title: Microsporidiosis in pediatric renal transplant patients in Cape Town, South Africa: two case reports.
abstract: Microsporidia are an emerging group of pathogens associated with life-threatening opportunistic infections in immunocompromised hosts, particularly human immunodeficiency virus (HIV)-infected individuals. There have, however, been recent reports of infection in adult solid organ transplant recipients. We report two cases in children, to our knowledge the first in the paediatric literature. Two 13-yr-old, HIV-seronegative females received deceased donor renal transplants from the same donor. Both patients suffered acute cell-mediated rejection and CMV infection reactivation, managed with intensified immunosuppression and ganciclovir. Pyrexia of unknown origin and intermittent diarrhea in both prompted extensive investigations. In both patients, numerous spores of a microsporidial species were demonstrated in renal tissue on biopsy and in the urine, using modified trichrome and quick-hot Gram-chromotrope staining. Electron microscopy and PCR confirmed Encephalitozoon cuniculi infections. Both patients were successfully treated with 400 mg twice daily of albendazole, with sustained clinical improvement. We recommend that microsporidiosis be considered in the differential diagnosis of pyrexia of unknown origin in severely immunocompromised pediatric solid organ transplant recipients, particularly when associated with diarrhea.
authors.affiliation: Department of Paediatrics, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Taiwo A
authors.initials: TA
authors.lastname: Ladapo
authors.forename: Peter
authors.initials: P
authors.lastname: Nourse
authors.forename: Komala
authors.initials: K
authors.lastname: Pillay
authors.forename: John
authors.initials: J
authors.lastname: Frean
authors.forename: Monica
authors.initials: M
authors.lastname: Birkhead
authors.forename: Bhavani
authors.initials: B
authors.lastname: Poonsamy
authors.forename: Priya
authors.initials: P
authors.lastname: Gajjar
mesh_terms: D000293:Adolescent; D015766:Albendazole / Q000627:therapeutic use; D003586:Cytomegalovirus Infections; D003967:Diarrhea / Q000209:etiology; D009670:Encephalitozoon cuniculi; D005260:Female; D005334:Fever; D015774:Ganciclovir / Q000627:therapeutic use; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D016881:Microsporidiosis / Q000209:etiology*; D009404:Nephrotic Syndrome / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications; D051437:Renal Insufficiency; D013019:South Africa
chemical_list: D007166:Immunosuppressive Agents; D015766:Albendazole; D015774:Ganciclovir
keywords: children; kidney; microsporidiosis; transplant