Occurrence of intestinal microsporidia in immunodeficient patients in Poland
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Department of Parasitology, Institute of Zoology, Faculty of Biology, University of Warsaw, Poland
Immunology Clinic, Children’s Memorial Health Institute, Warsaw, Poland
Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Poland
Department of Biology and Environmental Sciences, Northern Arizona University, Yuma, AZ, USA
Małgorzata Bednarska   

Department of Parasitology, Institute of Zoology, Faculty of Biology, University of Warsaw, Poland
Ann Agric Environ Med. 2014;21(2):244–248
Microsporidial infections may be asymptomatic in immunocompetent hosts, but can be severe and disseminated in HIV/AIDS patients, children, the elderly, or in immunocompromised individuals, including those with primary or medically-induced immunodeficiencies. 209 faecal samples were collected from 80 clinical patients, with or without abdominal symptoms, and tested for the presence of the parasites. Microsporidia were found in 10 of the 80 patients (12.5%) using trichrom staining of faecal smears and/or PCR. Encephalitozoon intestinalis and 1 unidentified species were identified in 2 of the 32 children with primary immunodeficiencies (6%), presenting with diarrhoea, including one co-infection with Cryptosporidium meleagridis. In the group of patients with medically-induced immunosuppression (transplant recipients), 8 of the 48 patients (17%) were tested positive for microsporidia. Thus, these pathogens should be taken into account when the other etiological agents cannot be found in diarrheic patients with PIDs or undergoing immunosuppressive treatment before or after transplantation. This article presents the results of the first epidemiological study on the ccurrence and prevalence of microsporidia in patients with primary and secondary immunodeficiency in Poland.
Didier ES. Microsporidiosis: An emerging and opportunistic infection in humans and animals. Act Trop. 2005;94: 61–76.
ranzen C. Microsporidia: a review of 150 years of research. Open Parasitol J. 2008; 2: 1–34.
Franzen C, Müller A. Microsporidiosis: human diseases and diagnosis. Microbes and Infection 2001; 3: 389–400.
Didier ES, Stovall ME, Green LC, et al. Epidemiology of microsporidiosis: sources and modes of transmission. Vet Parasitol. 2004; 126: 145–166.
Weiss LM. Microsporidia: emerging pathogenic protists. Act Tropic. 2001;78: 89–102.
Matsubayashi H, Koike T, Mikata I, et al. A case of Encephalitozoon-like body infection in man. AMA Arch Pathol. 1959; 67: 181–187.
Desportes I, Le Charpentier Y, Galian A, et al. Occurrence of a new microsporidan: Enterocytozoon bieneusi n.g.,n.sp., in the enterocytes of a human patient with AIDS. J Protozool. 1985; 32: 250–254.
Didier E. Microsporidiosis and HIV. J Acquir Immune Defic Syndr. 2000, 24: 290–292.
Garcia LS. Laboratory identification of the microsporidia. J Clin Microbiol 2002;40: 1892–1901.
Dworkin MS, Buskin SE, Davidson AJ, et al. Prevalence of intestinal microsporidiosis in human immunodeficiency virus infected patients with diarrhea in major United States cities. Rev Inst Med Trop Sao Paulo. 2007; 9: 339–342.
Galvan AL, Sánchez AM, Valentín MA, et al. First cases of microsporidiosis in transplant recipients in Spain and review of the literature J Clinic Microbiol. 2011; 49: 1301–1306.
Wichro E, Hoelzl D, Krause R, et al. Microsporidiosis in travel-associated chronic diarrhea in immune-competent patients. Am J Trop Med Hyg. 2005; 73: 285–287.
Rabodonirina ML, Cotte L, Radenne S, et al. Microsporidiosis and transplantation: a retrospective study of 23 cases. J Eukaryot Microbiol. 2003; 50: 583.
Sharma S, Das S, Joseph J, et al. Microsporidial keratitis: need for increased awareness. Surv Ophthalmol. 2011; 56: 1–22.
Sak B, Kváč M, Kučerová Z, et al. Latent microsporidial infection in immunocompetent individuals – a longitudinal study. PLoS Negl Trop Dis. 2011; 5: 1162.
Sak B, Brady D, Pelikánová M, et al. Unapparent microsporidial infection among immunocompetent humans in the Czech Republic. J Clin Microbiol. 2011; 49: 1064–1070.
Franzen C, Müller A. Molecular techniques for detection, species differentiation, and phylogenetic analysis of microsporidia . J Clin Microbiol. 1999; 12: 243–285.
Ghosh K, Weiss LM. Molecular diagnostic tests for microsporidia. Int Perspect Infect Dis. 2009: 92652.
Anane S, Attouchi H. Microsporidiosis: Epidemiology, clinical data and therapy. Gastroenterol Clin Biol 2010;34:450–464.
Sak B, Brady D, Pelikánová M, et al. Seropositivity for Enterocytozoon bieneusi, Czech Republic. Emerg Infect Dis. 2010; 16: 335–337.
Lobo ML, Xiao L, Antunes F, et al. Microsporidia as emerging pathogens and the implication for public health: a 10-year study on HIV-positive and -negative patients. Int J Parasitol. 2012; 42: 197–205.
