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Microsporidiosis

Authors
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Peter F Weller, MD, FACP
Section Editor
Edward T Ryan, MD, DTMH
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Microsporidia are intracellular spore-forming organisms that are ubiquitous in the environment and can infect a wide range of vertebrate and invertebrate hosts, including insects, birds, fish, and mammals. The clinical manifestations of microsporidiosis are diverse and include intestinal, pulmonary, ocular, muscular, and renal disease. Microsporidiosis has been identified in immunosuppressed hosts (eg, transplant and HIV-infected patients), travelers, children, and older adults [1].

MICROBIOLOGY

Approximately 150 genera and more than 1300 species of microsporidia have been described, which are classified based on spore size, arrangement of the nucleus, mode of replication within the host cell, and rRNA analysis. Microsporidia are considered protozoa, although comparative molecular phylogenetic studies support a relationship between the microsporidia and fungi [1]. Fourteen different species have been reported to infect humans, many of which were discovered as opportunistic infections in association with the AIDS epidemic (table 1).

The spores vary in size; those that infect humans are typically oval and 1 to 2 microns in diameter (figure 1). The spores are highly resistant to degradation and can survive in the environment for up to four months. Their structure is distinguished by the presence of a polar filament, which facilitates injection of the spore contents into the host cell.

The most common species causing infection in humans is Enterocytozoon bieneusi, followed by the Encephalitozoon species, particularly Encephalitozoon intestinalis. E. bieneusi consists of multiple genotypes; 26 different genotypes have been found in humans only and 8 genotypes reported in both humans and animals [2]. Among E. intestinalis isolates, there have been no molecular differences observed among those originating from infected humans and infected animals, which may imply there is no transmission barrier between different host species. Other Encephalitozoon species causing human infection are E. cuniculi and E. hellem. Antigenic diversity has also been demonstrated among these isolates [3,4].

E. bieneusi and Encephalitozoon species usually infect the gastrointestinal and biliary tracts, although there have been a few case reports of isolation of E. bieneusi from the respiratory tract [5]. Enterocytozoon infections normally cause localized infection; in contrast, Encephalitozoon species have the ability to disseminate widely via macrophages, thus causing systemic infection involving the intestinal and hepatobiliary tracts, respiratory tract, sinuses, kidney, eye, and brain.

                

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References
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  1. Didier ES, Weiss LM. Microsporidiosis: current status. Curr Opin Infect Dis 2006; 19:485.
  2. Santín M, Fayer R. Enterocytozoon bieneusi genotype nomenclature based on the internal transcribed spacer sequence: a consensus. J Eukaryot Microbiol 2009; 56:34.
  3. Mo L, Drancourt M. Antigenic diversity of Encephalitozoon hellem demonstrated by subspecies-specific monoclonal antibodies. J Eukaryot Microbiol 2002; 49:249.
  4. Xiao L, Li L, Moura H, et al. Genotyping Encephalitozoon hellem isolates by analysis of the polar tube protein gene. J Clin Microbiol 2001; 39:2191.
  5. Botterel F, Minozzi C, Vittecoq D, Bourée P. Pulmonary localization of Enterocytozoon bieneusi in an AIDS patient: case report and review. J Clin Microbiol 2002; 40:4800.
  6. Walker M, Kublin JG, Zunt JR. Parasitic central nervous system infections in immunocompromised hosts: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis. Clin Infect Dis 2006; 42:115.
  7. Coyle CM, Weiss LM, Rhodes LV 3rd, et al. Fatal myositis due to the microsporidian Brachiola algerae, a mosquito pathogen. N Engl J Med 2004; 351:42.
  8. Cali A, Takvorian PM. Ultrastructure and development of Pleistophora ronneafiei n. sp., a microsporidium (Protista) in the skeletal muscle of an immune-compromised individual. J Eukaryot Microbiol 2003; 50:77.
  9. Curry A, Beeching NJ, Gilbert JD, et al. Trachipleistophora hominis infection in the myocardium and skeletal muscle of a patient with AIDS. J Infect 2005; 51:e139.
  10. Orenstein JM, Chiang J, Steinberg W, et al. Intestinal microsporidiosis as a cause of diarrhea in human immunodeficiency virus-infected patients: a report of 20 cases. Hum Pathol 1990; 21:475.
