Respiratory microsporidiosis caused by Enterocytozoon bieneusi in an HIV-negative hematopoietic stem cell transplant recipient

A 23-year-old, HIV-negative woman who had undergone a hematopoietic stem cell transplantation was admitted to the hospital with respiratory failure and symptoms of bronchiolitis obliterans. A chest computed tomography scan revealed diffuse ground-glass opacification and fibrous plugs. Due to worsening respiratory failure despite treatment, ventilation was provided through a tracheostomy tube. Molecular examination of bronchoalveolar lavage and urine revealed Enterocytozoon bieneusi infection. After treatment with albendazole the patient gradually improved, but the pathogen was not eradicated and reappeared on follow-up examination. E. bieneusi belongs to the most clinically important microsporidial species infecting humans, mostly those who are immunocompromised. This fungus tends to infect enterocytes of the intestine, and there are limited studies concerning its extraintestinal location. This is the first report of a case of disseminated respiratory and urinary E. bieneusi infection in a transplant recipient. Keywords: Enterocytozoon bieneusi, Respiratory tract infection, Hematopoietic stem cell transplan

Antimicrobial prophylaxis in adults and children undergoing hematopoietic cell transplantation: 2021 Polish recommendations

Infections are still a major reason of morbidity and one of the most common causes of death after hematopoietic cell transplantation (HCT). Antimicrobial prophylaxis plays a crucial role in decreasing non-relapse mortality after HCT. The objective of this guideline paper is presentation of current recommendations of antimicrobial prophylaxis for children and adults after hematopoietic cell transplantation, prepared in cooperation of Polish scientific hematological societies. Recommendations were prepared by the working group and finally approved by all 23 Polish transplant centers for children and adults. Existing ECIL (European Conference on Infections in Leukemia) and EBMT (European Society of Blood and Marrow Transplantation) guidelines, as well as results of survey performed among all Polish transplant centers, were the background material for working group. Recommendations are presented in sections dedicated to antibacterial prophylaxis, antifungal prophylaxis, antiviral prophylaxis, as well as prophylaxis of toxoplasmosis and infections with Pneumocystis jiroveci. Recommendations on principles of vaccination against COVID-19 are provided based on the state of knowledge in September 2021. A section on guidelines of environmental prophylaxis is also presented