Chapter 128 : Microsporidia

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Microsporidia are obligate intracellular, unicellular, spore-forming eukaryotes that belong to the kingdom of the Fungi. Their host range is extensive, including most invertebrates and all classes of vertebrates. More than 160 microsporidial genera and 1,300 species have been identified. Nine genera (, , , , , , , , and ) and unclassified microsporidia have been implicated in human infections. Microsporidiosis appears to occur most frequently in HIV-infected patients, but it is emerging in otherwise immunocompromised and also in immunocompetent persons. The sources of microsporidia infecting humans and their modes of transmission are uncertain but ingestion of the environmentally resistant spores is probably the most important mode of transmission; transmission by dust or aerosol may also occur. Waterborne, foodborne, and zoonotic infections have been reported. In the immunocompromised host, microsporidial infections were found in organ-transplant recipients, in patients with hematologic malignancies receiving monoclonal antibody therapy, in patients with rheumatic disease undergoing anti-tumor necrosis factor therapy, in the elderly, and in malnourished children. The clinical manifestations are diverse, including intestinal, pulmonary, ocular, muscular, cerebral, renal disease, and disseminated infection. In immunocompetent persons, microsporidia are associated with keratoconjunctivitis, self-limiting diarrhea, and rarely cerebral infection. Microsporidia are also detected in asymptomatic persons. Diagnosis is made by morphological or molecular detection of the organisms. Immunofluorescence technique, electron microscopy, or genetic analyses allow species identification. Treatment options are limited; some microsporidial species respond to albendazole. The most frequent HIV-associated opportunistic species, , causing diarrhea, is not susceptible to albendazole but may be treated with the experimental drug fumagillin.

Citation: Weber R, Deplazes P, Mathis A. 2015. Microsporidia, p 2209-2219. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch128
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Image of FIGURE 1

Generalized life cycle of microsporidia and identifying characteristics of the genera known to infect humans. Light stippling indicates merogonic stages; heavy stippling indicates sporogonic stages; no stippling indicates spores and sporoplasm. (A) Basic life cycle, illustrated by Development may occur in direct contact with host-cell cytoplasm (, , and ) or in isolation by host cell membranes ( and ) or a cyst-like sporophorous vesicle of pathogen origin ( and ). 1, Sporoplasm: the infective stage emergent from the spore. It may have unpaired nuclei (monokaryotic) or two nuclei in close apposition (diplokaryotic), depending on the genus. 2, Merogony: proliferative stage. It may have a simple plasma membrane, but a surface coat is present in , , and . Division can be by binary or multiple fission into two or more individuals. 3, Sporont: the first stage of sporogony. If not already present, a surface coat is added (this step is delayed in ). 4, Sporogony: divisions culminating in spore production. Binary or multiple fissions give rise to sporoblasts. 5, Sporoblasts: end products of sporogony, which mature into spores. 6, Spores: resistant stages for transmission. Spores are characterized by an extrusion apparatus (polar tube), which serves to conduct the sporoplasm into a host cell. The polar tube may be of uniform diameter (isofilar) or show a sharp decrease in diameter in the most posterior coils (anisofilar). (B to G) Identifying characteristics of genera. (B) . Members of this genus are diplokaryotic and disporoblastic; the life cycle is like that of , but meronts are of bizarre shapes and possess a surface coat with vesiculotubular structures (vt) embedded in it and extended from it. (C) . Members of this genus are diplokaryotic and polysporoblastic; all stages, including spores, are isolated in a close-fitting, ribosome-studded cisterna of host endoplasmic reticulum (er). (D) . Members of this genus are monokaryotic and polysporoblastic; meronts and sporonts are multinucleate stages called plasmodia; a thick surface coat is already present on meronts and sporonts ( ); this coat separates from the sporogonial plasmodium to form a cyst-like vesicle, the sporophorous vesicle; the plasmodium divides within it to produce numerous spores ( ). (E) . Members of this genus are monokaryotic and polysporoblastic. The meront surface coat has branched extensions ( ); these are withdrawn when the coat separates to form the sporophorous vesicle around a uninucleate sporont; the sporont undergoes