Bednarska M, Bajer A, Welc-Faleciak R, Czubkowski P, Teisseyre M, Graczyk TK, Jankowska I. The first case of Enterocytozoon bieneusi infection in Poland. Ann Agric Environ Med. 2013; 20(2): 287–288.
Słodkowicz-Kowalska A, Graczyk TK, Tamang L, et al. Occurrence of Encephalitozoon intestinalis and E. cuniculi of haemodialysis patients (in Polish). Proceedings of the 22 nd Polish Parasitological Society; 2010 Sep 1–3; Puławy, Poland. National Veterinary Research Institute; PIWet-PIB;.
Wolska-Kusnierz B, Bajer A, Caccio S, et. al. Particular susceptibility to Cryptosporidium infection in patients with primary immunodeficiency syndromes. J Pediatr Gastroenterol Nutr. 2007; 45: 458–164.
Bajer A, Bednarska M, Cacciò SM, et al. Genotyping of Cryptosporidium isolates from human clinical cases in Poland. Parasitol Res. 2008; 103: 37–42.
Weber R, Bryan RT, Owen RL et al. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group. N Engl J Med. 1992; 16: 161–166.
Bajer A, Bednarska M, Pawełczyk A et al. Prevalence and abundance of Cryptosporidum parvum and Giardia spp. in wild rural rodents from the Mazury Lake District region of Poland. Parasitol. 2002; 125: 21–34.
Raynaud L, Delbac F, Broussolle V, et al. Identification of Encephalitozoon intestinalis in travelers with chronic diarrhea by specific PCR amplification J Clin Microbiol.1998; 36: 37–40.
Valencáková A, Bálent P, Novotný F, et al. The diagnosis of Encephalitozoon spp. Ann Agric Environ Med. 2005; 12: 321–323.
da Silva AJ, Schwartz DA, Visvesvara GS, et al. Sensitive PCR diagnosis of infections by Enterocytozoon bieneusi Microsporidia) using primers based on the region coding for small-subunit rRNA. Journal Clin Microbiol. 1996; 34: 986–987.
Valperga SM, de Jogna Prat SA, de Valperga GJ et al. Microsporidian spores in the stool specimens of toddlers, with or without diarrhea, from Tucuman. Argentina. Rev Argent Microbiol. 1999; 31: 157–164.
Müller A, Bialek R, Kämper A, et al. Detection of microsporidia in travelers with diarrhea. Journal Clin Microbiol. 2001; 39: 1630–1632.
Lores B, López-Miragaya I, Arias C, et al. Intestinal microsporidiosis due to Enterocytozoon bieneusi in elderly human immunodeficiency virus-negative patients from Vigo, Spain. Clin Infect Dis. 2002; 34: 918–921.
Tumwine JK, Kekitiinwa A, Nabukeera N, et al. Enterocytozoon bieneusi among children with diarrhea attending Mulago Hospital in Uganda Am J Trop Med Hyg. 2002; 67: 299–303.
Espern A, Morio F, Miegeville M, et al. Molecular study of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon intestinalis among human immunodeficiency virus-infected patients from two geographical areas: Niamey, Niger, and Hanoi, Vietnam. J Clinic Microbiol. 2007; 45: 2999–3002.
Sokolova OI, Demyanov AV, Bowers LC, et al. Emerging microsporidian infections in Russian HIV-infected patients. J Clinic Microbiol. 2011; 49: 2102–2108.
Słodkowicz-Kowalska A, Majewska AC, Trzesowska E, et al. Occurrence of Encephalitozoon intestinalis in the Red ruffedlemur ( Varecia rubra) and the Ring-tailed lemur (Lemur catta) housed in the Poznan Zoological Garden, Poland. Ann Parasitol. 2012; 58: 49–52.
Aoun K, Barbouche R, Bouratbine A, et al. Intestinal microsporidia infections in children with primary immunologic deficiencies. Parasite 1997; 4: 386–387.
Mungthin M, Suwannasaeng R, Naaglor T, et al. Asymptomatic intestinal microsporidiosis in Thai orphans and child-care workers. Trans R Soc Trop Med Hyg. 2001; 95: 304–306.
Sarfati, C, Bourgeois A, Menotti J, et al. Prevalence of intestinal parasites including microsporidia in human immunodeficiency virus-infected adults in Cameroon: a cross-sectional study. Am J Trop Med Hyg. 2006; 74: 162–164.
Endeshaw T, Kebede A, Verweij JJ, et al. Intestinal microsporidiosis in diarrheal patients infected with human immunodeficiency virus-1 in Addis Ababa, Ethiopia. Jpn J Infect Dis. 2006; 59: 306–310.
Liguory O, Sarfati C, Derouin F, et al. Evidence of different Enterocytozoon bieneusi genotypes in patients with and without human immunodeficiency virus infection. J Clin Microbiol. 2001; 39: 2672–2674.
Ten Hove RJ, Van Lieshout L, Beadsworth MB, et al. Characterization of genotypes of Enterocytozoon bieneusi in immunosuppressed and immunocompetent patient groups. J Eukaryot Microbiol. 2009; 56: 388–393.
Champion L, Durrbach A, Lang P, et al. Fumagillin for treatment of intestinal microsporidiosis in renal transplant recipients Am J Transplant. 2010; 10: 1925–1930.