Anna Maria Bernuzzi

The relationship of bacterial vaginosis, Candida and Trichomonas infection to symptomatic vaginitis in postmenopausal women attending a vaginitis clinic.

OBJECTIVE To estimate the prevalence of bacterial vaginosis, Candida albicans, and Trichomonas vaginalis infections in a population of postmenopausal women with symptoms of vaginitis seen at a vaginitis clinic either as self-referred or clinician referred patients. METHODS A cross-sectional study of 148 postmenopausal women (cases) and 1564 controls of reproductive age attending a vaginitis clinic. C. albicans and T. vaginalis infections were diagnosed by culture techniques. Bacterial vaginosis was diagnosed on the basis of clinical findings. RESULTS Fifty-six (37.8%) postmenopausal women and 834 (53.3%) controls were diagnosed with T. vaginalis or C. albicans infection, or bacterial vaginosis, or mixed infection (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.37-0.75). C. albicans and T. vaginalis infection were diagnosed in 34.1% (534/1564) and 1.92% (30/1564) of women of childbearing age and in 13.5% (20/148) and 10.8% of postmenopausal women, respectively. (P < 0.05 for both comparisons). The prevalence of bacterial vaginosis was similar between the two groups (14/148 in postmenopausal patients and 210/1564 in controls of reproductive age; P = 0.22). CONCLUSIONS Among postmenopausal women attending a vaginitis clinic, a defined diagnosis of bacterial vaginosis, C. albicans or T. vaginalis infection can be made in about one third of such patients. Concerning the two thirds of symptomatic women lacking such a microbiologic diagnosis, alternative causes (e.g., estrogen deficiency, nonanaerobic bacterial infections, local irritants or allergenes, and dermatologic conditions) need to be considered.

Asymptomatic Respiratory Tract Microsporidiosis Due to Encephalitozoon hellem in Three Patients with AIDS

Microsporidia of the genera Enterocytozoon and Encephalitozoon have been identified as frequent causes of intestinal and disseminated infections, respectively, in patients with AIDS. Even though most subjects infected with these protozoa develop overt disease, simple colonization without illness may occur, as we observed in three severely immunosuppressed patients with AIDS. The parasites, recognized in and isolated from bronchoalveolar lavage sediment specimens, were characterized as Encephalitozoon hellem. Colonization of the bronchial tree was temporary, and treatment with albendazole was not needed to clear the infection.

Pulmonary microsporidiosis due to Encephalitozoon hellem in a patient with AIDS

The microsporidian Encephalitozoon hellem is being reported with increasing frequency in HIV-positive subjects, as an agent of disseminated microsporidiosis without involving the gastrointestinal tract. We describe a case of pulmonary microsporidiosis in a 27-year-old Italian man with AIDS who developed fever, cough, and dyspnea. A chest X-ray showed multiple bilateral pulmonary opacities and mediastinal lymph-node enlargement. Stained smears of bronchoalveolar lavage sediment showed oval structures consistent with microsporidian spores. Viral, bacterial and fungal cultures were repeatedly negative, whereas microsporidia were successfully cultured in human and bovine fibroblast cell lines. Analysis of electron micrographs indicated that the isolate belonged to the genus Encephalitozoon. Based on further immunological, biochemical and molecular studies it was characterized as E. hellem. Even though a temporary improvement with albendazole therapy was noticed, the patient deteriorated clinically and died of severe respiratory distress.

Isolation and identification of Encephalitozoon hellem from an Italian AIDS patient with disseminated microsporidiosis.

Microsporidia are primitive mitochondria‐lacking spore‐forming eukaryotic protozoa that infect a wide variety of animals and also humans. Of the five genera (Encephalitozoon, Enterocytozoon, Septula, Nosema and Pleistophora) that cause infections in humans, Enterocytozoon bieneusi. Septula intestinulis, and Encephulitozoon hellem are being increasingly identified in patients with acquired immunodeficiency syndrome (AIDS). E. bieneusi causes gastrointestinal disease, S. intestinulis causes gastrointestinal and disseminated disease, and E. hellem causes ocular as well as disseminated disease. We have established in continuous culture a strain of microsporidia isolated from the urine and throat washings of an Italian AIDS patient and identified it as Encephalitozoon hellem, based on its ultrastructural morphology, antigenic pattern, and polymerase chain reaction‐amplified small subunit ribosomal RNA. We believe that this is the first time that a strain of microsporidia has been isolated from the throat washings of a patient with microsporidiosis.

Evidence of actin in the cytoskeleton of Microsporidia

Using transmission electron microscopy, fluorescence microscopy, immuno‐electron microscopy, and biochemical techniques such as 2‐D electrophoresis and immunoblotting, actin was found in all biological stages of the microsporidia Encephalitozoon hellem and Encephalitozoon cuniculi.

Incidence of Entamoeba histolytica/Entamoeba dispar in international travelers, extracommunitary immigrants, and adopted children.

Imported tropical infections have become a serious health problem in industrialized countries, and have greatly contributed to the birth of a new branch of medicine called travel medicine. Several specific factors play an important role in this pathology, including the progressive and constant increase of subjects who travel to tropical and subtropical countries for various reasons (tourism, job, missionary institutions, etc.), the extracommunitary, often underground, flow of immigration, and the adoption of children from the same areas. A high percentage of imported tropical pathology is constituted by intestinal helminthic and protozoan infections, in particular those due to the Entamoeba histolytica / Entamoeba dispar complex. The aim of our study was to evaluate E. histolytica / E. dispar incidence in a casuistry composed of international travelers (IT), adult immigrants (AI), and adopted children (AC) collected from 1994–1999.

In Vitro Efficacy of Nikkomycin Z against the Human Isolate of the Microsporidian Species Encephalitozoon hellem

ABSTRACT Since 1985 microsporidia have been recognized as a cause of emerging infections in humans, mainly in immunocompromised human immunodeficiency virus-positive subjects. As chitin is a basic component of the microsporidian infective stage, the spore, we evaluated in vitro the susceptibility of a human-derived strain ofEncephalitozoon hellem to nikkomycin Z, a peptide-nucleoside antibiotic known as a competitive inhibitor of chitin synthase enzymes. Transmission electron microscopy showed that this drug, at 25 μg/ml, reduced the number of parasitic foci by about 35% ± standard deviation after 7 days of culture (P< 0.0001) and induced cell damage of both mature and immature spores and also other sporogonic and merogonic stages. In particular, an irregular outline of the cell shape and an abnormally condensed cytoplasm in meronts and sporonts were documented. Also, the polar tubule and the polaroplast membranes appeared disarrayed in the sporoblast stage. The spore wall showed an enlarged endospore and delaminated exospore. Mature spores had a complete cytoplasmic disorganization and a swollen and delaminated cell wall. No ultrastructural cell damage was observed in uninfected control cultures treated with the drug.

Naegleria australiensis ssp. italica: Experimental study in mice

A subspecies of Naegleria australiensis, N. australiensis italica, pathogenic for mice, was recently isolated and identified from an Italian thermal spa. We describe the histopathological changes of the central nervous system with experimental infection of albino mice. The histopathological patterns are intermediate to those seen with infection caused by N. fowleri and N. australiensis or Acanthamoeba spp. An acute inflammatory reaction was present within the choroid plexus, ependyma, midbrain, cerebellum, and basal ganglia. Occasional single amebic trophozoites were found within some microabscesses. Cysts were not identified. Involvement of the olfactory neuroepithelium and of the nasal mucosa was not detected.