Myositis due to the microsporidian Anncaliia (Brachiola) algerae in a lung transplant recipient

Microsporidia are obligate intracellular parasites, more closely related to fungi than protozoa on molecular phylogenetic analysis, and are known to be a rare cause of opportunistic infection in immune compromised patients including human immunodeficiency virus‐positive patients and solid organ tran...

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Bibliographic Details
Published in:Transplant infectious disease 2012-04, Vol.14 (2), p.169-176
Main Authors: Field, A.S., Paik, J.Y., Stark, D., Qiu, M.R., Morey, A., Plit, M.L., Canning, E.U., Glanville, A.R.
Format: Article
Language:English
Subjects:
Anncaliia algerae
Brachiola algerae
Fatal Outcome
Humans
Lung Transplantation - adverse effects
Male
Microscopy, Electron, Transmission
Microsporidia
Microsporidia - isolation & purification
Microsporidiosis - complications
Microsporidiosis - microbiology
Middle Aged
myositis
Myositis - microbiology
organ transplants
Polymerase Chain Reaction
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Summary:Microsporidia are obligate intracellular parasites, more closely related to fungi than protozoa on molecular phylogenetic analysis, and are known to be a rare cause of opportunistic infection in immune compromised patients including human immunodeficiency virus‐positive patients and solid organ transplant recipients. We report the first case to our knowledge of microsporidial myositis in a lung transplant recipient. He was 49 years old and had received a lung transplant in 2000 for cystic fibrosis. He presented in 2009 with fevers, chronic diarrhea, myalgia, and pancytopenia, and developed progressive weakness and neurological symptoms before his death 35 days after hospital admission. Multiple investigations, including stool culture, rectal biopsy, colonoscopy, cerebrospinal fluid examination, bone marrow biopsy, lung biopsy, and bronchoalveolar lavage, failed to reveal a definite cause for the patient's deterioration. The diagnosis of microsporidial infection was made on post‐mortem light microscopic examination of tissue sections of the tongue and deltoid muscle. Light microscopy diagnosed a microsporidial myositis, confirmed by transmission electron microscopy, which suggested that the organism was Brachiola species. The identity of the organism was confirmed by polymerase chain reaction as Brachiola algerae (recently renamed Anncaliia algerae). The case highlights the need to consider protozoal organisms in the differential diagnosis of myalgia and multisystemic infections in immune compromised patients.
ISSN:1398-2273
1399-3062
DOI:10.1111/j.1399-3062.2012.00724.x