Microsporidium - Revision history

ClaireLewis at 23:06, 29 September 2019

2019-09-29T23:06:52Z

← Older revision		Revision as of 23:06, 29 September 2019
Line 9:		Line 9:
	*[[Cholangitis]] and [[acalculous cholecystitis]]		*[[Cholangitis]] and [[acalculous cholecystitis]]
	*Disseminated infection		*Disseminated infection
	*Myositis		*[[Myositis]]

	===Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref> ===		===Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref> ===
Line 19:		Line 19:
	*[[Cryptosporidiosis]]		*[[Cryptosporidiosis]]
	*[[CMV]] (CD4 < 100)		*[[CMV]] (CD4 < 100)
	*MAC (CD4 < 100)		*[[mycobacterium avium\|MAC]] (CD4 < 100)
	*[[Adenovirus]]		*[[Adenovirus]]
	*Isospora		*Isospora
Line 32:		Line 32:
	* CBC		* CBC
	* Metabolic panel		* Metabolic panel
	* C. difficile toxin EIA		* [[C. difficile]] toxin EIA
	* Fecal WBC and RBC		* Fecal WBC and RBC
	* Lactoferrin		* Lactoferrin
	* Wet mount microscopy		* Wet mount microscopy
	* Stool culture		* Stool culture

	~~===Evaluation===~~
	*It is important to differentiate bloody vs non-bloody and acute vs chronic diarrhea. Additionally helpful information includes recent antibiotic use, history of [[C. difficile]], presence of [[nausea]], [[vomiting]], [[fevers]], [[altered mental status]], severe [[abdominal pain]], and whether their [[diarrhea]] is distracting them from an additional problem.

	==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==
Line 62:		Line 59:

	[[Category:GI]]		[[Category:GI]]
			[[Category:ID]]

ClaireLewis at 18:22, 27 September 2017

2017-09-27T18:22:16Z

← Older revision		Revision as of 18:22, 27 September 2017
Line 17:		Line 17:
	==Differential Diagnosis==		==Differential Diagnosis==
	*Microsporidiosis		*Microsporidiosis
	*Cryptosporidiosis		*[[Cryptosporidiosis]]
	*CMV (CD4 < 100)		*[[CMV]] (CD4 < 100)
	*MAC (CD4 < 100)		*MAC (CD4 < 100)
	*Adenovirus		*[[Adenovirus]]
	*Isospora		*Isospora
	*[[Giardia]]		*[[Giardia]]

Rossdonaldson1: /* ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.) */

2017-09-19T11:47:55Z

ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)

← Older revision		Revision as of 11:47, 19 September 2017
Line 44:		Line 44:
	*Initial treatment consists of the ABCs		*Initial treatment consists of the ABCs
	**[[IV fluid resuscitation]] with LR or NS		**[[IV fluid resuscitation]] with LR or NS
	**Oral rehydrating solution for mild dehydration and tolerating PO intake ~~(WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)~~		**[[Oral rehydrating solution]] for mild dehydration and tolerating PO intake
	**Address [[electrolyte derangements]]		**Address [[electrolyte derangements]]
	*[[Albendazole]] 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)		*[[Albendazole]] 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)

Rossdonaldson1: /* ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.) */

2017-09-19T11:47:33Z

ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)

← Older revision		Revision as of 11:47, 19 September 2017
Line 43:		Line 43:
	==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==
	*Initial treatment consists of the ABCs		*Initial treatment consists of the ABCs
	**[[IV fluid resuscitation]] with LR or NS ~~(bolus 500 mL adults, 20/30 mL/kg in children)~~		**[[IV fluid resuscitation]] with LR or NS
	**Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)		**Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)
	**Address [[electrolyte derangements]]		**Address [[electrolyte derangements]]

Rossdonaldson1: /* ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.) */

2017-09-19T11:47:19Z

ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)

← Older revision		Revision as of 11:47, 19 September 2017
Line 47:		Line 47:
	**Address [[electrolyte derangements]]		**Address [[electrolyte derangements]]
	*[[Albendazole]] 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)		*[[Albendazole]] 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)
	*[[Ondansetron]] or [[promethazine]] for nausea (avoid [[metoclopramide]] due to pro-motility effects)		*[[Ondansetron]] or [[promethazine]] for [[nausea]] (avoid [[metoclopramide]] due to pro-motility effects)
	*[[Loperamide]] for symptom reduction (contraindicated with bloody stool)		*[[Loperamide]] for symptom reduction (contraindicated with bloody stool)

