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Li XM, Wang XY, Wei YJ, Jiang J, Cai Y, Zhang XX, Yang X, Cao H. Meta-analysis of the global prevalence and risk factors of Enterocytozoon bieneusi infection in pigs from 1999 to 2021. Prev Vet Med 2024; 225:106159. [PMID: 38422983 DOI: 10.1016/j.prevetmed.2024.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 01/21/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Enterocytozoon bieneusi (E. bieneusi), which is one of the most common microsporidia, has been identified as an important obligate intracellular pathogen that commonly colonizes in a variety of animal species and humans worldwide, including humans. In this study, the statistical analyses of E. bieneusi infection and prevalence were performed to clarify the relationship between different genotypes in different countries. The databases Chinese National Knowledge Infrastructure (CNKI), VIP Chinese Journal Database, Wanfang Data, PubMed, Web of Science and ScienceDirect were used for data collection. The research data were subjected to subgroup, univariate regression, and correlation, to reveal factors related to the high prevalence of E. bieneusi. A total of, 34 of the 498 articles published before April 2022 met the inclusion criteria. The global prevalence of E. bieneusi in pigs was 37.69% (5175/12672). The prevalence of E. bieneusi in nursery pigs was 58.87% (588/946). In developing countries and Asia, the highest prevalence of E. bieneusi in pigs were 37.62% (4752/11645) and 40.14% (4715/11345), respectively. Moreover, humans and pigs have been found to be infected with the same genotype of E. bieneusi in some cases, as evidenced by the consolidation of genotype information. The results showed that pigs are susceptible to E. bieneusi during the nursery period. The prevalence of E. bieneusi is high in developing countries, and its genotype prevalence varies in each country. Thus, it is essential to strengthen the health inspection of vulnerable groups and customs quarantine inspection.
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Affiliation(s)
- Xiao-Man Li
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao, Shandong Province 266109, China
| | - Xiang-Yu Wang
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao, Shandong Province 266109, China
| | - Yong-Jie Wei
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao, Shandong Province 266109, China
| | - Jing Jiang
- College of Life Sciences, Changchun Sci-Tech University, Shuangyang, Jilin Province 130600, China.
| | - Yanan Cai
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province 130118, China
| | - Xiao-Xuan Zhang
- College of Veterinary Medicine, Qingdao Agricultural University, Qingdao, Shandong Province 266109, China
| | - Xing Yang
- Department of Medical Microbiology and Immunology, School of Basic Medicine, Dali, Yunnan Province 671000, China.
| | - Hongwei Cao
- School of Pharmacy, Yancheng Teachers University, Yancheng, Jiangsu Province 224002, China.
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Wang Y, Li XM, Yang X, Wang XY, Wei YJ, Cai Y, Geng HL, Yang XB, Yu HL, Cao H, Jiang J. Global prevalence and risk factors of Enterocytozoon bieneusi infection in humans: a systematic review and meta-analysis. Parasite 2024; 31:9. [PMID: 38345479 PMCID: PMC10860563 DOI: 10.1051/parasite/2024007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/22/2024] [Indexed: 02/15/2024] Open
Abstract
Enterocytozoon bieneusi is one of the most important zoonotic pathogens. In this study, we present a systematic review and meta-analysis of the prevalence of human E. bieneusi infection in endemic regions and analyze the various potential risk factors. A total of 75 studies were included. Among 31,644 individuals tested, 2,291 (6.59%) were E. bieneusi-positive. The highest prevalence of E. bieneusi in the male population was 5.50%. The prevalence of E. bieneusi in different age groups was varied, with 10.97% in teenagers. The prevalence of E. bieneusi in asymptomatic patients (6.49%) is significantly lower than that in HIV-infected patients (11.49%), and in patients with diarrheal symptoms (16.45%). Rural areas had a higher rate (7.58%) than urban ones. The prevalence of E. bieneusi in humans was the highest (6.42%) at altitudes <10 m. Moreover, the temperate zone marine climate (13.55%) had the highest prevalence. A total of 69 genotypes of E. bieneusi have been found in humans. This is the first global study regarding E. bieneusi prevalence in humans. Not only people with low immunity (such as the elderly, children, people with HIV, etc.), but also people in Europe in temperate marine climates should exercise caution to prevent infection with E. bieneusi during contact process with animals.