a series of binary fissions ( and ) and finally encloses numerous spores ( ). (F) . Members of this genus are monokaryotic and di- or tetrasporoblastic; all stages of the life cycle, developing from the sporoplasm, occur concurrently within a host cell vacuole (parasitophorous vacuole); merogonic stages are appressed against the vacuole wall; sporogonic stages are free; the vacuole is finally packed with spores, so that it superficially resembles a sporophorous vesicle. (G) . Members of this genus are monokaryotic and polysporoblastic; meronts ( ) have irregular nuclei and lucent clefts; sporonts ( ) are multinucleate with rounded nuclei and have highly characteristic electron-dense disks, which are polar tube precursors; all spore organelles are formed prematurely, so that constriction around the sets of organelles and a nucleus ( ) gives rise directly to almost mature spores. The surface coat is deposited only during constriction. doi:10.1128/9781555817381.ch128.f1

Citation: Weber R, Deplazes P, Mathis A. 2015. Microsporidia, p 2209-2219. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch128
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Image of FIGURE 2

Transmission electron micrograph showing the duodenal epithelium of a HIV-infected patient infected with . The different developmental stages between the enterocyte nuclei and the microvillus border include a proliferative plasmodium ( ), late sporogonial plasmodia ( ), and mature spores (arrow). Magnification, ×5,370. (Courtesy of M. A. Spycher, University Hospital, Zurich, Switzerland.) doi:10.1128/9781555817381.ch128.f2

Citation: Weber R, Deplazes P, Mathis A. 2015. Microsporidia, p 2209-2219. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch128
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Image of FIGURE 3

Smear of a stool specimen from a patient with AIDS and chronic diarrhea, showing pinkish red-stained spores of that measure 0.7 to 1.0 by 1.1 to 1.6 μm. Chromotrope staining was used. Magnification, ×1,000 (oil immersion). doi:10.1128/9781555817381.ch128.f3

Citation: Weber R, Deplazes P, Mathis A. 2015. Microsporidia, p 2209-2219. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch128
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Image of FIGURE 4

(Left) Terminal ileal tissue obtained by ileocolonoscopy from a patient with AIDS and chronic diarrhea due to infection. Gram-labile microsporidial spores, measuring 0.7 to 1.0 by 1.1 to 1.6 μm, are found at a supranuclear location within small intestinal enterocytes. Brown-Brenn stain was used. Magnification ×1,000. (Middle) Cytospin preparation of bronchoalveolar-lavage fluid from a patient with AIDS and intestinal infection, showing intracellular microsporidia. Giemsa stain was used. Magnification ×1,000 (oil immersion). (Right) Urine sediment from a patient with AIDS and disseminated infection, showing pinkish red-stained microsporidial spores measuring 1.0 to 1.5 by 2.0 to 3.0 μm. Chromotrope stain was used. Magnification, ×1,000 (oil immersion). doi:10.1128/9781555817381.ch128.f4

Citation: Weber R, Deplazes P, Mathis A. 2015. Microsporidia, p 2209-2219. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch128
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1. Weber R,, Bryan RT,, Schwartz DA,, Owen RL. 1994. Human microsporidial infections. Clin Microbiol Rev 7: 42661.
2. Wittner M,, Weiss LM ( ed). 1999. The Microsporidia and Microsporidiosis. ASM Press, Washington, DC.
3. Mathis A,, Weber R,, Deplazes P. 2005. Zoonotic potential of the microsporidia. Clin Microbiol Rev 18: 423445.
4. Didier ES,, Weiss LM. 2011. Microsporidiosis: not just in AIDS patients. Curr Opin Infect Dis 24: 490495.
5. Weiss LM,. 2011. Microsporidiosis, p 598614. In Palmer SR,, Soulsby L,, Torgerson PR,, Brown DWG ( ed), Oxford Textbook of Zoonoses Biology, Clinical Practice, and Public Health Control. Oxford University Press, Inc, New York, NY.
6. Katinka MD,, Duprat S,, Cornillot E,, Méténier G,, Thomarat F,, Prensier G,, Barbe V,, Peyretaillade E,, Brottier P,, Wincker P,, Delbac F,, El Alaoui H,, Peyret P,, Saurin W,, Gouy M,, Weissenbach J,, Vivarès CP. 2001. Genome sequence and gene compaction of the eukaryote parasite Encephalitozoon cuniculi. Nature 414: 450453.
7. Akiyoshi DE,, Morrison HG,, Lei S,, Feng X,, Zhang Q,, Corradi N,, Mayanja H,, Tumwine JK,, Keeling PJ,, Weiss LM,, Tzipori S. 2009. Genomic survey of the non-cultivatable opportunistic human pathogen, Enterocytozoon bieneusi. PLoS Pathog 5: e1000261. 10.1371/journal.ppat. 1000261.
8. Williams BA,, Lee RC,, Becnel JJ,, Weiss LM,, Fast NM,, Keeling PJ. 2008. Genome sequence surveys of Brachiola algerae and Edhazardia aedis reveal microsporidia with low gene densities. BMC Genomics 9: 200.
