Differences in the intensity of infection caused by Encephalitozoon cuniculi genotype II and III - Comparison using quantitative real-time PCR

Microsporidia (Encephalitozoon cuniculi) in Patients with Degenerative Hip and Knee Disease, Czech Republic

Total joint arthroplasty is a commonly used surgical procedure in orthopedics. Revision surgeries are required in >10% of patients mainly because of prosthetic joint infection caused by bacteria or aseptic implant loosening caused by chronic inflammation. Encephalitozoon cuniculi is a microsporidium, an obligate intracellular parasite, capable of exploiting migrating proinflammatory immune cells for dissemination within the host. We used molecular detection methods to evaluate the incidence of E. cuniculi among patients who had total hip or knee arthroplasty revision. Out of 49 patients, E. cuniculi genotypes I, II, or III were confirmed in joint samples from 3 men and 2 women who had implant loosening. Understanding the risks associated with the presence of microsporidia in periprosthetic joint infections is essential for proper management of arthroplasty. Furthermore, E. cuniculi should be considered a potential contributing cause of joint inflammation and arthrosis.

Chronic Infections in Mammals Due to Microsporidia

Microsporidia are pathogenic organism related to fungi. They cause infections in a wide variety of mammals as well as in avian, amphibian, and reptilian hosts. Many microsporidia species play an important role in the development of serious diseases that have significant implications in human and veterinary medicine. While microsporidia were originally considered to be opportunistic pathogens in humans, it is now understood that infections also occur in immune competent humans. Encephalitozoon cuniculi, Encephalitozoon intestinalis, and Enterocytozoon bieneusi are primarily mammalian pathogens. However, many other species of microsporidia that have some other primary host that is not a mammal have been reported to cause sporadic mammalian infections. Experimental models and observations in natural infections have demonstrated that microsporidia can cause a latent infection in mammalian hosts. This chapter reviews the published studies on mammalian microsporidiosis and the data on chronic infections due to these enigmatic pathogens.

Intestinal parasites of dogs (Canis lupus familiaris) in Svalbard (Norway): low prevalence and limited transmission with wildlife

Domesticated dogs (Canis lupus familiaris Linnaeus, 1758) are widely kept on all continents and could share parasites with free-living animals. To understand the transmission of intestinal parasites between dogs kept on the four dog stations and wildlife in Svalbard, 170 faecal samples from dogs and 203 faecal samples from wildlife, including Arctic fox (Vulpes lagopus (Linnaeus, 1758); n = 62), Svalbard reindeer (Rangifer tarandus platyrhynchus (Vrolik, 1829); n = 106), sibling vole (Microtus levis Miller, 1908; n = 63), Pink-footed Goose (Anser brachyrhynchus Baillon, 1834; n = 30), Little Auk (Alle alle (Linnaeus, 1758); n = 49), and Black-legged Kittiwake (Rissa tridactyla (Linnaeus, 1758); n = 18), were individually screened for the presence of intestinal parasites using microscopy and PCR and nucleotide sequencing methods. Additionally, the results of the study were compared with previous studies performed in the same area. The roundworm Toxascaris leonina (Linstow, 1902) was found microscopically and by PCR in a dog (n = 1). The specific DNA of three species of parasitic protists was detected in dogs from different yards. Phylogenetic analyses revealed the presence of Cryptosporidium canis Fayer, Trout, Xiao, Morgan, Lal and Dubey, 2001 (n = 1), Encephalitozoon cuniculi Levaditi, Nicolau and Schoen, 1923 genotype II (n = 4), and dog-specific Enterocytozoon bieneusi Desportes, Le Charpentier, Galian, Bernard, Cochand-Priollet, Lavergne, Ravisse and Modigliani, 1985 genotypes (n = 12). This study showed overall a low prevalence of intestinal parasites in dogs in Svalbard and possible but minimal transmission with wildlife.

The course of infection of Encephalitozoon cuniculi genotype I in mice possess combination of features reported in genotypes II and III

Out of three genotypes of Encephalitozoon cuniculi (I-III) available for experimental studies, E. cuniculi genotype I remains the less characterized. This study describes for the first time individual phases of microsporidiosis caused by E. cuniculi genotype I and efficacy of albendazole treatment in immunocompetent BALB/c and C57Bl/6 mice and immunodeficient SCID, CD4^-/- and CD8^-/- mice using molecular detection and quantification methods. We demonstrate asymptomatic infection despite an intense dissemination of microsporidia into most organs within the first weeks post infection, followed by a chronic infection characterized by significant microsporidia persistence in immunocompetent, CD4^-/- and CD8^-/- mice and a lethal outcome for SCID mice. Albendazole application led to loss E. cuniculi genotype I infection in immunocompetent mouse strains, decreased spore burden by half in CD4^-/- and CD8^-/- mice, and prolongation of survival of SCID mice. These results showed Encephalitozoon cuniculi genotype I infection extend and albendazole sensitivity was comparable to E. cuniculi genotype II, but the infection onset speed and mortality rate was similar to E. cuniculi genotype III. These imply that differences in the course of infection and the response to treatment depend not only on immunological status of the host, but also on the genotype causing the infection.

Encephalitozoon cuniculi Genotype II Concentrates in Inflammation Foci

Background

Microsporidia of the genus Encephalitozoon are generally connected with severe infections with lethal outcome in immunodeficient hosts. In immunocompetent hosts, microsporidiosis typically establishes a balanced host–parasite relationship that produces minimal clinically overt disease. Although the alimentary tract represents one of the main primary target tissues, the mechanisms of reaching other tissues during systemic microsporidian infections remain unclear.

Methods

In the present study, we tested the relation between inflammation induction in immunocompetent and immunodeficient mice and the presence of spores of E. cuniculi genotype II in selected organs and in fecal specimens by using molecular and histology methods.

Results

We reported the positive connection between inflammation induction and the significant increase of E. cuniculi genotype II occurrence in inflammation foci in both immunocompetent BALB/c and immunodeficient severe combined immunodeficient (SCID) mice in the acute phase of infection and the re-activation of latent microsporidial infection following inflammation induction in immunocompetent mice.

Conclusion

The results imply possible involvement of immune cells serving as vehicles transporting E. cuniculi genotype II purposefully across the whole host body towards inflammation. With increasing number of records of infections, it is necessary to reconsider microsporidia as agents responsible for various pathologies. The elucidation of possible connection with pro-inflammatory immune responses represents an important challenge with consequences for human health and development of therapeutic strategies.