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Affiliation(s)
- Yanchun Wang
- School of Pharmacy, Yancheng Teachers University Yancheng 224002 Jiangsu Province PR China
- College of Life Sciences, Changchun Sci-Tech University Shuangyang 130600 Jilin Province PR China
- Department of Technology, Ningbo Sansheng Biotechnology Co., Ltd Ningbo 315000 Zhejiang Province PR China
| | - Xiao-Man Li
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Xing Yang
- Department of Medical Microbiology and Immunology, School of Basic Medicine, Dali University Dali 671000 Yunnan Province PR China
| | - Xiang-Yu Wang
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Yong-Jie Wei
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Yanan Cai
- College of Animal Science and Technology, Jilin Agricultural University Changchun 130118 Jilin Province PR China
| | - Hong-Li Geng
- College of Veterinary Medicine, Qingdao Agricultural University Qingdao 266109 Shandong Province PR China
| | - Xin-Bo Yang
- College of Animal Science and Technology, Jilin Agricultural University Changchun 130118 Jilin Province PR China
| | - Hai-Long Yu
- College of Animal Science and Technology, Jilin Agricultural University Changchun 130118 Jilin Province PR China
| | - Hongwei Cao
- School of Pharmacy, Yancheng Teachers University Yancheng 224002 Jiangsu Province PR China
| | - Jing Jiang
- College of Life Sciences, Changchun Sci-Tech University Shuangyang 130600 Jilin Province PR China
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Aseeja P, Shaikh Y, Bajpai A, Sirsikar P, Kalra SK. Advancement in our understanding of immune response against Encephalitozoon infection. Parasite Immunol 2021; 43:e12828. [PMID: 33682117 DOI: 10.1111/pim.12828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 01/15/2023]
Abstract
Microsporidia are a group of obligate, intracellular, spore-forming eukaryotic pathogens, which predominantly infects immunocompromised individuals worldwide. Encephalitozoon spp. is one of the most prevalent microsporidia known to infect humans. Host immune system plays a major role in combating pathogens including Encephalitozoon spp. infecting humans. Both innate and adaptive arms of host immune system work together in combating Encephalitozoon infection. Researchers are conducting studies to elucidate the role of both arms of immune system against Encephalitozoon infection. In addition to cell-mediated adaptive immunity, role of innate immunity is also being highlighted in clearance of Encephalitozoon spp. from host body. Therefore, the current review will give a clear and consolidated update on the role of innate as well as adaptive immunity in protection against Encephalitozoon spp.
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Affiliation(s)
- Praisy Aseeja
- Faculty of Applied Sciences & Biotechnology, Shoolini university of Biotechnology & Management Sciences, Solan, India
| | - Yasmin Shaikh
- Faculty of Applied Sciences & Biotechnology, Shoolini university of Biotechnology & Management Sciences, Solan, India
| | - Anamika Bajpai
- Centre for Translational Medicine, Lewis Katz School of Medicine, Medicine Education & Research Building, Temple University, Philadelphia, PA, USA
| | - Prachitee Sirsikar
- Faculty of Applied Sciences & Biotechnology, Shoolini university of Biotechnology & Management Sciences, Solan, India
| | - Sonali K Kalra
- Faculty of Applied Sciences & Biotechnology, Shoolini university of Biotechnology & Management Sciences, Solan, India
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Multimethodological Approach to Gastrointestinal Microsporidiosis in HIV-Infected Patients. Acta Parasitol 2019; 64:658-669. [PMID: 31286356 DOI: 10.2478/s11686-019-00095-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/14/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Microsporidiosis is an opportunistic infection that produces chronic diarrhoea and cholangiopathy in patients with AIDS, mainly caused by two species of microsporidia, Enterocytozoon bieneusi and Encephalitozon intestinalis. The aim of this work was to develop an integral system for the diagnosis of microsporidiosis of the intestine and biliary tract in HIV-infected patients, comprising microscopic and molecular techniques. METHODS The study population comprised 143 adult patients of both sexes with diagnosis of HIV infection, with chronic diarrhoea, and with or without HIV-associated cholangiopathy. Stool studies for microsporidia identification of spores were performed on each patient. A video esofagogastroduodenoscopy with biopsy collection was also carried out for routine histology and semi-thin sections stained with Azure II. Species identification was carried out by transmission electron microscopy and/or polymerase chain reaction for the species E. bieneusi and E. intestinalis. RESULTS Out of the 143 patients a total of 12.6% (n = 18) were infected with microsporidia. Microsporidia species identified in most cases was E. bieneusi (16/18 cases), followed by E. intestinalis (4/18), all of these last ones in coinfection with E. bieneusi. CONCLUSIONS Clinical, imaging, microscopic and molecular analyses, when applied in a systematic and integrated approach, allow diagnosis and identification of microsporidia at species level in AIDS patients with chronic diarrhoea, and with or without HIV-associated cholangiopathy.
