Chapter 6 : The Microsporidial Infections: Progress in Epidemiology and Prevention

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Microsporidia have risen from obscure and anecdotal causes of keratitis and systemic disease in humans to become one of the most medically significant groups of emerging infectious agents. This chapter focuses on what is known regarding the epidemiology of human microsporidiosis and what we may be poised to better understand in the very near future. Topics covered include prevalence and geographic distribution, case demographics and populations at risk, and potential modes of transmission. The most common clinical presentation of infection, similar to that of infection, is severe chronic diarrhea, which often progresses to malabsorption and wasting syndrome. Surveys for antibodies to microsporidia in human sera have focused exclusively on human exposure to species. Although most recognized cases of human microsporidiosis are associated with some form of immunosuppression, reports describing microsporidial infections in HIV-negative, immunocompetent patients are also increasing. Microsporidia have been isolated from ditch water in a mosquito larval habitat in Florida. The only two factors which were associated with microsporidian infection were swimming in a pool and male homosexuality. One of the most exciting observations in the prevention of microsporidiosis in persons with AIDS has been the role of highly active antiretroviral therapy (HAART) in raising CD4 lymphocyte counts and heightening immunity. A high standard of personal hygiene seems mandatory for patients infected with microsporidia. Cohabitating sexual partners of infected patients should be offered screening for microsporidiosis regardless of their HIV status.

Citation: Schwartz D, Bryan R. 1999. The Microsporidial Infections: Progress in Epidemiology and Prevention, p 73-98. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch6

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Lower Respiratory Tract Infections
Upper Respiratory Tract Infections
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Color Plate 1

Keratoconjunctivitis due to showing the characteristic finding of punctate epithelial keratopathy by slit-lamp examination.

Citation: Schwartz D, Bryan R. 1999. The Microsporidial Infections: Progress in Epidemiology and Prevention, p 73-98. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch6
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Figure 1

Sample from a transplanted kidney removed from an HIV-negative kidney-pancreas transplant recipient following development of renal failure. Microsporidiosis due to was identified as the cause of renal failure. This electron micrograph shows mature spores of within necrotic renal tubules. Magnification, ×20,000.

Citation: Schwartz D, Bryan R. 1999. The Microsporidial Infections: Progress in Epidemiology and Prevention, p 73-98. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch6
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Figure 2

Electron micrograph of pig stool from Mexico showing empty microsporidian spores (ES). These microsporidia were identified as is by species-specific fluorescent-antibody examination and PCR. Magnification, ca. × 31,500.

Citation: Schwartz D, Bryan R. 1999. The Microsporidial Infections: Progress in Epidemiology and Prevention, p 73-98. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch6
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Table 1

Microsporidial species pathogenic for humans, their clinical manifestations, and recognized animal hosts or reservoirs

Citation: Schwartz D, Bryan R. 1999. The Microsporidial Infections: Progress in Epidemiology and Prevention, p 73-98. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch6

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