Disseminated Encephalitozoon (Septata) intestinalis infection in a patient with AIDS: novel diagnostic approaches and autopsy-confirmed parasitological cure following treatment with albendazole

Abstract

Encephalitozoon intestinalis is a recently described microsporidian which causes intestinal and disseminated infections in severely immunocompromised patients with AIDS. Preliminary data suggest that albendazole can be an effective therapy for patients with E. intestinalis infection. However, relapses have been reported following treatment in some cases. These results were based upon examination of cytologic, biopsy, or stool samples with an inherent sampling bias. This report documents the first postmortem evaluation of a patient with E. intestinalis infection treated with albendazole. Antemortem microsporidial diagnosis was performed on nasal mucosal smear and duodenal biopsy specimens by electron microscopy and a newly developed indirect fluorescent-antibody method based upon in vitro cultivation of the organism. This case represents the initial report of using nasal cytologic specimens for ultrastructural and antibody-based species-level diagnosis of microsporidiosis. Following successful treatment of this infection with albendazole, the patient died of other causes. A thorough autopsy examination failed to reveal the presence of E. intestinalis in any tissue, providing confirmatory evidence for a complete parasitological cure with albendazole.