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Prado JBF, Ramos CADN, Fiuza VRDS, Terra VJB. Occurrence of zoonotic Enterocytozoon bieneusi in cats in Brazil. ACTA ACUST UNITED AC 2019; 28:80-90. [PMID: 30785555 DOI: 10.1590/s1984-296120180096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022]
Abstract
Enterocytozoon bieneusi is an opportunistic intestinal pathogen that infects humans and a wide variety of animals worldwide. Our aim in this study was to investigate the occurrence of E. bieneusi in a domestic cat population in Campo Grande, Mato Grosso do Sul, Brazil. Sixty fecal samples from diarrheic cats were subjected to polymerase chain reaction (PCR) and the amplicons were sequenced for identification. E. bieneusi was detected in two samples (3.3%), both identified as genotype D. This genotype has already been reported in animals and humans and is considered a zoonotic genotype. Our findings represent the first report of E. bieneusi in domestic cats in Brazil, reinforcing the importance of identifying this agent as a source of infection in animals and humans.
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Affiliation(s)
- Jamille Batista Faria Prado
- Programa de Pós-graduação em Ciências Veterinárias, Faculdade de Medicina Veterinária e Zootecnia, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brasil
| | | | - Vagner Ricardo da Silva Fiuza
- Instituto de Biociências, Universidade Federal de Mato Grosso do Sul - UFMS, Cidade Universitária - Pioneiros, Campo Grande, MS, Brasil
| | - Veronica Jorge Babo Terra
- Faculdade de Medicina Veterinária e Zootecnia, Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brasil
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Yamashiro S, Fiuza VRDS, Teixeira ÂTLS, Branco N, Levy CE, Castro ICVSD, Franco RMB. Enterocytozoon bieneusi detected by molecular methods in raw sewage and treated effluent from a combined system in Brazil. Mem Inst Oswaldo Cruz 2017; 112:403-410. [PMID: 28591400 PMCID: PMC5446229 DOI: 10.1590/0074-02760160435] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/04/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Enterocytozoon bieneusi are the most common microsporidia associated with different clinical manifestations such as diarrhoea, respiratory tract inflammation and acalculous cholecystitis, especially in immunocompromised patients. Infection usually occurs by ingestion of food and water contaminated with spores, but can also result from direct contact with spores through broken skin, eye lesions, and sexual transmission, depending on the microsporidian species. Although there are reports of E. bieneusi found in humans and animals in Brazil, there are no published studies of environmental samples examined by molecular methods. OBJECTIVES The purpose of this study was to verify the presence of E. bieneusi in raw sewage and treated effluent from a combined system by molecular methods. METHODS Raw sewage and treated effluent samples collected from a combined system were analysed for the presence of E. bieneusi using the internal transcriber spacer (ITS) region of E. bieneusi by nested polymerase chain reaction. FINDINGS The analysis revealed E. bieneusi presence and a novel genotype (EbRB) in one raw sewage sample and one treated effluent. MAIN CONCLUSIONS The presence of E. bieneusi in final effluent indicates that the combined system may not remove microsporidian spores. This study is the first report of E. bieneusi in environmental samples in Brazil.