Rossdonaldson1: /* ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.) */

2017-09-19T11:45:56Z

ManagementLeder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)

← Older revision		Revision as of 11:45, 19 September 2017
Line 43:		Line 43:
	==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==
	*Initial treatment consists of the ABCs		*Initial treatment consists of the ABCs
	**IV fluid resuscitation with LR or NS (bolus 500 mL adults, 20/30 mL/kg in children)		**[[IV fluid resuscitation]] with LR or NS (bolus 500 mL adults, 20/30 mL/kg in children)
	**Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)		**Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)
	**Address electrolyte derangements		**Address [[electrolyte derangements]]
	*Albendazole 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)		*[[Albendazole]] 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)
	*Ondansetron or promethazine for nausea (avoid metoclopramide due to pro-motility effects)		*[[Ondansetron]] or [[promethazine]] for nausea (avoid [[metoclopramide]] due to pro-motility effects)
	*Loperamide for symptom reduction (contraindicated with bloody stool)		*[[Loperamide]] for symptom reduction (contraindicated with bloody stool)

	==Disposition<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Disposition<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==

Rossdonaldson1: /* Differential Diagnosis */

2017-09-19T11:44:53Z

Differential Diagnosis

← Older revision		Revision as of 11:44, 19 September 2017
Line 25:		Line 25:
	*[[E. coli]]		*[[E. coli]]
	*[[C. difficile]]		*[[C. difficile]]

			{{Diarrhea DDX}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 11:29, 19 September 2017

2017-09-19T11:29:31Z

← Older revision		Revision as of 11:29, 19 September 2017
Line 1:		Line 1:
	==Background==		==Background==
	*~~Microsporidia are unicellular~~ spore-forming parasitic protozoa that are found pervasively throughout the environment.<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref> Microsporidiosis most commonly affects immunosuppressed individuals and seldom has implications for the immunocompetent patient.		*Unicellular spore-forming parasitic [[protozoa]] that are found pervasively throughout the environment.<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref> Microsporidiosis most commonly affects immunosuppressed individuals and seldom has implications for the immunocompetent patient.

	==Clinical Features==		==Clinical Features==
	*Clinical manifestations are wide ranging and typically affect immunosuppressed hosts (e.g. HIV/AIDS, long-term steroid use, transplant and chemotherapy patients), travelers, children, and the elderly<ref>Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.</ref>. The most common manifestation is copious diarrhea with volume depletion leading to electrolyte derangements.<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>		''Clinical manifestations are wide ranging and typically affect immunosuppressed hosts (e.g. HIV/AIDS, long-term steroid use, transplant and chemotherapy patients), travelers, children, and the elderly<ref>Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.</ref>. The most common manifestation is copious [[diarrhea]] with volume depletion leading to [[electrolyte derangements]].<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref> ''

	Immunosuppressed patients:<ref>Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.</ref>		===Immunosuppressed patients:<ref>Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.</ref>===
	*Profuse watery diarrhea with massive fluid loss		*Profuse watery [[diarrhea]] with massive fluid loss
	*Cholangitis and acalculous cholecystitis		*[[Cholangitis]] and [[acalculous cholecystitis]]
	*Disseminated infection		*Disseminated infection
	*Myositis		*Myositis

	Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>		===Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref> ===

	*Self-limited diarrhea		*Self-limited [[diarrhea]]

	==Differential Diagnosis==		==Differential Diagnosis==
Line 22:		Line 22:
	*Adenovirus		*Adenovirus
	*Isospora		*Isospora
	*Giardia		*[[Giardia]]
	*E. coli		*[[E. coli]]
	*C. difficile		*[[C. difficile]]

	==Evaluation==		==Evaluation==
	Work-up		===Work-up===
	* CBC		* CBC
	* Metabolic panel		* Metabolic panel
Line 36:		Line 36:
	* Stool culture		* Stool culture

	Evaluation		===Evaluation===
	*It is important to differentiate bloody vs non-bloody and acute vs chronic diarrhea. Additionally helpful information includes recent antibiotic use, history of C. difficile, presence of nausea, vomiting, fevers, altered mental status, severe abdominal pain, and whether their diarrhea is distracting them from an additional problem.		*It is important to differentiate bloody vs non-bloody and acute vs chronic diarrhea. Additionally helpful information includes recent antibiotic use, history of [[C. difficile]], presence of [[nausea]], [[vomiting]], [[fevers]], [[altered mental status]], severe [[abdominal pain]], and whether their [[diarrhea]] is distracting them from an additional problem.

