Microsporidium: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| (3 intermediate revisions by 2 users not shown) | |||
| 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 17: | Line 17: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Microsporidiosis | *Microsporidiosis | ||
*Cryptosporidiosis | *[[Cryptosporidiosis]] | ||
*CMV (CD4 < 100) | *[[CMV]] (CD4 < 100) | ||
*MAC (CD4 < 100) | *[[mycobacterium avium|MAC]] (CD4 < 100) | ||
*Adenovirus | *[[Adenovirus]] | ||
*Isospora | *Isospora | ||
*[[Giardia]] | *[[Giardia]] | ||
| 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 | ||
==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 | **[[IV fluid resuscitation]] with LR or NS | ||
**Oral rehydrating solution for mild dehydration and tolerating PO intake | **[[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) | ||
| Line 62: | Line 59: | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | |||
Latest revision as of 23:06, 29 September 2019
Background
- Unicellular spore-forming parasitic protozoa that are found pervasively throughout the environment.[1] 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[2]. The most common manifestation is copious diarrhea with volume depletion leading to electrolyte derangements.[3]
Immunosuppressed patients:[4]
- Profuse watery diarrhea with massive fluid loss
- Cholangitis and acalculous cholecystitis
- Disseminated infection
- Myositis
Immunocompetent patients:[5]
- Self-limited diarrhea
Differential Diagnosis
- Microsporidiosis
- Cryptosporidiosis
- CMV (CD4 < 100)
- MAC (CD4 < 100)
- Adenovirus
- Isospora
- Giardia
- E. coli
- C. difficile
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[6]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
Evaluation
Work-up
- CBC
- Metabolic panel
- C. difficile toxin EIA
- Fecal WBC and RBC
- Lactoferrin
- Wet mount microscopy
- Stool culture
Management[7]
- Initial treatment consists of the ABCs
- IV fluid resuscitation with LR or NS
- Oral rehydrating solution for mild dehydration and tolerating PO intake
- 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[8]
- 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
References
- ↑ Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)
- ↑ Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.
- ↑ 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
- ↑ 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.
- ↑ 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
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
- ↑ Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)
- ↑ Leder K, Weller PF. Microsporidiosis. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com (Accessed on September 4, 2017.)