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home - Colon - Colonic Infection - Microsporidiosis Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Microsporidiosis

Enterocytozoon bieneusi, Encephalitozoon species:Encephalitozoon intestinalis.E.cuniculi: Intestinal infection rare.E.hellem Type 1: Assoc with HIV Type II: Assoc with non-HIV Genera associated with human disease include Seroprevalence: 6% in non-HIV7-50% in symptomatic HIV-Associated with no protease inhibitors and high viral loadWith HIV can be asymptomatic Nosema species DiagnosisThe gold standard is electon microscopy.It is not detected on routine examination of ova/ parasites.Usually use fluorescent technique to screen, then light microscopy on stool/mucous/urine+ modified trichrome stain: Pink spores are visible against blue-green backgrounds.Serology can be useful vs IgM and IgG anti-microsporidial antibodies.7. Tissue culture/Indirect immunofluorescence. Treatments:Albendazole(2-4 weeks 400 mg bd).Topical Fumidil B for ocular infections.Systemic fumagillin - variable success for E.bieneusi but bone marrow toxicity. E. bieneusiE. intestinalis E. heliemE. cuniculiE. intestinalis Risk factors for E.bieneusi: Contact with duck/chicken droppings.Poor sanitation and many animals shed bieneusi oocysts. Urine Faeces Resp secretions Transmission PathogenesisSpore injects nucleus into the host cell.Susequent proliferation occurs to form multinucleate plasmodial forms.Maturation phase of new spores occurs.Spores then burst out of cell. Macroscopically: Distortion of small villus architecture + no real inflammatory response.Intracellular nature of the infection may interfere with intestinal absorption and secretion. Dissemination around body via mac-rophages and to neighbouring cells Associated with myositis; Trachipleistophora species have also been associated with encephalitis and death. Pleistophora, Trachipleistophora Anncaliia Usually causes watery diarrhoea and crampy abdo pain.Fever is rareCan cause disseminated infection: including bronchiolitis, pneumonitis, sinusitis, nephritis, cystitis, prostatitis, hepati-tis, peritonitis, keratoconjunctivitis, encephalitis, nodular cutaneous lesions. Can cause keratoconjunctivitis Usually in the setting of severe immunodeficiency. Microsporidiosis Can cause an asympto-matic infection, a self-limited watery diarrheal illness or, less com-monly, chronic diarrheaFever is rare Immunocompetents can resolve with no therapy. Written by Dr Sebastian Zeki

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