9. Vossbrinck CR,, Maddox JV,, Friedman S,, Debrunner-Vossbrinck BA,, Woese CR. 1987. Ribosomal RNA sequence suggests microsporidia are extremely ancient eukaryotes. Nature 326: 411414.
10. Williams BA,, Hirt RP,, Lucocq JM,, Embley TM. 2002. A mitochondrial remnant in the microsporidian Trachipleistophora hominis. Nature 418: 865869.
11. Vávra J. 2005. "Polar vesicles” of microsporidia are mitochondrial remnants (“mitosomes”)? Folia Parasitol (Praha) 52: 193195.
12. Hibbett DS,, Binder M,, Bischoff JF,, Blackwell M,, Cannon PF,, Eriksson OE,, Huhndorf S,, James T,, Kirk PM,, Lücking R,, Thorsten Lumbsch H,, Lutzoni F,, Matheny PB,, McLaughlin DJ,, Powell MJ,, Redhead S,, Schoch CL,, Spatafora JW,, Stalpers JA,, Vilgalys R,, Aime MC,, Aptroot A,, Bauer R,, Begerow D,, Benny GL,, Castlebury LA,, Crous PW,, Dai YC,, Gams W,, Geiser DM,, Griffith GW,, Gueidan C,, Hawksworth DL,, Hestmark G,, Hosaka K,, Humber RA,, Hyde KD,, Ironside JE,, Kõljalg U,, Kurtzman K,, Larsson KH,, Lichtwardt R,, Longcore J,, Miadlikowska J,, Miller A,, Moncalvo JM,, Mozley-Standridge S,, Oberwinkler F,, Parmasto E,, Reeb V,, Rogers JD,, Roux C,, Ryvarden L,, Sampaio JP,, Schüssler A,, Sugiyama J,, Thorn RG,, Tibell L,, Untereiner WA,, Walker C,, Wang Z,, Weir A,, Weiss M,, White MM,, Winka K,, Yao YJ,, Zhang N. 2007. A higher-level phylogenetic classification of the Fungi. Mycol Res 111: 509547.
13. James TY,, Kauff F,, Schoch CL,, Matheny PB,, Hofstetter V,, Cox CJ,, Celio G,, Gueidan C,, Fraker E,, Miadlikowska J,, Lumbsch HT,, Rauhut A,, Reeb V,, Arnold AE,, Amtoft A,, Stajich JE,, Hosaka K,, Sung GH,, Johnson D,, O’Rourke B,, Crockett M,, Binder M,, Curtis JM,, Slot JC,, Wang Z,, Wilson AW,, Schüssler A,, Longcore JE,, O’Donnell K,, Mozley-Standridge S,, Porter D,, Letcher PM,, Powell MJ,, Taylor JW,, White MM,, Griffith GW,, Davies DR,, Humber RA,, Morton JB,, Sugiyama J,, Rossman AY,, Rogers JD,, Pfister DH,, Hewitt D,, Hansen K,, Hambleton S,, Shoemaker RA,, Kohlmeyer J,, Volkmann-Kohlmeyer B,, Spotts RA,, Serdani M,, Crous PW,, Hughes KW,, Matsuura K,, Langer E,, Langer G,, Untereiner WA,, Lucking R,, Büdel B,, Geiser DM,, Aptroot A,, Diederich P,, Schmitt I,, Schultz M,, Yahr R,, Hibbett DS,, Lutzoni F,, McLaughlin DJ,, Spatafora JW,, Vilgalys R. 2006. Reconstructing the early evolution of Fungi using a six-gene phylogeny. Nature 443: 818822.
14. Lee SC,, Corradi N,, Byrnes EJ III,, Torres-Martinez S,, Dietrich FS,, Keeling PJ,, Heitman J. 2008. Microsporidia evolved from ancestral sexual fungi. Curr Biol 18: 16751679.
15. Franzen C,, Nassonova ES,, Schölmerich J,, Issi IV. 2006. Transfer of the members of the genus Brachiola (microsporidia) to the genus Anncaliia based on ultrastructural and molecular data. J Eukaryot Microbiol 53: 2635.
16. Cali A,, Takvorian PM,, Lewin S,, Rendel M,, Sian CS,, Wittner M,, Tanowitz HB,, Keohane E,, Weiss LM. 1998. Brachiola vesicularum, n. g., n. sp. a new microsporidium associated with AIDS and myositis. J Eukaryot Microbiol 45: 240251.
17. Margileth AM,, Strano AJ,, Chandra R,, Neafie R,, Blum M,, McCully RM. 1973. Disseminated nosematosis in an immunologically compromised infant. Arch Pathol 95: 145150.