  11. Batman PA, Kotler DP, Kapembwa MS, et al. HIV enteropathy: crypt stem and transit cell hyperproliferation induces villous atrophy in HIV/Microsporidia-infected jejunal mucosa. AIDS 2007; 21:433.
  12. van Gool T, Vetter JC, Weinmayr B, et al. High seroprevalence of Encephalitozoon species in immunocompetent subjects. J Infect Dis 1997; 175:1020.
  13. Anane S, Attouchi H. Microsporidiosis: epidemiology, clinical data and therapy. Gastroenterol Clin Biol 2010; 34:450.
  14. Kotler DP, Orenstein JM. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol 1994; 89:1998.
  15. Eeftinck Schattenkerk JK, van Gool T, van Ketel RJ, et al. Clinical significance of small-intestinal microsporidiosis in HIV-1-infected individuals. Lancet 1991; 337:895.
  16. Kotler DP, Francisco A, Clayton F, et al. Small intestinal injury and parasitic diseases in AIDS. Ann Intern Med 1990; 113:444.
  17. Conteas CN, Berlin OG, Lariviere MJ, et al. Examination of the prevalence and seasonal variation of intestinal microsporidiosis in the stools of persons with chronic diarrhea and human immunodeficiency virus infection. Am J Trop Med Hyg 1998; 58:559.
  18. Framm SR, Soave R. Agents of diarrhea. Med Clin North Am 1997; 81:427.
  19. Wuhib T, Silva TM, Newman RD, et al. Cryptosporidial and microsporidial infections in human immunodeficiency virus-infected patients in northeastern Brazil. J Infect Dis 1994; 170:494.
  20. Drobniewski F, Kelly P, Carew A, et al. Human microsporidiosis in African AIDS patients with chronic diarrhea. J Infect Dis 1995; 171:515.
  21. van Gool T, Luderhoff E, Nathoo KJ, et al. High prevalence of Enterocytozoon bieneusi infections among HIV-positive individuals with persistent diarrhoea in Harare, Zimbabwe. Trans R Soc Trop Med Hyg 1995; 89:478.
  22. Sobottka I, Schwartz DA, Schottelius J, et al. Prevalence and clinical significance of intestinal microsporidiosis in human immunodeficiency virus-infected patients with and without diarrhea in Germany: a prospective coprodiagnostic study. Clin Infect Dis 1998; 26:475.
  23. Bern C, Kawai V, Vargas D, et al. The epidemiology of intestinal microsporidiosis in patients with HIV/AIDS in Lima, Peru. J Infect Dis 2005; 191:1658.
  24. Rabeneck L, Gyorkey F, Genta RM, et al. The role of Microsporidia in the pathogenesis of HIV-related chronic diarrhea. Ann Intern Med 1993; 119:895.
  25. Coyle CM, Wittner M, Kotler DP, et al. Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon (Septata) intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene. Clin Infect Dis 1996; 23:1002.
  26. Weber R, Bryan RT. Microsporidial infections in immunodeficient and immunocompetent patients. Clin Infect Dis 1994; 19:517.
  27. Sax PE, Rich JD, Pieciak WS, Trnka YM. Intestinal microsporidiosis occurring in a liver transplant recipient. Transplantation 1995; 60:617.
  28. Gumbo T, Hobbs RE, Carlyn C, et al. Microsporidia infection in transplant patients. Transplantation 1999; 67:482.
  29. Rabodonirina M, Bertocchi M, Desportes-Livage I, et al. Enterocytozoon bieneusi as a cause of chronic diarrhea in a heart-lung transplant recipient who was seronegative for human immunodeficiency virus. Clin Infect Dis 1996; 23:114.
  30. Metge S, Van Nhieu JT, Dahmane D, et al. A case of Enterocytozoon bieneusi infection in an HIV-negative renal transplant recipient. Eur J Clin Microbiol Infect Dis 2000; 19:221.
  31. Lanternier F, Boutboul D, Menotti J, et al. Microsporidiosis in solid organ transplant recipients: two Enterocytozoon bieneusi cases and review. Transpl Infect Dis 2009; 11:83.
  32. Champion L, Durrbach A, Lang P, et al. Fumagillin for treatment of intestinal microsporidiosis in renal transplant recipients. Am J Transplant 2010; 10:1925.
  33. 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.
  34. Fournier S, Liguory O, Garrait V, et al. Microsporidiosis due to Enterocytozoon bieneusi infection as a possible cause of traveller's diarrhea. Eur J Clin Microbiol Infect Dis 1998; 17:743.
