Traveller's diarrhea due to microsporidia in a immunocompetent patient back from Guatemala

Microsporidia are spore forming protozoan parasites who cause a variety of diseases
among immunodeficiency patients. Only a few cases are reported among
immunocompetent patients. We report a case of intestinal microsporidial infection in a
22-year-old student, coming back from Guatemala, after one month travel.
Clinical aspects: The young boy was admitted to the hospital for napache with
stiffness, backache and fever at 39°C. He reported nonbloody diarrhea 5 days before
hospitalization, without nausea or vomiting. During his travel he also presented a few
days of self-limited diarrhea, with watery stools without fever. At the end of the trip he
had lost 10 kg. Before his travel he was vaccinated against A hepatitis, poliomyelitis,
typhoid fever and he receved a malaria prophylaxis by Nivaquine. The clinical
examination pointed out a discreet pain at the left iliac fossa, napache and fever.
Diagnosis: The biology schows an inflammatory syndrome, hyperleucocytosis, and
impairing of the hepatic tests with cholestasis. Routine cultures for bacterial pathogens
were negative. Stool examination for parasites with use of direct examination or after
diphasic concentration didn't reveal the presence of pathogens. The search of
cryptosporidia was also negative. All the serologies even against the HIV for the
search of a viral etiology were negative. By the use of a modified trichrome stain, some
bright pink-red organism mesuring 1-2µ were detected by light microscopy in three
consecutive stools. We concluded to the presence of protozoa of the phylum
Microspora. Treatment: The patient receved first ciprofloxacine then albendazole, as
specifically treatment. All the symptoms disappeared one month after hospitalization.
The low charge of parasites didn't allow electron microscopy nor polymerase chain
reaction for the determination of the species.