18. Cali A,, Weiss LM,, Takvorian PM. 2004. An analysis of the microsporidian genus Brachiola, with comparisons of human and insect isolates of Brachiola algerae. J Eukaryot Microbiol 51: 678685.
19. Didier ES,, Didier PJ,, Friedberg DN,, Stenson SM,, Orenstein JM,, Yee RW,, Tio FO,, Davis RM,, Vossbrinck C,, Millichamp N,, Shadduck JA. 1991. Isolation and characterization of a new human microsporidian, Encephalitozoon hellem (n. sp.), from three AIDS patients with keratoconjunctivitis. J Infect Dis 163: 617621.
20. Cali A,, Kotler DP,, Orenstein JM. 1993. Septata intestinalis n.g., n. sp., an intestinal microsporidian associated with chronic diarrhea and dissemination in AIDS patients. J Eukaryot Microbiol 40: 101112.
21. Didier ES,, Vossbrinck CR,, Baker MD,, Rogers LB,, Bertucci DC,, Shadduck JA. 1995. Identification and characterization of three Encephalitozoon cuniculi strains. Parasitology 111( Pt 4) : 411421.
22. Benz P,, Maass G,, Csokai J,, Fuchs-Baumgartinger A,, Schwendenwein I,, Tichy A,, Nell B. 2011. Detection of Encephalitozoon cuniculi in the feline cataractous lens. Vet Ophthalmol 14( Suppl 1) : 3747.
23. Suankratay C,, Thiansukhon E,, Nilaratanakul V,, Putaporntip C,, Jongwutiwes S. 2012. Disseminated infection caused by novel species of Microsporidium, Thailand. Emerg Infect Dis 18: 302304.
24. Desportes I,, Le Charpentier Y,, Galian A,, Bernard F,, Cochand-Priollet B,, Lavergne A,, Ravisse P,, Modigliani R. 1985. Occurrence of a new microsporidan: Enterocytozoon bieneusi n.g., n. sp., in the enterocytes of a human patient with AIDS. J Protozool 32: 250254.
25. Cali A,, Takvorian PM. 2003. Ultrastructure and development of Pleistophora ronneafiei n. sp., a microsporidium (Protista) in the skeletal muscle of an immune-compromised individual. J Eukaryot Microbiol 50: 7785.
26. Hollister WS,, Canning EU,, Weidner E,, Field AS,, Kench J,, Marriott DJ. 1996. Development and ultrastructure of Trachipleistophora hominis n.g., n.sp. after in vitro isolation from an AIDS patient and inoculation into athymic mice. Parasitology 112( Pt 1) : 143154.
27. Vávra J,, Yachnis AT,, Shadduck JA,, and Orenstein JM. 1998. Microsporidia of the genus Trachipleistophora—causative agents of human microsporidiosis: description of Trachipleistophora anthropophthera n. sp. (Protozoa: Microsporidia). J Eukaryot Microbiol 45: 273283.
28. Choudhary MM,, Metcalfe MG,, Arrambide K,, Bern C,, Visvesvara GS,, Pieniazek NJ,, Bandea RD,, Deleon-Carnes M,, Adem P,, Choudhary MM,, Zaki SR,, Saeed. 2011 MU. Tubulinosema sp. microsporidian myositis in immunosuppressed patient. Emerg Infect Dis 17: 17271730.
29. Meissner EG,, Bennett JE,, Qvarnstrom Y,, da Silva A,, Chu EY,, Tsokos M,, Gea-Banacloche J. 2012. Disseminated microsporidiosis in an immunosuppressed patient. Emerg Infect Dis 18: 11551158.
30. Silveira H,, Canning EU. 1995. Vittaforma corneae n. comb. for the human microsporidium Nosema corneum Shadduck, Meccoli, Davis & Font, 1990, based on its ultrastructure in the liver of experimentally infected athymic mice. J Eukaryot Microbiol 42: 158165.
31. Canning EU,. 1993. Microsporidia, p 299370. In Kreier JP ( ed), Parasitic Protozoa, vol 6. Academic Press, London, United Kingdom.
32. Weber R,, Kuster H,, Visvesvara GS,, Bryan RT,, Schwartz DA,, Luthy R. 1993. Disseminated microsporidiosis due to Encephalitozoon hellem: pulmonary colonization, microhematuria, and mild conjunctivitis in a patient with AIDS. Clin Infect Dis 17: 415419.
33. Lam TS,, Wong MH,, Chuang SK. 2013. Microsporidial keratoconjunctivitis outbreak among athletes from Hong Kong who visited Singapore, 2012. Emerg Infect Dis 19: 516517.