  35. Bryan RT, Weber R, Schwartz DA. Microsporidiosis in patients who are not infected with human immunodeficiency virus. Clin Infect Dis 1997; 24:534.
  36. López-Vélez R, Turrientes MC, Garrón C, et al. Microsporidiosis in travelers with diarrhea from the tropics. J Travel Med 1999; 6:223.
  37. 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.
  38. Decraene V, Lebbad M, Botero-Kleiven S, et al. First reported foodborne outbreak associated with microsporidia, Sweden, October 2009. Epidemiol Infect 2012; 140:519.
  39. Didier ES, Stovall ME, Green LC, et al. Epidemiology of microsporidiosis: sources and modes of transmission. Vet Parasitol 2004; 126:145.
  40. Cotte L, Rabodonirina M, Chapuis F, et al. Waterborne outbreak of intestinal microsporidiosis in persons with and without human immunodeficiency virus infection. J Infect Dis 1999; 180:2003.
  41. Slodkowicz-Kowalska A, Graczyk TK, Tamang L, et al. Microsporidian species known to infect humans are present in aquatic birds: implications for transmission via water? Appl Environ Microbiol 2006; 72:4540.
  42. Hutin YJ, Sombardier MN, Liguory O, et al. Risk factors for intestinal microsporidiosis in patients with human immunodeficiency virus infection: a case-control study. J Infect Dis 1998; 178:904.
  43. Bornay-Llinares FJ, da Silva AJ, Moura H, et al. Immunologic, microscopic, and molecular evidence of Encephalitozoon intestinalis (Septata intestinalis) infection in mammals other than humans. J Infect Dis 1998; 178:820.
  44. Cegielski JP, Ortega YR, McKee S, et al. Cryptosporidium, enterocytozoon, and cyclospora infections in pediatric and adult patients with diarrhea in Tanzania. Clin Infect Dis 1999; 28:314.
  45. Sandfort J, Hannemann A, Gelderblom H, et al. Enterocytozoon bieneusi infection in an immunocompetent patient who had acute diarrhea and who was not infected with the human immunodeficiency virus. Clin Infect Dis 1994; 19:514.
  46. Wanke CA, DeGirolami P, Federman M. Enterocytozoon bieneusi infection and diarrheal disease in patients who were not infected with human immunodeficiency virus: case report and review. Clin Infect Dis 1996; 23:816.
  47. Gainzarain JC, Canut A, Lozano M, et al. Detection of Enterocytozoon bieneusi in two human immunodeficiency virus-negative patients with chronic diarrhea by polymerase chain reaction in duodenal biopsy specimens and review. Clin Infect Dis 1998; 27:394.
  48. 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.
  49. Ramanan P, Pritt BS. Extraintestinal microsporidiosis. J Clin Microbiol 2014; 52:3839.
  50. Lewis NL, Francis IC, Hawkins GS, Coroneo MT. Bilateral microsporidial keratoconjunctivitis in an immunocompetent non-contact lens wearer. Cornea 2003; 22:374.
  51. Chan CM, Theng JT, Li L, Tan DT. Microsporidial keratoconjunctivitis in healthy individuals: a case series. Ophthalmology 2003; 110:1420.
  52. Fan NW, Wu CC, Chen TL, et al. Microsporidial keratitis in patients with hot springs exposure. J Clin Microbiol 2012; 50:414.
  53. Kwok AK, Tong JM, Tang BS, et al. Outbreak of microsporidial keratoconjunctivitis with rugby sport due to soil exposure. Eye (Lond) 2013; 27:747.
  54. Visvesvara GS, Belloso M, Moura H, et al. Isolation of Nosema algerae from the cornea of an immunocompetent patient. J Eukaryot Microbiol 1999; 46:10S.
  55. Ashton N, Wirasinha PA. Encephalitozoonosis (nosematosis) of the cornea. Br J Ophthalmol 1973; 57:669.
  56. Cali A, Meisler DM, Lowder CY, et al. Corneal microsporidioses: characterization and identification. J Protozool 1991; 38:215S.
  57. Bergquist NR, Stintzing G, Smedman L, et al. Diagnosis of encephalitozoonosis in man by serological tests. Br Med J (Clin Res Ed) 1984; 288:902.
