Ismail Khadiga Ahmed, Hawash Yousry A, Saber Taisir, Eed Emad M, Khalifa Amany S, Alsharif Khalaf F, Alghamdi Saleh A, Khalifa Ahmed M, Khalifa Osama Mahmoud, Althubiti Hatem K, Alsofyani Gala M
Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia; Department of Medical Parasitology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia; Department of Molecular and Clinical Parasitology, National Liver Institute, Menoufia University, Menoufia, Egypt.
Indian J Med Microbiol. 2020 Jul-Dec;38(3 & 4):409-414. doi: 10.4103/ijmm.IJMM_20_325.
Microsporidium is a spore-forming intracellular parasite that affects a wide range of hosts including humans. The tumor necrosis factor alpha (TNF-α) plays a key role in the immunity to infection with microsporidia. Recently, the TNF-α antagonists have proven successful in treating variable autoimmune diseases. In the current study, we aimed to investigate the impact of using TNF-α antagonists as a therapeutic regimen in the prevalence of infections with microsporidia.
Diarrheal patients with distinct autoimmune diseases (n = 100) were assigned to the study. Patients taking anti-TNF-α medications (n = 60) were allocated to Group 1A and those undergoing non-TNF-α inhibitor treatment (n = 40) to Group 1B. Furthermore, patients with diarrhea without autoimmune disorders (n = 20) were allocated as controls. Stool specimens, 3 per patient, were collected and microscopically examined for microsporidia spores. A microsporidia-specific stool polymerase chain reaction was used to confirm the microscopic findings.
Microsporidia infection was identified in 28.3% (17/60), 10% (4/40), and in 5% (1/20) of patients in Group 1A, Group 1B, and in the control group, respectively. Overall, infection was significantly high in cases compared to the controls and in patients receiving TNF-α antagonists compared to patients not given TNF-α inhibitors (P < 0.05). Finally, infection was significantly higher in cases treated with TNF-α antagonists for ≥2 months compared to cases treated for <2 months of duration (P < 0.05).
There was a significant increase in microsporidia infection in autoimmune disease patients undergoing treatment with TNF-α antagonists, and the duration of treatment is one of the risk factors. The study highlights the importance of microsporidia testing in immunocompromised patients, particularly those undergoing treatment with anti-TNF-α drugs and emphasises the need for awareness among clinicians regarding this opportunistic parasite.
微孢子虫是一种形成孢子的细胞内寄生虫，可感染包括人类在内的多种宿主。肿瘤坏死因子α（TNF-α）在抵抗微孢子虫感染的免疫过程中起关键作用。近来，TNF-α拮抗剂已被证明在治疗多种自身免疫性疾病方面取得成功。在本研究中，我们旨在调查使用TNF-α拮抗剂作为治疗方案对微孢子虫感染率的影响。
将患有不同自身免疫性疾病的腹泻患者（n = 100）纳入研究。服用抗TNF-α药物的患者（n = 60）被分配到1A组，接受非TNF-α抑制剂治疗的患者（n = 40）被分配到1B组。此外，将无自身免疫性疾病的腹泻患者（n = 20）作为对照组。每位患者收集3份粪便标本，进行显微镜检查以查找微孢子虫孢子。使用微孢子虫特异性粪便聚合酶链反应来确认显微镜检查结果。
1A组、1B组和对照组中微孢子虫感染的患者分别占28.3%（17/60）、10%（4/40）和5%（1/20）。总体而言，与对照组相比，病例组感染率显著更高；与未使用TNF-α抑制剂的患者相比，接受TNF-α拮抗剂治疗的患者感染率显著更高（P < 0.05）。最后，与治疗时间<2个月的病例相比，接受TNF-α拮抗剂治疗≥2个月的病例感染率显著更高（P < 0.05）。
接受TNF-α拮抗剂治疗的自身免疫性疾病患者中微孢子虫感染显著增加，治疗持续时间是危险因素之一。该研究突出了对免疫功能低下患者，尤其是接受抗TNF-α药物治疗的患者进行微孢子虫检测的重要性，并强调临床医生需要了解这种机会性寄生虫。
