Co-infection by Cryptosporidium meleagridis and Enterocytozoon bieneusi in an HIV+ Colombian patient

Authors: HERNÁNDEZ-CASTRO, CAROLINA - National Center For Microbiology, The Institute Of Health Carlos Iii; MARTÍNEZ-ROSADO, LARRY - La Maria Hospital; DASHTI, ALEJANDRO - National Center For Microbiology, The Institute Of Health Carlos Iii; KÖSTER, PAMELA - National Center For Microbiology, The Institute Of Health Carlos Iii; BAILO, BEGOÑA - National Center For Microbiology, The Institute Of Health Carlos Iii; OROZCO, MARÍA - National Center For Microbiology, The Institute Of Health Carlos Iii; Santin-Duran, Monica; GONZÁLEZ-BARRIO, DAVID - National Center For Microbiology, The Institute Of Health Carlos Iii; CARMENA, DAVID - National Center For Microbiology, The Institute Of Health Carlos Iii

Submitted to: Parasitologia
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/16/2023
Publication Date: 1/18/2023
Citation: Hernández-Castro, C., Martínez-Rosado, L.L., Dashti, A., Köster, P.C., Bailo, B., Orozco, M.C., Santin, M., González-Barrio, D., Carmena, D. 2023. Co-infection by Cryptosporidium meleagridis and Enterocytozoon bieneusi in an HIV+ Colombian patient. Parasitologia. 3:48-52. https://doi.org/10.3390/parasitologia3010006.
DOI: https://doi.org/10.3390/parasitologia3010006

Interpretive Summary: The protozoan Cryptosporidium spp. and the microsporidia Enterocytozoon bieneusi are opportunistic enteric pathogens able to cause severe disease in immunocompromised patients. Here, we present the case of woman infected with the human immunodeficiency virus-infected (HIV) with severe immunodeficiency admitted to hospital with acute diarrhea. Microscopical examination of fecal specimens revealed the presence of Cryptosporidium spp. oocysts. Molecular testing confirmed a concomitant infection by C. meleagridis and Enterocytozoon bieneusi. The patient was treated with metronidazole and nitazoxanide. After requesting voluntary discharge and abandoning antiretroviral therapy and parasiticidal treatments, she experienced a dramatic deterioration of her state of health. Data presented demonstrated that molecular-based testing improves the detection of opportunistic pathogens that are difficult to detect by routine microscopy, allows transmission dynamics investigations, and assists in choosing the best chemotherapeutical option. This information is useful to other scientists, health care professionals, infectious diseases specialists, and public health agencies in understanding zoonotic potential and public health importance of opportunist pathogens.

Technical Abstract: Case description: A 44-year-old human immunodeficiency virus-infected (HIV+) female with severe immunodeficiency Category 3 (C3) diagnosed in 2010 was admitted to hospital with acute diarrhoea. She was non-adherent to antiretroviral therapy (ART) and had a previous suspicion of respiratory symptoms with a persistent cough of 15 days. Clinical findings: Severe immune deterioration (viral load: 109,655 copies/mL; CD4+ count: 14 cells/mm3), respiratory symptoms (negative sputum Gram stain and tuberculosis culture) and neurological deterioration (serological assays negative for Cryptococcus spp. and Toxoplasma gondii). Coproculture negative for Campylobacter spp., Salmonella sp. and Shigella sp. Ziehl-Neelsen staining of faecal smears revealed the presence of Cryptosporidium spp. oocysts. PCR testing and sequencing confirms a concomitant infection by C. meleagridis and Enterocytozoon bieneusi. Treatment and outcome: The patient was treated with metronidazole (500 mg every 8 h for 5 days) and nitazoxanide (500 mg every 12 h for 14 days). After requesting voluntary discharge and abandoning ART and parasiticidal treatments, she experienced a dramatic deterioration of her state of health. Contact was lost. Clinical relevance: Molecular-based testing improves the detection of opportunistic pathogens that are difficult to detect by routine microscopy, allows transmission dynamics investigations, and assists in choosing the best chemotherapeutical option.