an 8-year-old black girl presented with seizures and declining mental status. Central nervous system (CNS) imaging studies revealed small peripherally and diffusely enhancing lesions present for at least 2 and 4 months before death, respectively. Both patients expired despite empirical anti-toxoplasma therapy. Their brains contained innumerable soft gray matter lesions that consisted of central areas of necrosis, filled with free spores and spore- laden macrophages, surrounded by microsporidia-infected astrocytes. The complete autopsy of the child also revealed necrotizingand sclerosing cardiac and renal microsporidiosis and infection of the pancreas, thyroid, parathyroids, liver, spleen, lymph nodes, and bone marrow. Infected cells included astrocytes, cardiac myocytes, epithelium, endothelium, vascular smooth muscle cells, hepatocytes, adipocytes, Schwann cells, and macrophages. Light and electron microscopic studies revealed pansporoblastic development within thick-walled sporophorous vacuoles of parasite origin. Although most similar to Pleistophora sp and Thelohania sp, this microsporidian is different from any known species. Microsporidiosis should be considered as the possible cause of a wide range of diseases in AIDS patients, including CNS, cardiac, and renal.

Original languageEnglish (US)
Pages (from-to)535-543
Number of pages9
JournalAmerican Journal of Clinical Pathology
Volume106
Issue number4
DOIs
StatePublished - Oct 1996
Externally publishedYes

Keywords

  • AIDS
  • Central nervous system
  • Disseminated
  • Heart
  • Kidneys
  • Microsporidia
  • Pancreas
  • Pansporoblast ic
  • Parathyroid
  • Thyroid

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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