34. Fan NW,, Wu CC,, Chen TL,, Yu WK,, Chen CP,, Lee SM,, Lin PY. 2012. Microsporidial keratitis in patients with hot springs exposure. J Clin Microbiol 50: 414418.
35. Karanis P,, Kourenti C,, Smith H. 2007. Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt. J Water Health 5: 138.
36. Cheng HW,, Lucy FE,, Graczyk TK,, Broaders MA,, Mastitsky SE. 2011. Municipal wastewater treatment plants as removal systems and environmental sources of human-virulent microsporidian spores. Parasitol Res 109: 595603.
37. Decraene V,, Lebbad M,, Botero-Kleiven S,, Gustavsson AM,, Löfdahl M. 2012. First reported foodborne outbreak associated with microsporidia, Sweden, October 2009. Epidemiol Infect 140: 519527.
38. Jedrzejewski S,, Graczyk TK,, Slodkowicz-Kowalska A,, Tamang L,, Majewska AC. 2007. Quantitative assessment of contamination of fresh food produce of various retail types by human-virulent microsporidian spores. Appl Environ Microbiol 73: 40714073.
39. Lee JH. 2008. Molecular detection of Enterocytozoon bieneusi and identification of a potentially human-pathogenic genotype in milk. Appl Environ Microbiol 74: 16641666.
40. Deplazes P,, Mathis A,, Baumgartner R,, Tanner I,, Weber R. 1996. Immunologic and molecular characteristics of Encephalitozoon-like microsporidia isolated from humans and rabbits indicate that Encephalitozoon cuniculi is a zoonotic parasite. Clin Infect Dis 22: 557559.
41. Bart A,, Wentink-Bonnema EM,, Heddema ER,, Buijs J,, van Gool T. 2008. Frequent occurrence of human-associated microsporidia in fecal droppings of urban pigeons in Amsterdam, the Netherlands. Appl Environ Microbiol 74: 70567058.
42. Bornay-Llinares FJ,, da Silva AJ,, Moura H,, Schwartz DA,, Visvesvara GS,, Pieniazek NJ,, Cruz-López A,, Hernández-Jaúregui P,, Guerrero J,, Enriquez FJ. 1998. Immunologic, microscopic, and molecular evidence of Encephalitozoon intestinalis ( Septata intestinalis) infection in mammals other than humans. J Infect Dis 178: 820826.
43. Li W,, Cama V,, Akinbo FO,, Ganguly S,, Kiulia NM,, Zhang X,, Xiao L. 2013. Multilocus sequence typing of Enterocytozoon bieneusi: lack of geographic segregation and existence of genetically isolated sub-populations. Infect Genet Evol 14: 111119.
44. Coyle CM,, Weiss LM,, Rhodes LV III,, Cali A,, Takvorian PM,, Brown DF,, Visvesvara GS,, Xiao L,, Naktin J,, Young E,, Gareca M,, Colasante G,, Wittner M. 2004. Fatal myositis due to the microsporidian Brachiola algerae, a mosquito pathogen. N. Engl J Med 351: 4247.
45. Visvesvara GS,, Belloso M,, Moura H,, Da Silva AJ,, Moura IN,, Leitch GJ,, Schwartz DA,, Chevez-Barrios P,, Wallace S,, Pieniazek NJ,, Goosey JD. 1999. Isolation of Nosema algerae from the cornea of an immunocompetent patient. J Eukaryot Microbiol 46: 10S.
46. Lanternier F,, Boutboul D,, Menotti J,, Chandesris MO,, Sarfati C,, Mamzer Bruneel MF,, Calmus Y,, Mechaï F,, Viard JP,, Lecuit M,, Bougnoux ME,, Lortholary O. 2009. Microsporidiosis in solid organ transplant recipients: two Enterocytozoon bieneusi cases and review. Transpl Infect Dis 11: 8388.
47. Desoubeaux G,, Caumont C,, Passot C,, Dartigeas C,, Bailly E,, Chandenier J,, Duong TH. 2012. Two cases of opportunistic parasite infections in patients receiving alemtuzumab. J Clin Pathol 65: 9295.
48. Aikawa NE,, Twardowsky Ade O,, Carvalho JF,, Silva CA,, Silva IL,, Ribeiro AC,, Saad CG,, Moraes JC,, Toledo RA,, Bonfá E. 2011. Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs? Clinics (Sao Paulo) 66: 11711175.
49. Lores B,, López-Miragaya I,, Arias C,, Fenoy S,, Torres J,, del Aguila C. 2002. Intestinal microsporidiosis due to Enterocytozoon bieneusi in elderly human immunodeficiency virus-negative patients from Vigo, Spain. Clin Infect Dis 34: 918921.
