Microsporidial polymyositis in human immunodeficiency virus-infected patients, a rare life-threatening opportunistic infection: clinical suspicion, diagnosis, and management in resource-limited settings.
BACKGROUND
Microsporidial myositis is a rare opportunistic infection that has been reported in HIV-infected and HIV-uninfected immunocompromised patients.


METHODS
In this study we present a retrospective analysis of 5 cases of microsporidial myositis in HIV-infected patients, including the clinical, laboratory, and histologic features, and a review of the literature.


RESULTS
Five young men with HIV infection [median CD4 count of 20 cells (range 14-144)/mm(3) ] who presented with signs and symptoms suggestive of myositis underwent EMG-NCV and muscle biopsy, which revealed signs compatible with microsporidial myositis. Early and aggressive treatment led to improvement in 3 patients. Two of the 5 patients died due to a delay in diagnosis, because the spores were mistaken for Candida without confirmatory stains or a high index of suspicion.


CONCLUSIONS
Myositis in HIV-infected patients with low CD4 counts should be evaluated using muscle biopsy. A high index of suspicion is required for early diagnosis of microsporidial myositis in HIV-infected patients. Early diagnosis and immediate, aggressive treatment are the keys to favorable outcomes in these patients.
Infectious Diseases Clinic, Vedanta Institute of Medical Sciences, Navarangpura, Ahmedabad, 380009, India.
Atul K
AK
Patel
Ketan K
KK
Patel
Yasha T
YT
Chickabasaviah
Shalin D
SD
Shah
Drupad J
DJ
Patel
Gayathri
G
Narayanappa
Ambuj
A
Kumar
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D000890:Anti-Infective Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D017809:Fatal Outcome; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D016814:Microsporidia / Q000302:isolation & purification; D016881:Microsporidiosis / Q000150:complications*; D018482:Muscle, Skeletal / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D017285:Polymyositis / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D044966:Anti-Retroviral Agents
HIV; IRIS; immunocompromise; microsporidial myositis; muscle disease; myositis