title: Intestinal microsporidiosis in renal transplant recipients: Prevalence, predictors of occurrence and genetic characterization.
abstract: OBJECTIVE
  Intestinal microsporidiosis, which occurs in immunocompromised states such as acquired immunodeficiency syndrome, has rarely been studied in patients with renal transplantation (RT) on immunosuppressive therapy.
  
  
  METHODS
  Three hundred and twenty-four consecutive RT recipients on immunosuppressive treatment and 170 healthy subjects were evaluated for intestinal microsporidiosis and other parasites by modified trichrome staining, wet mount using normal saline, iodine and polymerase chain reaction (PCR). Clinical, demographic and laboratory parameters associated with occurrence of intestinal microsporidiosis were studied using univariate and multivariate analysis. The species of microsporidia were studied using PCR-restriction fragment length polymorphism (RFLP). Patients were treated with albendazole (400 mg twice daily for 2 weeks).
  
  
  RESULTS
  Of 324 RT recipients initially screened, 52 were excluded from final analysis due to incomplete data. Patients with RT [n=272, age 42±12.54 years, 222 (81.6%) male] more often had microsporidiosis than healthy subjects by modified trichrome stain and PCR [n=170, age 33.8±6.7 years, 123 (72.3%) male] [16/272 (5.8%) vs. 0/170 (0%), P<0.001]. Patients with intestinal microsporidiosis were younger (33.9±8.3 years vs. 42.3±12.6 years; P=0.009), had diarrhoea more often (13/16, 81% vs. 123/256, 48%; P=0.02), which was longer in duration (60, 32.5-105 days vs. 12, 6.2-18 days; P<0.001) and had associated giardiasis (2/16, 12.5% vs. 2/256, 0.8%; P=0.018). Younger age, presence of diarrhoea and associated giardiasis were significant on multivariate analysis. Enterocytozoon bieneusi was detected in 15/16 (93%) patients with intestinal microsporidiosis.
  
  
  CONCLUSIONS
  Intestinal microsporidiosis occurs frequently in patients with RT on immunosuppressive treatment, particularly among younger patients with longer diarrhoea duration and associated giardiasis. E. bieneusi is the major species identified among these patients.
authors.affiliation: Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: U
authors.initials: U
authors.lastname: Ghoshal
authors.forename: S
authors.initials: S
authors.lastname: Khanduja
authors.forename: P
authors.initials: P
authors.lastname: Pant
authors.forename: K N
authors.initials: KN
authors.lastname: Prasad
authors.forename: T N
authors.initials: TN
authors.lastname: Dhole
authors.forename: R K
authors.initials: RK
authors.lastname: Sharma
authors.forename: U C
authors.initials: UC
authors.lastname: Ghoshal
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000382:microbiology*; D016030:Kidney Transplantation; D008297:Male; D008828:Microbiological Techniques; D016814:Microsporidia / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D016881:Microsporidiosis / Q000453:epidemiology* / Q000382:microbiology*; D008875:Middle Aged; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D015995:Prevalence; D012189:Retrospective Studies; D066027:Transplant Recipients