50. Mor SM,, Tumwine JK,, Naumova EN,, Ndeezi G,, Tzipori S. 2009. Microsporidiosis and malnutrition in children with persistent diarrhea, Uganda. Emerg Infect Dis 15: 4952.
51. Tham AC,, Sanjay S. 2012. Clinical spectrum of microsporidial keratoconjunctivitis. Clin Experiment Ophthalmol 40: 512518.
52. Wright SG. 2012. Protozoan infections of the gastrointestinal tract. Infect Dis Clin North Am 26: 323339.
53. Matsubayashi H,, Koike T,, Mikata I,, Takei H,, Hagiwara S. 1959. A case of Encephalitozoon-like body infection in man. AMA Arch Pathol 67: 181187.
54. Bergquist NR,, Stintzing G,, Smedman L,, Waller T,, Andersson T. 1984. Diagnosis of encephalitozoonosis in man by serological tests. Br Med J (Clin Res Ed) 288: 902.
55. Ditrich O,, Chrdle A,, Sak B,, Chmelik V,, Kubále J,, Dyková I,, Kvác M. 2011. Encephalitozoon cuniculi genotype I as a causative agent of brain abscess in an immunocompetent patient. J Clin Microbiol 49: 27692771.
56. Sak B,, Kvácˇ M,, Kucˇerová Z,, Kveˇnˇtonová D,, Saková K. 2011. Latent microsporidial infection in immunocompetent individuals: a longitudinal study. PLoS Negl Trop Dis 5: e1162. 10.1371/journal.pntd.0001162
57. Moretto MM,, Khan IA,, Weiss LM. 2012. Gastrointestinal cell mediated immunity and the microsporidia. PLoS Pathog 8: e1002775. 10.1371/journal.ppat.1002775
58. Weber R,, Ledergerber B,, Zbinden R,, Altwegg M,, Pfyffer GE,, Spycher MA,, Briner J,, Kaiser L,, Opravil M,, Meyenberger C,, Flepp M. 1999. Enteric infections and diarrhea in human immunodeficiency virus-infected persons: prospective community-based cohort study. Swiss HIV Cohort Study. Arch Intern Med 159: 14731480.
59. Weber R,, Kuster H,, Keller R,, Bächi T,, Spycher MA,, Briner J,, Russi E,, Lüthy R. 1992. Pulmonary and intestinal microsporidiosis in a patient with the acquired immunodeficiency syndrome. Am Rev Respir Dis 146: 16031605.
60. Breton J,, Bart-Delabesse E,, Biligui S,, Carbone A,, Seiller X,, Okome-Nkoumou M,, Nzamba C,, Kombila M,, Accoceberry I,, Thellier M. 2007. New highly divergent rRNA sequence among biodiverse genotypes of Enterocytozoon bieneusi strains isolated from humans in Gabon and Cameroon. J Clin Microbiol 45: 25802589.
61. Weber R,, Deplazes P,, Flepp M,, Mathis A,, Baumann R,, Sauer B,, Kuster H,, Lüthy R. 1997. Cerebral microsporidiosis due to Encephalitozoon cuniculi in a patient with human immunodeficiency virus infection. N Engl J Med 336: 474478.
62. Mertens RB,, Didier ES,, Fishbein MC,, Bertucci DC,, Rogers LB,, Orenstein JM. 1997. Encephalitozoon cuniculi microsporidiosis: infection of the brain, heart, kidneys, trachea, adrenal glands, and urinary bladder in a patient with AIDS. Mod Pathol 10: 6877.
63. Filho MM,, Ribeiro HB,, Paula LJC,, Nishioka SAD,, Tamaki WT,, Costa R,, Siqueira SF,, Kawakami JT,, Higuchi ML. 2009. Endocarditis secondary to microsporidia: giant vegetation in a pacemaker user. Circulation 119: e386e388. (Erratum, 121:e9, 2010.)
64. Kester KE,, Turiansky GW,, McEvoy PL. 1998. Nodular cutaneous microsporidiosis in a patient with AIDS and successful treatment with long-term oral clindamycin therapy. Ann Intern Med 128: 911914.
65. Enriquez FJ,, Taren D,, Cruz-López A,, Muramoto M,, Palting JD,, Cruz P. 1998. Prevalence of intestinal encephalitozoonosis in Mexico. Clin Infect Dis 26: 12271229.
66. Raynaud L,, Delbac F,, Broussolle V,, Rabodonirina M,, Girault V,, Wallon M,, Cozon G,, Vivares CP,, Peyron F. 1998. Identification of Encephalitozoon intestinalis in travelers with chronic diarrhea by specific PCR amplification. J Clin Microbiol 36: 3740.