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Affiliation(s)
- Sandra Yamashiro
- Universidade Estadual de Campinas, Instituto de Biologia, Departamento de Biologia Animal, Laboratório de Protozoologia, Campinas, SP, Brasil
| | - Vagner Ricardo da Silva Fiuza
- Universidade Estadual de Campinas, Faculdade de Engenharia Civil, Arquitetura e Urbanismo, Departamento de Saneamento e Ambiente, Campinas, SP, Brasil
| | | | - Nilson Branco
- Universidade Estadual de Campinas, Instituto de Biologia, Departamento de Biologia Animal, Laboratório de Protozoologia, Campinas, SP, Brasil
| | - Carlos Emílio Levy
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Patologia Clínica, Hospital de Clínicas, Campinas, SP, Brasil
| | | | - Regina Maura Bueno Franco
- Universidade Estadual de Campinas, Instituto de Biologia, Departamento de Biologia Animal, Laboratório de Protozoologia, Campinas, SP, Brasil
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New findings of Enterocytozoon bieneusi in beef and dairy cattle in Brazil. Vet Parasitol 2016; 216:46-51. [DOI: 10.1016/j.vetpar.2015.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/30/2015] [Accepted: 12/12/2015] [Indexed: 11/15/2022]
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da Cunha MJR, Cury MC, Santín M. Widespread presence of human-pathogenic Enterocytozoon bieneusi genotypes in chickens. Vet Parasitol 2015; 217:108-12. [PMID: 26827870 DOI: 10.1016/j.vetpar.2015.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
Abstract
A total of 151 fecal specimens from chickens were randomly collected from local markets in Uberlândia and Belo Horizonte in the state of Minas Gerais, Brazil, to evaluate the presence of Enterocytozoon bieneusi by polymerase chain reaction (PCR). Enterocytozoon bieneusi was identified in 24 fecal samples (15.9%). This represents the first report of E. bieneusi in chickens in Brazil. All PCR-positive specimens were sequenced and 4 genotypes were identified, Peru 6, Peru 11, Type IV, and D. All four genotypes have previously been reported as human pathogens and are potentially zoonotic. Our results demonstrate that human-pathogenic E. bieneusi genotypes are present in chickens in Brazil, corroborating their potential role as a source of human infection and environmental contamination.
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Affiliation(s)
- Maria Júlia Rodrigues da Cunha
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Building 173, BARC-East, 10300 Baltimore Avenue, Beltsville, MD 20705, USA; Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Laboratório de Parasitologia, Av. Pará, 1720, Campus Umuarama, 38400-902, Uberlândia, Minas Gerais, Brazil; CAPES Foundation, Ministry of Education of Brazil, Caixa Postal 250, 70040-020 Brasília, DF, Brazil
| | - Márcia Cristina Cury
- Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Laboratório de Parasitologia, Av. Pará, 1720, Campus Umuarama, 38400-902, Uberlândia, Minas Gerais, Brazil
| | - Monica Santín
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Building 173, BARC-East, 10300 Baltimore Avenue, Beltsville, MD 20705, USA.
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Ndzi ES, Asonganyi T, Nkinin MB, Xiao L, Didier ES, Bowers LC, Nkinin SW, Kaneshiro ES. Fast Technology Analysis Enables Identification of Species and Genotypes of Latent Microsporidia Infections in Healthy Native Cameroonians. J Eukaryot Microbiol 2015; 63:146-52. [PMID: 26303263 DOI: 10.1111/jeu.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
Abstract
Several enteric microsporidia species have been detected in humans and other vertebrates and their identifications at the genotype level are currently being elucidated. As advanced methods, reagents, and disposal kits for detecting and identifying pathogens become commercially available, it is important to test them in settings other than in laboratories with "state-of-the-art" equipment and well-trained staff members. In the present study, we sought to detect microsporidia DNA preserved and extracted from FTA (fast technology analysis) cards spotted with human fecal suspensions obtained from Cameroonian volunteers living in the capital city of Yaoundé to preclude the need for employing spore-concentrating protocols. Further, we tested whether amplicon nucleotide sequencing approaches could be used on small aliquots taken from the cards to elucidate the diversity of microsporidia species and strains infecting native residents. Of 196 samples analyzed, 12 (6.1%) were positive for microsporidia DNA; Enterocytozoon bieneusi (Type IV and KIN-1), Encephalitozoon cuniculi, and Encephalitozoon intestinalis were identified. These data demonstrate the utility of the FTA cards in identifying genotypes of microsporidia DNA in human fecal samples that may be applied to field testing for prevalence studies.
