ENCEPHALITOZOON-CUNICULI MICROSPORIDIOSIS - INFECTION OF THE BRAIN, HEART, KIDNEYS, TRACHEA, ADRENAL-GLANDS, AND URINARY-BLADDER IN A PATIENT WITH AIDS

A female AIDS patient, dying with widely disseminated Encephalitozoon cuniculi microsporidiosis, cytomegalovirus (CMV) disease, and Pneumocy stis carinii infection, is described. Indirect immunofluorescent antib ody staining studies and molecular analyses identified the microsporid ian as the dog strain of E. cuniculi. Autopsy revealed necrotizing mic rosporidiosis of the adrenal glands and kidneys, with lesser involveme nt of the brain, heart, trachea, urinary bladder, spleen, and lymph no des. Cellular targets included macrophages, epithelium, endothelium, a nd cardiac myocytes. Spore detection was enhanced by Gram-staining pol arization and fluorescence chitin stains. Central nervous system micro glial nodules were present and either contained microsporidia, CMV, or no identifiable pathogen. CMV disease was most severe in the central nervous system, trachea, adrenal glands, and colon, whereas the Pneumo cystis carinii infection was focal in the lungs, lymph nodes, and sple en. This is the first demonstration of Encephalitozoon microsporidiosi s of the brain, heart, and adrenal glands in a patient with AIDS. E. c uniculi should be included in the differential diagnosis of disseminat ed opportunistic infections in patients with AIDS.