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Clinical Microbiology Reviews, October 2009, p. 634-650, Vol. 22, No. 4
0893-8512/09/$08.00+0     doi:10.1128/CMR.00017-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

D. Stark,1,2* J. L. N. Barratt,1,2 S. van Hal,3 D. Marriott,1,2 J. Harkness,1,2 and J. T. Ellis2 Author Bios

Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia,1 Institute for the Biotechnology of Infectious Diseases, University of Technology Sydney, and Department of Medical and Molecular Biosciences, Broadway, New South Wales, Australia,2 Microbiology and Infectious Diseases Department, Liverpool Hospital, Sydney, New South Wales, Australia3

Summary: 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.

* Corresponding author. Mailing address: Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia. Phone: 61 2 8382 9196. Fax: 61 2 8382 2989. E-mail: dstark{at}stvincents.com.au

Clinical Microbiology Reviews, October 2009, p. 634-650, Vol. 22, No. 4
0893-8512/09/$08.00+0     doi:10.1128/CMR.00017-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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