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Affiliation(s)
- Edward S Ndzi
- Institute of Medical Research and Medicinal Plants Studies (IMPM), Yaoundé, Cameroon.,University of Buea, Buea, Cameroon
| | - Tazoacha Asonganyi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé-1, Yaoundé, Cameroon
| | - Mary Bello Nkinin
- Neurology & Physical Medicine Services, Electroencephalograph Laboratory, Central Hospital Yaoundé, Yaoundé, Cameroon
| | - Lihua Xiao
- Division of Foodborne, Waterborne and Environmental Diseases, National Center of Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Lisa C Bowers
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Stephenson W Nkinin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biological Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Edna S Kaneshiro
- Department of Biological Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Epidemiology of Enterocytozoon bieneusi Infection in Humans. J Parasitol Res 2012; 2012:981424. [PMID: 23091702 PMCID: PMC3469256 DOI: 10.1155/2012/981424] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/20/2012] [Indexed: 11/21/2022] Open
Abstract
A review was conducted to examine published works that focus on the complex epidemiology of Enterocytozoon bieneusi infection in humans. Studies on the prevalence of these emerging microsporidian pathogens in humans, in developed and developing countries, the different clinical spectra of E. bieneusi intestinal infection in children, in different settings, and the risk factors associated with E. bieneusi infection have been reviewed. This paper also analyses the impact of the recent application of PCR-based molecular methods for species-specific identification and genotype differentiation has had in increasing the knowledge of the molecular epidemiology of E. bieneusi in humans. The advances in the epidemiology of E. bieneusi, in the last two decades, emphasize the importance of epidemiological control and prevention of E. bieneusi infections, from both the veterinary and human medical perspectives.
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Abstract
Microsporidia were identified in stool specimens by histochemistry and PCR of 30 (18.9%) of 159 HIV-infected patients presenting to the S. P. Botkin Memorial Clinical Hospital of Infectious Diseases, St. Petersburg, Russia. The higher prevalence of Encephalitozoon intestinalis, in 21 (12.8%) patients, than of Enterocytozoon bieneusi, in 2 patients (1.2%), was unexpected. Encephalitozoon cuniculi was detected in three patients: one with strain I and two with strain II. Encephalitozoon hellem was detected in one patient, and two patients were identified as being infected by Microsporidium species. One patient was infected with both E. intestinalis and E. cuniculi. In two patients, the microsporidian species were not identifiable. No statistically significant differences in gender, age, and stage of AIDS were observed between the microsporidian-positive and -negative HIV-infected patients. HIV-infected patients diagnosed with microsporidian infection, however, were significantly more likely to exhibit ≤ 100 CD4(+) T cells/μl blood (20/30 patients [67%]; odds ratio [OR], 3.150; 95% confidence interval [CI(95)], 1.280 to 7.750; P = 0.0116) and weight loss of >10% of the baseline (19/30 patients [63%]; odds ratio, 2.995; CI(95), 1.100 to 8.158; P = 0.0352) than HIV-infected patients not diagnosed with microsporidian infection. In summary, this is the first report describing the diagnosis of microsporidian infection of HIV-infected patients in Russia and the first detection of E. cuniculi strain II in a human.