	==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==

Mholtz at 05:52, 7 September 2017

2017-09-07T05:52:46Z

← Older revision		Revision as of 05:52, 7 September 2017
Line 1:		Line 1:
	==Background==		==Background==
	Microsporidia are unicellular spore-forming parasitic protozoa that are found pervasively throughout the environment.<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref> Microsporidiosis most commonly affects immunosuppressed individuals and seldom has implications for the immunocompetent patient.		*Microsporidia are unicellular spore-forming parasitic protozoa that are found pervasively throughout the environment.<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref> Microsporidiosis most commonly affects immunosuppressed individuals and seldom has implications for the immunocompetent patient.

	==Clinical Features==		==Clinical Features==
	Clinical manifestations are wide ranging and typically affect immunosuppressed hosts (e.g. HIV/AIDS, long-term steroid use, transplant and chemotherapy patients), travelers, children, and the elderly<ref>Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.</ref>. The most common manifestation is copious diarrhea with volume depletion leading to electrolyte derangements.<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>		*Clinical manifestations are wide ranging and typically affect immunosuppressed hosts (e.g. HIV/AIDS, long-term steroid use, transplant and chemotherapy patients), travelers, children, and the elderly<ref>Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.</ref>. The most common manifestation is copious diarrhea with volume depletion leading to electrolyte derangements.<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>

	Immunosuppressed patients:<ref>Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.</ref>		Immunosuppressed patients:<ref>Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.</ref>
	* Profuse watery diarrhea with massive fluid loss		*Profuse watery diarrhea with massive fluid loss
	* Cholangitis and acalculous cholecystitis		*Cholangitis and acalculous cholecystitis
	* Disseminated infection		*Disseminated infection
	* Myositis		*Myositis

	Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>		Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>

	* Self-limited diarrhea		*Self-limited diarrhea

	==Differential Diagnosis==		==Differential Diagnosis==
	* Microsporidiosis		*Microsporidiosis
	* Cryptosporidiosis		*Cryptosporidiosis
	* CMV (CD4 < 100)		*CMV (CD4 < 100)
	* MAC (CD4 < 100)		*MAC (CD4 < 100)
	* Adenovirus		*Adenovirus
	* Isospora		*Isospora
	* Giardia		*Giardia
	* E. coli		*E. coli
	* C. difficile		*C. difficile

	==Evaluation==		==Evaluation==

	Work-up		Work-up
	* CBC		* CBC
Line 38:		Line 37:

	Evaluation		Evaluation
	* It is important to differentiate bloody vs non-bloody and acute vs chronic diarrhea. Additionally helpful information includes recent antibiotic use, history of C. difficile, presence of nausea, vomiting, fevers, altered mental status, severe abdominal pain, and whether their diarrhea is distracting them from an additional problem.		*It is important to differentiate bloody vs non-bloody and acute vs chronic diarrhea. Additionally helpful information includes recent antibiotic use, history of C. difficile, presence of nausea, vomiting, fevers, altered mental status, severe abdominal pain, and whether their diarrhea is distracting them from an additional problem.

	==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==
			*Initial treatment consists of the ABCs
	* Initial treatment consists of the ABCs		**IV fluid resuscitation with LR or NS (bolus 500 mL adults, 20/30 mL/kg in children)
	** IV fluid resuscitation with LR or NS (bolus 500 mL adults, 20/30 mL/kg in children)		**Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)
	** Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)		**Address electrolyte derangements
	** Address electrolyte derangements		*Albendazole 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)
	* Albendazole 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)		*Ondansetron or promethazine for nausea (avoid metoclopramide due to pro-motility effects)
	* Ondansetron or promethazine for nausea (avoid metoclopramide due to pro-motility effects)		*Loperamide for symptom reduction (contraindicated with bloody stool)
	* Loperamide for symptom reduction (contraindicated with bloody stool)

