Clinical significance of enteric protozoa in the immunosuppressed human population

Abstract

Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4(+) cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.

FIG. 1.

Photomicrographs of enteric protozoa stained with a modified iron-hematoxylin stain (incorporating a carbol fuschin staining step). (A) Cyclospora oocysts; (B) Cryptosporidium oocysts; (C) Dientamoeba fragilis binucleated trophozoite; (D) Dientamoeba fragilis uninucleated trophozoite; (E) Entamoeba histolytica cysts; (F) Entamoeba histolytica trophozoite; (G) Giardia cysts; (H) Giardia trophozoites. Bars represent 10 μm.