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Stark D, Barratt JLN, van Hal S, Marriott D, Harkness J, Ellis JT. Clinical significance of enteric protozoa in the immunosuppressed human population. Clin Microbiol Rev 2009; 22:634-50. [PMID: 19822892 PMCID: PMC2772358 DOI: 10.1128/cmr.00017-09] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4(+) cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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Anane S, Kaouech E, Belhadj S, Abdelmalek R, Ammari L, Ben Othman T, Bejaoui M, Ben Chaabane T, Kallel K, Chaker E. [Identification of Enterocytozoon bieneusi by PCR in stools of Tunisian immunocompromised patients]. ACTA ACUST UNITED AC 2009; 59:234-9. [PMID: 19481368 DOI: 10.1016/j.patbio.2009.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 03/18/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intestinal microsporidiosis is recognised as an important cause of opportunistic parasitosis in immunocompromised patients, especially HIV-infected patients. Enterocytozoon bieneusi is the common causal agent. The diagnosis of intestinal microsporidiosis has usually based on microscopic detection of the spores of microsporidia species in stool samples, requires additional staining techniques as Modified Weber's trichrome stain. However, the detection of the spores can be difficult and species determination, which is important for defining the appropriate treatment, is impossible. Polymerase chain reaction (PCR)-based methods have been successfully used for detection of microsporidian infections. They are more sensitive and are able to identify microsporidia species. The purpose of this study is to identify E. bieneusi to adapt treatment and assess the true prevalence of the intestinal microsporidiosis due to this species in compromised patients in Tunisia. PATIENTS AND METHODS One hundred and eighteen stools from immunocompromised patients, with a symptomatology in favour of the intestinal microsporidiosis, were analysed using light microscopy after staining with Modified Weber's trichrome stain and PCR. RESULTS Only four were positive by Modified Weber's trichrome stain whereas eleven stools were positive by PCR, giving a prevalence of 20% in HIV-infected patients and 5,35% in human immunodeficiency virus-negative patients. CONCLUSION This study confirms the usefulness of PCR in the diagnosis of the intestinal microsporidiosis due to E. bieneusi. Indeed, PCR has greater sensitivity than Modified Weber's trichrome stain and can identify the species of microsporidia in order to adapt the treatment.
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Affiliation(s)
- S Anane
- Service de Parasitologie-Mycologie, CHU La Rabta, 15 Rue Djebel-Lakhdar, 1007 Tunis, Tunisie
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Rossit ARB, Gonçalves ACM, Franco C, Machado RLD. Etiological agents of diarrhea in patients infected by the human immunodeficiency virus-1: a review. Rev Inst Med Trop Sao Paulo 2009; 51:59-65. [PMID: 19390732 DOI: 10.1590/s0036-46652009000200001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 02/19/2009] [Indexed: 11/22/2022] Open
Abstract
Despite the importance of understanding the epidemiology of agents responsible for infectious diarrhea in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) population, the number of articles about this subject is relatively few. The current article summarizes published data on bacterial, fungal, viral and parasitic enteropathogens in the HIV/AIDS seropositive subjects in different countries, regions and localities. In general, there is a great difference in the frequencies of etiological agents due to factors which include immune status, geographical location, climate and socioeconomic conditions. It is important to stress that a great prevalence of infection by emergent agents has been reported in the more advanced stages of AIDS. Therefore, to establish specific treatment depends directly on knowledge of these agents and risk factors associated to their distribution. Moreover, the colonization by potential pathogenic agents verified in these individuals is high thus implicating that they act as carriers. Finally, public health measures of control and prevention must take into consideration the regional previously identified enteropathogens, especially in areas where HIV prevalence is high.
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Affiliation(s)
- Andréa Regina Baptista Rossit
- Center for Microorganisms Investigation, Department of Dermatological, Parasitical and Infectious Diseases, Faculty of Medicine of São José do Rio Preto, Brazil.
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A preliminary study on the prevalence of intestinal microsporidiosis in patients with and without gastrointestinal symptoms in Malaysia. Trans R Soc Trop Med Hyg 2008; 102:1274-8. [PMID: 18602128 DOI: 10.1016/j.trstmh.2008.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 05/22/2008] [Accepted: 05/23/2008] [Indexed: 11/23/2022] Open
Abstract
An observational study was carried out to establish the existence of intestinal microsporidiosis among patients with and without gastrointestinal symptoms in Hospital Universiti Kebangsaan Malaysia, Malaysia. A total of 893 faecal specimens from hospitalized patients were examined for microsporidia using a modification of the usual Gram-chromotrope stain technique. One hundred and sixteen (13.0%) patients were positive for microsporidia: 84 (72.4%), 27 (23.3%) and 5 (4.3%) were low, moderate and high excreters of microsporidia spores, respectively. Of the 91 patients with available medical records, microsporidiosis was commonly observed in children aged 0-6 years (26.4%) and adults aged >or=31 years (57.2%). About one-third of this infection was observed in immunocompetent individuals. Among the immunosuppressive group, microsporidia were observed to be more prevalent in patients with haematological malignancy or a combination of malignancy and diabetes mellitus. About 74% of the patients who had microsporidia in their faeces had gastrointestinal symptoms, which could be related to infections or induced by immunosuppressive therapy. The role of microsporidia in causing gastrointestinal symptoms in this population is as yet unclear.
