GENERALIZED
MICROSPORIDIOSIS CAUSED BY ENCEPHALYTOZOON SP. IN A PEDIATRIC PATIENT WITH
BRUTON´S DISEASE
Carbajal RL, Barrios FR, Vázquez TO, Zarco RJ, Rodríguez HR, Reynés MJ.
Pediatrics National
Institute, México City, México.
With the emergence of diseases like AIDS, the study of a number of
opportunistic parasites has undergone, with microsporidyas being accounted
for in this group. The Encepphalytozoon generus of microsporidyas has been
recognized as the cause of encephalitis, hepatitis, peritonitis,
kerato-conjuntivitis, pneumonia, sinusitis, nephritis and disseminated
infections, specialy in immunocompromised patients.
We present the first mexican case of generalized
infection caused by Encephalytozoon sp. In a 4-year old male patient with a
previous diagnosis of Bruton´s disease or X linked Hipogamaglobulinemia
(Low levels of: IgA lees then 0.5mg/dl, IgG 0.5mg/dl, and normal levels of
IgM 44.4mg/dl and low counts of CD19 1.9% and CD8 18.5%). During the course
of the disease the patient presented signs of encephalitis, cerebral
vasculitis, maxilar sinusistis and pneumonitis as well as physicall
findings of aphasia, spastic quadriparesis, universal hyperreflexia and
afecction of cranial nerves IX and X. We decided to discard infectious and
parasitic causes of the disease including microsporidiosis for wich samples
of bronchial and sinus secretions were taken ass well as urine and
cerebrospinal fluid (CSF). A smear test plus Giemsa and chromotrope R2
stains and indirect immunofluorescene with monoclonal 3B6 antibodies for
Encephalytozoon species were practices with all of them resulting positive.
Treatment was started with Albendazol 400mg every 12 hours for 4 weeks as
well as IV Gammaglobuline at 400mg/kg on a monthly regimen and Transference
Factor (TF) 2U every 24 hours for 5 days. At 4 weeks of treatment the
patient showed clinical improvement, but control parasitology exams
remained positive wich led to the continuation of Albendazol for another 4
weeks with negativization of the exams at the end of such period. The
patient was discharged with minimal pyramidal affection signs a fine dystal
tremor and spastic quadriparesia. He is currently seen as an outpatient.
The
present constitutes the first ever-generalized microsporidiosis caused by
Encephalytozoon sp. diagnosed in Mexico. Based on the former we consider
that it would be prudent to discard this etiology as part of the
differential diagnosis of patients with immune defficiencies, particurarily
those associated with pneumonia, sinusitis, encephalitis and cerebral
vasculitis.