67. Tu EY,, Joslin CE. 2012. Microsporidia and Acanthamoeba: the role of emerging corneal pathogens. Eye (Lond) 26: 222227.
68. Deplazes P,, Mathis A,, van Saanen M,, Iten A,, Keller R,, Tanner I,, Glauser MP,, Weber R,, Canning EU. 1998. Dual microsporidial infection due to Vittaforma corneae and Encephalitozoon hellem in a patient with AIDS. Clin Infect Dis 27: 15211524.
69. Ledford DK,, Overman MD,, Gonzalvo A,, Cali A,, Mester SW,, Lockey RF. 1985. Microsporidiosis myositis in a patient with the acquired immunodeficiency syndrome. Ann Intern Med 102: 628630.
70. Field AS,, Marriott DJ,, Milliken ST,, Brew BJ,, Canning EU,, Kench JG,, Darveniza P,, Harkness JL. 1996. Myositis associated with a newly described microsporidian, Trachipleistophora hominis, in a patient with AIDS. J Clin Microbiol 34: 28032811.
71. Visvesvara GS,, Moura H,, Leitch GJ,, Schwartz DA,, Xiao LX. 2005. Public health importance of Brachiola algerae (Microsporidia)—an emerging pathogen of humans. Folia Parasitol (Praha) 52: 8394.
72. Yachnis AT,, Berg J,, Martinez-Salazar A,, Bender BS,, Diaz L,, Rojiani AM,, Eskin TA,, Orenstein JM. 1996. Disseminated microsporidiosis especially infecting the brain, heart, and kidneys. Report of a newly recognized pansporoblastic species in two symptomatic AIDS patients. Am J Clin Pathol 106: 535543.
73. Weber R,, Schwartz DA,, Deplazes P,. 1999. Laboratory diagnosis of microsporidiosis, p 315361. In, Wittner M,, Weiss LM ( ed), The Microsporidia and Microsporidiosis. ASM Press, Washington, DC.
74. Weber R,, Bryan RT,, Owen RL,, Wilcox CM,, Gorelkin L,, Visvesvara GS. 1992. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group. N Engl J Med 326: 161166.
75. Vávra J,, Dahbiová R,, Hollister WS,, Canning EU. 1993. Staining of microsporidian spores by optical brighteners with remarks on the use of brighteners for the diagnosis of AIDS associated human microsporidioses. Folia Parasitol (Praha) 40: 267272.
76. van Gool T,, Snijders F,, Reiss P,, Eeftinck Schattenkerk JK,, van den Bergh Weerman MA,, Bartelsman JF,, Bruins JJ,, Canning EU,, Dankert J. 1993. Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique. J Clin Pathol 46: 694699.
77. Didier ES,, Orenstein JM,, Aldras A,, Bertucci D,, Rogers LB,, Janney FA. 1995. Comparison of three staining methods for detecting microsporidia in fluids. J Clin Microbiol 33: 31383145.
78. Ignatius R,, Lehmann M,, Miksits K,, Regnath T,, Arvand M,, Engelmann E,, Futh U,, Hahn H,, Wagner J. 1997. A new acid-fast trichrome stain for simultaneous detection of Cryptosporidium parvum and microsporidial species in stool specimens. J Clin Microbiol 35: 446449.
79. Moura H,, Schwartz DA,, Bornay-Llinares F,, Sodré FC,, Wallace S,, Visvesvara GS. 1997. A new and improved “quick-hot Gram-chromotrope” technique that differentially stains microsporidian spores in clinical samples, including paraffin-embedded tissue sections. Arch Pathol Lab Med 121: 888893.
80. Enriquez FJ,, Ditrich O,, Palting JD,, Smith K. 1997. Simple diagnosis of Encephalitozoon sp. microsporidial infections by using a panspecific antiexospore monoclonal antibody. J Clin Microbiol 35: 724729.
81. Accoceberry I,, Thellier M,, Desportes-Livage I,, Achbarou A,, Biligui S,, Danis M,, Datry A. 1999. Production of monoclonal antibodies directed against the microsporidium Enterocytozoon bieneusi. J Clin Microbiol 37: 41074112.
82. Field AS,, Hing MC,, Milliken ST,, Marriott DJ. 1993. Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. Med J Aust 158: 390394.
83. Menotti J,, Cassinat B,, Porcher R,, Sarfati C,, Derouin F,, Molina JM. 2003. Development of a real-time polymerase-chain-reaction assay for quantitative detection of Enterocytozoon bieneusi DNA in stool specimens from immunocompromised patients with intestinal microsporidiosis. J Infect Dis 187: 14691474.