  58. MATSUBAYASHI H, KOIKE T, MIKATA I, et al. A case of Encephalitozoon-like body infection in man. AMA Arch Pathol 1959; 67:181.
  59. Filho MM, Ribeiro HB, Paula LJ, et al. Images in cardiovascular medicine. Endocarditis secondary to microsporidia: giant vegetation in a pacemaker user. Circulation 2009; 119:e386.
  60. Watts MR, Chan RC, Cheong EY, et al. Anncaliia algerae microsporidial myositis. Emerg Infect Dis 2014; 20:185.
  61. Dore GJ, Marriott DJ, Hing MC, et al. Disseminated microsporidiosis due to Septata intestinalis in nine patients infected with the human immunodeficiency virus: response to therapy with albendazole. Clin Infect Dis 1995; 21:70.
  62. Leder K, Ryan N, Spelman D, Crowe SM. Microsporidial disease in HIV-infected patients: a report of 42 patients and review of the literature. Scand J Infect Dis 1998; 30:331.
  63. American Gastroenterological Association medical position statement: guidelines for the management of malnutrition and cachexia, chronic diarrhea, and hepatobiliary disease in patients with human immunodeficiency virus infection. Gastroenterology 1996; 111:1722.
  64. Agholi M, Hatam GR, Motazedian MH. HIV/AIDS-associated opportunistic protozoal diarrhea. AIDS Res Hum Retroviruses 2013; 29:35.
  65. Pol S, Romana CA, Richard S, et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. N Engl J Med 1993; 328:95.
  66. Weber R, Kuster H, Keller R, et al. Pulmonary and intestinal microsporidiosis in a patient with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1992; 146:1603.
  67. del Aguila C, Lopez-Velez R, Fenoy S, et al. Identification of Enterocytozoon bieneusi spores in respiratory samples from an AIDS patient with a 2-year history of intestinal microsporidiosis. J Clin Microbiol 1997; 35:1862.
  68. Georges E, Rabaud C, Amiel C, et al. Enterocytozoon bieneusi multiorgan microsporidiosis in a HIV-infected patient. J Infect 1998; 36:223.
  69. Schwartz DA, Visvesvara GS, Leitch GJ, et al. Pathology of symptomatic microsporidial (Encephalitozoon hellem) bronchiolitis in the acquired immunodeficiency syndrome: a new respiratory pathogen diagnosed from lung biopsy, bronchoalveolar lavage, sputum, and tissue culture. Hum Pathol 1993; 24:937.
  70. Scaglia M, Gatti S, Sacchi L, et al. Asymptomatic respiratory tract microsporidiosis due to Encephalitozoon hellem in three patients with AIDS. Clin Infect Dis 1998; 26:174.
  71. Franzen C, Schwartz DA, Visvesvara GS, et al. Immunologically confirmed disseminated, asymptomatic Encephalitozoon cuniculi infection of the gastrointestinal tract in a patient with AIDS. Clin Infect Dis 1995; 21:1480.
  72. Hollister WS, Canning EU, Weidner E, et al. Development and ultrastructure of Trachipleistophora hominis n.g., n.sp. after in vitro isolation from an AIDS patient and inoculation into athymic mice. Parasitology 1996; 112 ( Pt 1):143.
  73. Deplazes P, Mathis A, van Saanen M, et al. Dual microsporidial infection due to Vittaforma corneae and Encephalitozoon hellem in a patient with AIDS. Clin Infect Dis 1998; 27:1521.
  74. Walker M, Kublin JG, Zunt JR. Parasitic central nervous system infections in immunocompromised hosts: malaria, microsporidiosis, leishmaniasis, and African trypanosomiasis. Clin Infect Dis 2006; 42:115.
  75. Weber R, Deplazes P, Flepp M, et al. Cerebral microsporidiosis due to Encephalitozoon cuniculi in a patient with human immunodeficiency virus infection. N Engl J Med 1997; 336:474.
  76. Nagpal A, Pritt BS, Lorenz EC, et al. Disseminated microsporidiosis in a renal transplant recipient: case report and review of the literature. Transpl Infect Dis 2013; 15:526.
  77. Dascomb K, Clark R, Aberg J, et al. Natural history of intestinal microsporidiosis among patients infected with human immunodeficiency virus. J Clin Microbiol 1999; 37:3421.
  78. Hocevar SN, Paddock CD, Spak CW, et al. Microsporidiosis acquired through solid organ transplantation: a public health investigation. Ann Intern Med 2014; 160:213.