	==Disposition<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==		==Disposition<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==
			*Discharge: immunocompetent or low risk patients with unclear etiology but normal examination findings after rehydration
	* Discharge: immunocompetent or low risk patients with unclear etiology but normal examination findings after rehydration		*Admission: patients with life-threatening volume loss, failure to improve after resuscitation, electrolyte abnormalities requiring gradual and/or significant correction, toxic or ill-appearing, intolerant of PO intake or significant risk factors (CD4 < 100, chemotherapy, transplant, etc.)
	* Admission: patients with life-threatening volume loss, failure to improve after resuscitation, electrolyte abnormalities requiring gradual and/or significant correction, toxic or ill-appearing, intolerant of PO intake or significant risk factors (CD4 < 100, chemotherapy, transplant, etc.)		*Pearl: Obtain contact information for patients PCP and specialist providers (oncology, infectious disease, rheumatology, etc). Consultation and coordination of care is especially important for patients with significant and relevant co-morbidities
	* Pearl: Obtain contact information for patients PCP and specialist providers (oncology, infectious disease, rheumatology, etc). Consultation and coordination of care is especially important for patients with significant and relevant co-morbidities

	==External Links==		==External Links==
	[https://www.cdc.gov/dpdx/microsporidiosis/index.html] CDC-Microsporidiosis		*[https://www.cdc.gov/dpdx/microsporidiosis/index.html CDC-Microsporidiosis]

	==References==		==References==
	<references/>		<references/>

	~~Erich KDHCD Burton~~		[[Category:GI]]

Erichburton: Created microsporidium page 09/05/2017

2017-09-05T18:13:10Z

Created microsporidium page 09/05/2017

New page

==Background==
Microsporidia are unicellular spore-forming parasitic protozoa that are found pervasively throughout the environment.<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref> Microsporidiosis most commonly affects immunosuppressed individuals and seldom has implications for the immunocompetent patient.

==Clinical Features==
Clinical manifestations are wide ranging and typically affect immunosuppressed hosts (e.g. HIV/AIDS, long-term steroid use, transplant and chemotherapy patients), travelers, children, and the elderly<ref>Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.</ref>. The most common manifestation is copious diarrhea with volume depletion leading to electrolyte derangements.<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>

Immunosuppressed patients:<ref>Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.</ref>
* Profuse watery diarrhea with massive fluid loss
* Cholangitis and acalculous cholecystitis
* Disseminated infection
* Myositis

Immunocompetent patients:<ref>Centers for Disease Control and Prevention. (2016). DPDx - Laboratory Identification of Parasitic Diseases of Public Health Concern - Microsporidiosis. Retrieved from https://www.cdc.gov/dpdx/microsporidiosis/index.html</ref>

* Self-limited diarrhea

==Differential Diagnosis==
* Microsporidiosis
* Cryptosporidiosis
* CMV (CD4 < 100)
* MAC (CD4 < 100)
* Adenovirus
* Isospora
* Giardia
* E. coli
* C. difficile

==Evaluation==

Work-up
* CBC
* Metabolic panel
* C. difficile toxin EIA
* Fecal WBC and RBC
* Lactoferrin
* Wet mount microscopy
* Stool culture

Evaluation
* It is important to differentiate bloody vs non-bloody and acute vs chronic diarrhea. Additionally helpful information includes recent antibiotic use, history of C. difficile, presence of nausea, vomiting, fevers, altered mental status, severe abdominal pain, and whether their diarrhea is distracting them from an additional problem.

==Management<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==

* Initial treatment consists of the ABCs
** IV fluid resuscitation with LR or NS (bolus 500 mL adults, 20/30 mL/kg in children)
** Oral rehydrating solution for mild dehydration and tolerating PO intake (WHO advocates 250 mL orange juice, 4 tsp sugar, 1 tsp baking powder, 3.75 mL salt in 1 L of boiled water. Goal is 50-100 mL/kg over the first 4 hours)
** Address electrolyte derangements
* Albendazole 400 mg PO bid for 14-28 days in adults (15mg/kg PO bid for 7 days in children)
* Ondansetron or promethazine for nausea (avoid metoclopramide due to pro-motility effects)
* Loperamide for symptom reduction (contraindicated with bloody stool)

==Disposition<ref>Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)</ref>==

* Discharge: immunocompetent or low risk patients with unclear etiology but normal examination findings after rehydration
* Admission: patients with life-threatening volume loss, failure to improve after resuscitation, electrolyte abnormalities requiring gradual and/or significant correction, toxic or ill-appearing, intolerant of PO intake or significant risk factors (CD4 < 100, chemotherapy, transplant, etc.)
* Pearl: Obtain contact information for patients PCP and specialist providers (oncology, infectious disease, rheumatology, etc). Consultation and coordination of care is especially important for patients with significant and relevant co-morbidities

==External Links==
[https://www.cdc.gov/dpdx/microsporidiosis/index.html] CDC-Microsporidiosis
==References==
<references/>

Erich KDHCD Burton