Einhorn Nathan, Lamphier Isis, Klinkova Olga, Baluch Aliyah, Pasikhova Yanina, Greene John
Infectious Diseases, University of South Florida Morsani College of Medicine, Tampa, USA.
Infection Control, Moffitt Cancer Center, Tampa, USA.
Cureus. 2023 Apr 28;15(4):e38256. doi: 10.7759/cureus.38256. eCollection 2023 Apr.
Introduction Coccidian protozoa and microsporidian fungi are opportunistic pathogens increasingly implicated in infections in immunosuppressed individuals. These parasites typically infect the intestinal epithelium, resulting in secretory diarrhea and malabsorption. The disease burden and timeline are both greater and longer among immunosuppressed patients. Therapeutic options for immunocompromised individuals are limited. As a result, we wanted to better characterize the disease course and treatment efficacy of these parasitic gastrointestinal infections. Methods We performed a single-center, retrospective MedMined (BD Healthsight Analytics, Birmingham, AL, USA) chart review of patients between January 2012 and June 2022 diagnosed with coccidian or microsporidian infections. Relevant data were collected from Cerner's PowerChart (Oracle Cerner, Austin, TX, USA). Descriptive analysis was performed with IBM SPSS Statistics (IBM Corp., Armonk, NY, USA), and Microsoft Excel (Microsoft, Redmond, WA, USA) was used to generate graphs and tables. Results In these 10 years, there were 17 patients with infections, four with infections, and no positive cultures for or microsporidian infections. In both infections, the majority of patients experienced diarrhea, fatigue, and nausea, with vomiting, abdominal pain, appetite loss, weight loss, and fever occurring to a lesser degree. Nitazoxanide was the most common treatment for , while trimethoprim-sulfamethoxazole or ciprofloxacin were the treatments of choice for . Of the infections, three received combination therapy with azithromycin, immunoreconstitution, or IV immunoglobulins. Among the four -infected patients, one received combination therapy of ciprofloxacin and trimethoprim-sulfamethoxazole. Treatment lasted around two weeks, and 88% of patients and 75% of patients had a resolution of symptoms. Conclusion The most detected coccidian infection was followed by , with the lack of or microsporidian infections likely due to diagnostic limitations and prevalence. and likely caused their associated symptoms in most cases, with other possible etiologies, including graft-versus-host disease, medications, and feeding tubes. The small number of patients receiving combination therapy prohibited a comparison with monotherapy. In our patient population, though, there was a clinical response to treatment despite immunosuppression. While promising, additional randomized control experiments are required to fully understand the efficacy of parasitic treatments.
引言 球虫原生动物和微孢子虫真菌是机会性病原体，越来越多地与免疫抑制个体的感染有关。这些寄生虫通常感染肠道上皮，导致分泌性腹泻和吸收不良。免疫抑制患者的疾病负担和病程更长。免疫功能低下个体的治疗选择有限。因此，我们希望更好地描述这些寄生性胃肠道感染的病程和治疗效果。
方法 我们对2012年1月至2022年6月期间诊断为球虫或微孢子虫感染的患者进行了单中心回顾性MedMined（BD Healthsight Analytics，美国阿拉巴马州伯明翰）图表审查。相关数据从Cerner的PowerChart（甲骨文Cerner，美国德克萨斯州奥斯汀）收集。使用IBM SPSS Statistics（IBM公司，美国纽约州阿蒙克）进行描述性分析，并使用Microsoft Excel（微软，美国华盛顿州雷德蒙德）生成图表。
结果 在这10年中，有17例 感染患者，4例 感染患者，未发现 或微孢子虫感染的阳性培养结果。在这两种感染中，大多数患者出现腹泻、疲劳和恶心，呕吐、腹痛、食欲不振、体重减轻和发热的发生率较低。硝唑尼特是 最常用的治疗药物，而甲氧苄啶-磺胺甲恶唑或环丙沙星是 感染的首选治疗药物。在 感染患者中，3例接受了阿奇霉素、免疫重建或静脉注射免疫球蛋白的联合治疗。在4例 感染患者中，1例接受了环丙沙星和甲氧苄啶-磺胺甲恶唑的联合治疗。治疗持续约两周，88%的 感染患者和75%的 感染患者症状得到缓解。
结论 最常见的球虫感染是 ，其次是 ，未发现 或微孢子虫感染可能是由于诊断局限性和患病率。在大多数情况下， 和 可能导致了相关症状，其他可能的病因包括移植物抗宿主病、药物和饲管。接受联合治疗的患者数量较少，无法与单一疗法进行比较。然而，在我们的患者群体中，尽管存在免疫抑制，治疗仍有临床反应。虽然有前景，但需要更多的随机对照实验来全面了解寄生虫治疗的疗效。
