Purpose: Microsporidium is a spore-forming intracellular parasite that affects a wide range of hosts including humans. The tumor necrosis factor alpha (TNF-α) plays a key role in the immunity to infection with microsporidia. Recently, the TNF-α antagonists have proven successful in treating variable autoimmune diseases. In the current study, we aimed to investigate the impact of using TNF-α antagonists as a therapeutic regimen in the prevalence of infections with microsporidia. Materials and Methods: Diarrheal patients with distinct autoimmune diseases (n = 100) were assigned to the study. Patients taking anti-TNF-α medications (n = 60) were allocated to Group 1A and those undergoing non-TNF-α inhibitor treatment (n = 40) to Group 1B. Furthermore, patients with diarrhea without autoimmune disorders (n = 20) were allocated as controls. Stool specimens, 3 per patient, were collected and microscopically examined for microsporidia spores. A microsporidia-specific stool polymerase chain reaction was used to confirm the microscopic findings. Results: Microsporidia infection was identified in 28.3% (17/60), 10% (4/40), and in 5% (1/20) of patients in Group 1A, Group 1B, and in the control group, respectively. Overall, infection was significantly high in cases compared to the controls and in patients receiving TNF-α antagonists compared to patients not given TNF-α inhibitors (P < 0.05). Finally, infection was significantly higher in cases treated with TNF-α antagonists for ≥2 months compared to cases treated for <2 months of duration (P < 0.05). Conclusion: There was a significant increase in microsporidia infection in autoimmune disease patients undergoing treatment with TNF-α antagonists, and the duration of treatment is one of the risk factors. The study highlights the importance of microsporidia testing in immunocompromised patients, particularly those undergoing treatment with anti-TNF-α drugs and emphasises the need for awareness among clinicians regarding this opportunistic parasite.


中文翻译：

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自身免疫性疾病患者的微孢子虫感染



目的：微孢子虫是一种形成孢子的细胞内寄生虫，影响包括人类在内的多种宿主。肿瘤坏死因子α（TNF-α）在抵抗微孢子虫感染的免疫力中发挥着关键作用。最近，TNF-α拮抗剂已被证明可以成功治疗多种自身免疫性疾病。在当前的研究中，我们旨在调查使用 TNF-α 拮抗剂作为治疗方案对微孢子虫感染患病率的影响。材料和方法：患有不同自身免疫性疾病的腹泻患者 ( n = 100) 被分配到该研究中。服用抗 TNF-α 药物的患者 ( n = 60) 被分配到 1A 组，接受非 TNF-α 抑制剂治疗的患者 ( n = 40) 被分配到 1B 组。此外，无自身免疫性疾病的腹泻患者 ( n = 20) 被分配为对照。收集每位患者 3 个粪便样本，并在显微镜下检查是否有微孢子虫孢子。使用微孢子虫特异性粪便聚合酶链反应来证实显微镜检查结果。结果： 1A 组、1B 组和对照组的患者中微孢子虫感染率分别为 28.3%（17/60）、10%（4/40）和 5%（1/20）。总体而言，与对照组相比，以及接受 TNF-α 拮抗剂的患者与未接受 TNF-α 抑制剂的患者相比，感染率显着升高（ P < 0.05）。最后，与接受<2id=178>P<0.05)治疗的病例相比，使用TNF-α拮抗剂治疗≥2个月的病例的感染率显着更高。 结论：接受TNF-α拮抗剂治疗的自身免疫性疾病患者微孢子虫感染显着增加，且治疗持续时间是危险因素之一。该研究强调了微孢子虫检测对免疫功能低下患者的重要性，特别是那些接受抗 TNF-α 药物治疗的患者，并强调临床医生需要提高对这种机会性寄生虫的认识。