Etiology and pathogenesis of microsporidiosis in persons infected with the human immunodeficiency virus
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Description
The purpose of this study was to determine the pathogenesis and etiology of microsporidia in HIV-infected patients. All HIV-infected patients, seeking care at the Medical Center of Louisiana at New Orleans, submitting a stool specimen between October 3, 1996 and June 30, 1997 were eligible for this study. The medical charts of all eligible patients were retrospectively abstracted for demographic, clinical, and laboratory information. Logistic regression was used to determine if the presence of microsporidia in the stool were associated with persistent diarrhea or weight loss > = 10% of baseline weight six months after the index specimen, as compared to patients with cryptosporidiosis, or non-cryptosporidiosis controls. Linear regression was used to determine if the presence of microsporidia in the stool was associated with a decline in CD4 cell count. An examination of only those patients positive for microsporidia was conducted to determine the factors related to poor outcomes among these patients. A questionnaire was administered to eligible participants to determine the etiology of microsporidiosis in this population Patients with microsporidiosis were significantly more likely to have experienced chronic diarrhea and weight loss than non-cryptosporidiosis controls (OR chronic diarrhea: 2.10, [1.01, 4.38], OR weight loss: 2.23, [1.02, 5.33]). There was no significant difference between patients with cryptosporidiosis and patients with microsporidiosis with respect to the risk of chronic diarrhea or weight loss or death (OR chronic diarrhea 1.50, [0.62, 3.67], OR weight loss/death 0.94, [0.16, 1.97]). There was also no significant decline in CD4 cell count associated with microsporidiosis (-25.5 cells/dl, [-76.2, 25.1]). Factors associated with chronic diarrhea among patients with microsporidiosis included high HIV-viral load and no initiation of anti-retroviral therapy (p < 0.05). Factors associated with weight loss included very low CD4 cell count (< = 50 cells/dl) and no utilization of anti-retroviral therapy (p < 0.05). The associations between microsporidia and weight loss and chronic diarrhea indicate that microsporidia are pathogenic and may be an opportunistic pathogen In a multivariate logistic regression, well water and contact with horses were significantly associated with a stool positive for microsporidia. Rural environments and water sources should be investigated further as potential sources of microsporidia in the environment