84. Menotti J,, Cassinat B,, Sarfati C,, Liguory O,, Derouin F,, Molina JM. 2003. Development of a real-time PCR assay for quantitative detection of Encephalitozoon intestinalis DNA. J Clin Microbiol 41: 14101413.
85. Carville A,, Mansfield K,, Widmer G,, Lackner A,, Kotler D,, Wiest P,, Gumbo T,, Sarbah S,, Tzipori S. 1997. Development and application of genetic probes for detection of Enterocytozoon bieneusi in formalin-fixed stools and in intestinal biopsy specimens from infected patients. Clin Diagn Lab Immunol 4: 405408.
86. Visvesvara GS. 2002. In vitro cultivation of microsporidia of clinical importance. Clin Microbiol Rev 15: 401413.
87. van Gool T,, Biderre C,, Delbac F,, Wentink-Bonnema E,, Peek R,, Vivarès CP. 2004. Serodiagnostic studies in an immunocompetent individual infected with Encephalitozoon cuniculi. J Infect Dis 189: 22432249.
88. Didier ES. 1997. Effects of albendazole, fumagillin, and TNP-470 on microsporidial replication in vitro. Antimicrob Agents Chemother 41: 15411546.
89. Didier PJ,, Phillips JN,, Kuebler DJ,, Nasr M,, Brindley PJ,, Stovall ME,, Bowers LC,, Didier ES. 2006. Antimicrosporidial activities of fumagillin, TNP-470, ovalicin, and ovalicin derivatives in vitro and in vivo. Antimicrob Agents Chemother 50: 21462155.
90. Molina JM,, Chastang C,, Goguel J,, Michiels JF,, Sarfati C,, Desportes-Livage I,, Horton J,, Derouin F,, Modaï J. 1998. Albendazole for treatment and prophylaxis of microsporidiosis due to Encephalitozoon intestinalis in patients with AIDS: a randomized double-blind controlled trial. J Infect Dis 177: 13731377.
91. Molina JM,, Tourneur M,, Sarfati C,, Chevret S,, de Gouvello A,, Gobert JG,, Balkan S,, Derouin F; Agence Nationale de Recherches surle le SIDA 090 Study Group. 2002. Fumagillin treatment of intestinal microsporidiosis. N Engl J Med 346: 19631969.
92. Champion L,, Durrbach A,, Lang P,, Delahousse M,, Chauvet C,, Sarfati C,, Glotz D,, Molina JM. 2010. Fumagillin for treatment of intestinal microsporidiosis in renal transplant recipients. Am J Transplant 10: 19251930.
93. Audemard A,, Le Bellec ML,, Carluer L,, Dargère S,, Verdon R,, Castrale C,, Lobbedez T,, Hurault de Ligny B. 2012. Fumagillin-induced aseptic meningoencephalitis in a kidney transplant recipient with microsporidiosis. Transpl Infect Dis 14: E147E149.
94. Carr A,, Marriott D,, Field A,, Vasak E,, Cooper DA. 1998. Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet 351: 256261.
95. Das S,, Sahu SK,, Sharma S,, Nayak SS,, Kar S. 2010. Clinical trial of 0.02% polyhexamethylene biguanide versus placebo in the treatment of microsporidial keratoconjunctivitis. Am J Ophthalmol 150: 110115.e2.
96. Das S,, Sharma S,, Sahu SK,, Nayak SS,, Kar S. 2012. Diagnosis, clinical features and treatment outcome of microsporidial keratoconjunctivitis. Br J Ophthalmol 96: 793795.
97. Fan NW,, Lin PY,, Chen TL,, Chen CP,, Lee SM. 2012. Treatment of microsporidial keratoconjunctivitis with repeated corneal swabbing. Am J Ophthalmol 154: 927933.e1.
98. Sangit VA,, Murthy SI,, Garg P. 2011. Microsporidial stromal keratitis successfully treated with medical therapy: a case report. Cornea 30: 12641266.
99. Khandelwal SS,, Woodward MA,, Hall T,, Grossniklaus HE,, Stulting RD. 2011. Treatment of microsporidia keratitis with topical voriconazole monotherapy. Arch Ophthalmol 129: 509510.
100. Weber R,, Deplazes P,, Mathis A,. 2011. Microsporidia, p 2190–2199. In Versalovic J,, Carroll KC,, Jorgensen JH,, Funke G,, Landry ML,, Warnock DW ( ed), Manual of Clinical Microbiology, 10th ed, vol 2. ASM Press, Washington, DC.


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Microsporidial species pathogenic in humans, and clinical manifestations

Citation: Weber R, Deplazes P, Mathis A. 2015. Microsporidia, p 2209-2219. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch128

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