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Volume 20, Number 2—February 2014
Synopsis

Anncaliia algerae Microsporidial Myositis

Matthew R. WattsComments to Author , Renee C.F. Chan, Elaine Y.L. Cheong, Susan Brammah, Kate R. Clezy, Chiwai Tong, Deborah Marriott, Cameron E. Webb, Bobby Chacko, Vivienne Tobias, Alexander C. Outhred, Andrew S. Field, Michael V. Prowse, James V. Bertouch, Damien Stark, and Stephen W. Reddel
Author affiliations: Centre for Infectious Diseases and Microbiology Public Health, Westmead, New South Wales, Australia (M.R. Watts, C.E. Webb, A.C. Outhred); Pathology West–Institute for Clinical Pathology and Medical Research Westmead, Westmead (M.R. Watts, C.E. Webb); University of Sydney, Sydney, New South Wales, Australia (M.R. Watts, C.E. Webb, E.Y.L. Cheong, A.C. Outhred, S.W. Reddel); Concord Repatriation General Hospital, Concord West, New South Wales, Australia (R.C.F. Chan, E.Y.L. Cheong, S. Brammah, S.W. Reddel); Prince of Wales Hospital, Randwick, New South Wales, Australia (K.R. Clezy, C. Tong, J.V. Bertouch); St Vincent’s Hospital, Darlinghurst, New South Wales, Australia (D. Marriott, A.S. Field, D. Stark); John Hunter Hospital, Newcastle, New South Wales, Australia (B. Chacko); Liverpool Hospital, Liverpool, New South Wales, Australia (V. Tobias); Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia (M.V. Prowse)

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Table 2

Diagnostic test results, management, and outcome for persons with Anncaliia algerae myositis*

Variable† Case-patient A Case-patient B Case-patient 1 (3) Case-patient 2 (5) Case-patient 3 (8)
Hemoglobin, g/L (130–180)‡ 95 122 ND 100 96
Lymphocytes ×109/L (1.5–4.0) 0.3 0.4 ND 0.2 0.1
CK U/L, peak (<200) 2,028 6,630 6,337 685 441
ALT, U/L (<45) 154 93 ND 66 50
AST, U/L (<45) 320 210 ND 129 70
ESR, mm/hr (0–14) 85 26 ND 38 30
CRP, mg/L (<3) 152 134 ND 16 41
Serum albumin, lowest, g/L (33–48) 21 19 ND 19 14
Serum creatinine, µmol/L (60–100)§ 44 202 ND 81 216
Urinary protein, g/24 h (<0.1)¶ 0.56 1.8 ND NT 1.53
Fecal stain# No microsporidia NT ND No microsporidia No microsporidia
Neurophysiology/EMG Myopathy; axonal neuropathy Myopathy; axonal neuropathy ND Myopathy; axonal neuropathy Myopathy; axonal neuropathy
Negative biopsy/fluid sites CSF Esophagus, stomach, duodenum Tracheal aspirate Bone marrow, lung, rectum, BAL, CSF NT
Positive biopsy sites Vastus lateralis Vastus lateralis Quadriceps femoris** Deltoid, tongue Deltoid
A. algerae sequence Yes Yes Yes Yes Yes
Immunosuppression reduced Yes Yes Yes Yes Yes
Albendazole Yes No Yes No Yes
Outcome Survived >18 mo Died, aspiration pneumonia Died, stroke Died, palliated Died, aspiration pneumonia

*ND, not described in publication; CK, creatinine kinase; ALT, alanine transaminase; AST, aspartate transaminase; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; EMG, electromyography; NT, not tested; CSF, cerebrospinal fluid; BAL, bronchoalveolar lavage.
†Biochemical and hematologic values are from the most recent visit to hospital, unless otherwise indicated. Reference values are in parentheses.
‡Anemia was normocytic.
§Case-patient A: serum creatinine was higher (150 μmol/L) at the first admission; case-patient B: baseline creatinine was ≈160μμmol/L; case-patient 3: preexisting renal impairment, with transplant.
¶Case-patient A: urinary myoglobin was negative; case-patient B urinary albumin:creatinine ratio 8 mo previously was normal; case-patient 3: urinary protein 2 mo previously was 0.68 g/24 h.
#Modified trichrome stain on concentrated feces.
**Component of quadriceps femoris not specified in publication.

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