Zusammenfassung
Mikrosporidien sind obligat intrazelluläre, opportunistische Protozoen, die bei Immunsupprimierten wie z. B. AIDS-Patienten oder Patienten nach Organtransplantation aber auch bei immunkompetenten Personen wie Reisenden aus subtropischen und tropischen Gebieten verschiedene Krankheitsbilder hervorrufen können. Der überwiegende Teil der Mikrosporidiosen in Deutschland sind gastrointestinale Manifestationen bei AIDS-Patienten wie Durchfälle oder Cholangitiden hervorgerufen durch Enterocytozoon bieneusi oder Encephalitozoon intestinalis. Da Enterocytozoon bieneusi und Encephalitozoon intestinalis einen teilweise unterschiedlichen Organtropismus aufweisen und auch unterschiedlich gut therapierbar sind, sollten diese Erreger bei den entsprechenden Risikogruppen nicht nur nachgewiesen sondern auch differenziert werden. Nachweis und Differenzierung können mit Spezialfärbungen, elektronenmikroskopisch und mit molekularbiologischen Methoden erfolgen.
Summary
Microsporidia are obligate intracellular opportunistic parasites that are capable to cause significant morbidity in immunocompromised patients with AIDS as well as in transplant recipients and immunocompetent persons as travellers from tropics and subtropic areas. The majority of microsporidian infections in Germany are gastrointestinal manifestations such as diarrhea or cholangitis due to Enterocytozoon bieneusi or Encephalitozoon intestinalis. These pathogens tend to infect various organ systems and therapeutic options depend on microsporidian species. Thus the most prevalent microsporidia should not only be detected but also be idientified to species level that can be performed by special stainings, by electron microscopy and by molecular-based methods.
Literatur
-
1
Desportes I, Le Charpentier Y, Galian A. et al .
Occurence of a new microsporidian: Enterocytozoon
bieneusi, n. g., n. s., in the enterocytes of a
human patient with AIDS.
J Protozool.
1985;
32
250-254
-
2
Didier E S, Didier P J, Friedberg D N. et al .
Isolation and characterization of
a new human microsporidian, Encephalitozoon hellem (n. sp.), from
three AIDS patients with keratoconjunctivitis.
J Infect
Dis.
1991;
163
617-621
-
3
Franzen C, Muller A.
Molecular techniques
for detection, species differentiation, and phylogenetic analysis
of microsporidia.
Clin Microbiol Rev.
1999;
12
243-285
-
4
Hartskeerl R A, Van Gool T, Schuitema A R, Didier E S, Terpstra W J.
Genetic and immunological characterization
of the microsporidian Septata intestinalis Cali, Kotler and Orenstein,
1993: reclassification to Encephalitozoon intestinalis.
Parasitology.
1995;
110
277-285
-
5
Lores B, Lopez-Miragaya I, Arias C, Fenoy S, Torres J, del Aguila C.
Intestinal microsporidiosis
due to Enterocytozoon bieneusi in elderly human immunodeficiency
virus - negative patients from Vigo, Spain.
Clin
Infect Dis.
2002;
34
918-921
-
6
Maggi P, Larocca A M, Quarto M. et al .
Effect of antiretroviral therapy on cryptosporidiosis
and microsporidiosis in patients infected with human immunodeficiency
virus type 1.
Eur J Clin Microbiol Infect Dis.
2000;
19
213-217
-
7
Molina J M, Tourneur M, Sarfati C. et al .
Fumagillin treatment of intestinal microsporidiosis.
N
Engl J Med.
2002;
346
1963-1969
-
8
Orenstein J M, Tenner M, Cali A, Kotler D P.
A microsporidian
previously undescribed in humans, infecting enterocytes and macrophages, and
associated with diarrhea in an acquired immunodeficiency syndrome
patient.
Hum Pathol.
1992;
23
722-728
-
9
Rinder H, Janitschke K, Aspock H. et al .
Blinded, externally controlled multicenter
evaluation of light microscopy and PCR for detection of microsporidia
in stool specimens. The Diagnostic Multicenter Study Group on Microsporidia.
J
Clin Microbiol.
1998;
36
1814-1818
-
10
Sobottka I, Albrecht H, Schaefer H. et al .
Disseminated Encephalitozoon (Septata)
intestinalis infection in a patient with AIDS: Novel diagnostic
approaches and autopsy-confirmed parasitological cure following
treatment with albendazole.
J Clin Microbiol.
1995;
33
2948-2952
-
11
Sobottka I, Albrecht H, Schottelius J. et al .
Self-limited traveller’s diarrhea
due to a dual infection with Enterocytozoon bieneusi and Cryptosporidium
parvum in an immunocompetent HIV-negative child.
Eur J
Clin Microbiol Infect Dis.
1995;
14
919-920
-
12
Sobottka I, Schwartz D A, Schottelius J. et al .
Prevalence and clinical
significance of intestinal microsporidiosis in human immunodeficiency
virus-infected patients with and without diarrhea in Germany: a prospective
coprodiagnostic study.
Clin Infect Dis.
1998;
26
475-480
-
13 Sobottka I, Schmetz C, Schottelius J. Microsporidia. Springer In:
Dionisio D, ed. Textbook-Atlas of Intestinal Infections in AIDS 2003 in press
-
14 Weber R, Schwartz D A, Bryan R. Microsporidia. Philadelphia: Churchill
Livingstone In: Dolin R, ed. Principles and Practice
of Infectious Diseases. 5th ed 2000: 2920-2933.
-
15 Wittner M, Weiss L M. The microsporidia
and microsporidosis. Washington, D.C.: American Society
for Microbiology Press 1999
Prof. Dr. J. Schottelius
Bernhard-Nocht-Institut für Tropenmedizin
Bernhard-Nocht-Str. 74
20359 Hamburg