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Gonçalves EMDN, Uemura IH, Orban M, Castilho VLP, Corbett CEP. Microsporidiosis in a Brazilian University Hospital: case report. Rev Inst Med Trop Sao Paulo 2006; 48:351-2. [PMID: 17221134 DOI: 10.1590/s0036-46652006000600010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 07/12/2006] [Indexed: 11/22/2022] Open
Abstract
This is the report on a patient with chronic diarrhea caused by microsporidia. He is married, infected with HIV and has low CD4 cell count. The diagnosis was established through stool parasite search using concentration methods and Gram - chromotrope staining technique. Ileum biopsy was also performed in this case. The etiological diagnosis may be established in a clinical laboratory, by chromotrope staining technique in routine microscopic examination of stool specimens.
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Abstract
Microsporidia are long-known parasitic organisms of almost every animal group, including invertebrates and vertebrates. Microsporidia emerged as important opportunistic pathogens in humans when AIDS became pandemic and, more recently, have also increasingly been detected in otherwise immunocompromised patients, including organ transplant recipients, and in immunocompetent persons with corneal infection or diarrhea. Two species causing rare infections in humans, Encephalitozoon cuniculi and Brachiola vesicularum, had previously been described from animal hosts (vertebrates and insects, respectively). However, several new microsporidial species, including Enterocytozoon bieneusi, the most prevalent human microsporidian causing human immunodeficiency virus-associated diarrhea, have been discovered in humans, raising the question of their natural origin. Vertebrate hosts are now identified for all four major microsporidial species infecting humans (E. bieneusi and the three Encephalitozoon spp.), implying a zoonotic nature of these parasites. Molecular studies have identified phenotypic and/or genetic variability within these species, indicating that they are not uniform, and have allowed the question of their zoonotic potential to be addressed. The focus of this review is the zoonotic potential of the various microsporidia and a brief update on other microsporidia which have no known host or an invertebrate host and which cause rare infections in humans.
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Affiliation(s)
- Alexander Mathis
- Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
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Wolk DM, Schneider SK, Wengenack NL, Sloan LM, Rosenblatt JE. Real-time PCR method for detection of Encephalitozoon intestinalis from stool specimens. J Clin Microbiol 2002; 40:3922-8. [PMID: 12409353 PMCID: PMC139654 DOI: 10.1128/jcm.40.11.3922-3928.2002] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of microsporidiosis is likely underestimated due to the labor-intensive, insensitive, and nonspecific clinical laboratory methods used for the diagnosis of this disease. A real-time PCR assay was designed to assess DNA extraction methods and to detect three Encephalitozoon species in feces. Modifications of the MagNA Pure LC DNA isolation kit protocol (Roche Applied Sciences, Indianapolis, Ind.) were compared by using the automated MagNA Pure LC instrument (Roche) and fecal specimens spiked with Encephalitozoon intestinalis spores. Extracted DNA was amplified by the LightCycler (Roche) PCR assay. Assay sensitivity, reproducibility, and efficiency were assessed by comparing threshold crossover values achieved with different extraction and storage conditions (fresh, refrigerated, frozen, and preserved specimens). Optimal extraction conditions were achieved by using a commercial buffer, tissue lysis buffer (Roche), as the specimen diluent. LightCycler PCR results were compared to those obtained from routine stool microscopy with trichrome blue stain. The lower limit of detection for the LightCycler PCR assay varied by storage conditions from 10(2) to 10(4) spores/ml of feces, a value which represented a significant improvement over that achieved by staining (> or =1.0 x 10(6) spores/ml). Melting temperature analysis of the amplicons allowed for the differentiation of three Encephalitozoon species (E. intestinalis, E. cuniculi, and E. hellem). The assay is readily adaptable to the clinical laboratory and represents the first real-time PCR assay designed to detect Encephalitozoon species.
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Affiliation(s)
- D M Wolk
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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