  79. DeGirolami PC, Ezratty CR, Desai G, et al. Diagnosis of intestinal microsporidiosis by examination of stool and duodenal aspirate with Weber's modified trichrome and Uvitex 2B strains. J Clin Microbiol 1995; 33:805.
  80. Ryan NJ, Sutherland G, Coughlan K, et al. A new trichrome-blue stain for detection of microsporidial species in urine, stool, and nasopharyngeal specimens. J Clin Microbiol 1993; 31:3264.
  81. Matos O, Lobo ML, Gonçalves L, Antunes F. Diagnostic use of 3 techniques for identification of microsporidian spores among AIDS patients in Portugal. Scand J Infect Dis 2002; 34:591.
  82. Conteas CN, Sowerby T, Berlin GW, et al. Fluorescence techniques for diagnosing intestinal microsporidiosis in stool, enteric fluid, and biopsy specimens from acquired immunodeficiency syndrome patients with chronic diarrhea. Arch Pathol Lab Med 1996; 120:847.
  83. Fedorko DP, Hijazi YM. Application of molecular techniques to the diagnosis of microsporidial infection. Emerg Infect Dis 1996; 2:183.
  84. van Gool T, Snijders F, Reiss P, et al. Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique. J Clin Pathol 1993; 46:694.
  85. Weiss LM, Vossbrinck CR. Microsporidiosis: molecular and diagnostic aspects. Adv Parasitol 1998; 40:351.
  86. Müller A, Stellermann K, Hartmann P, et al. A powerful DNA extraction method and PCR for detection of microsporidia in clinical stool specimens. Clin Diagn Lab Immunol 1999; 6:243.
  87. Liguory O, David F, Sarfati C, et al. Diagnosis of infections caused by Enterocytozoon bieneusi and Encephalitozoon intestinalis using polymerase chain reaction in stool specimens. AIDS 1997; 11:723.
  88. Franzen C, Müller A. Molecular techniques for detection, species differentiation, and phylogenetic analysis of microsporidia. Clin Microbiol Rev 1999; 12:243.
  89. Didier ES, Orenstein JM, Aldras A, et al. Comparison of three staining methods for detecting microsporidia in fluids. J Clin Microbiol 1995; 33:3138.
  90. Accoceberry I, Thellier M, Desportes-Livage I, et al. Production of monoclonal antibodies directed against the microsporidium Enterocytozoon bieneusi. J Clin Microbiol 1999; 37:4107.
  91. 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; 326:161.
  92. Ignatius R, Henschel S, Liesenfeld O, et al. Comparative evaluation of modified trichrome and Uvitex 2B stains for detection of low numbers of microsporidial spores in stool specimens. J Clin Microbiol 1997; 35:2266.
  93. Conners MS, Gibler TS, Van Gelder RN. Diagnosis of microsporidia keratitis by polymerase chain reaction. Arch Ophthalmol 2004; 122:283.
  94. Fedorko DP, Nelson NA, Didier ES, et al. Speciation of human microsporidia by polymerase chain reaction single-strand conformation polymorphism. Am J Trop Med Hyg 2001; 65:397.
  95. Hester JD, Varma M, Bobst AM, et al. Species-specific detection of three human-pathogenic microsporidial species from the genus Encephalitozoon via fluorogenic 5' nuclease PCR assays. Mol Cell Probes 2002; 16:435.
  96. Menotti J, Cassinat B, Porcher R, et al. 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 2003; 187:1469.
  97. Subrungruang I, Mungthin M, Chavalitshewinkoon-Petmitr P, et al. Evaluation of DNA extraction and PCR methods for detection of Enterocytozoon bienuesi in stool specimens. J Clin Microbiol 2004; 42:3490.
  98. Wolk DM, Schneider SK, Wengenack NL, et al. Real-time PCR method for detection of Encephalitozoon intestinalis from stool specimens. J Clin Microbiol 2002; 40:3922.
  99. Polley SD, Boadi S, Watson J, et al. Detection and species identification of microsporidial infections using SYBR Green real-time PCR. J Med Microbiol 2011; 60:459.
  100. Saigal K, Khurana S, Sharma A, et al. Comparison of staining techniques and multiplex nested PCR for diagnosis of intestinal microsporidiosis. Diagn Microbiol Infect Dis 2013; 77:248.
  101. Mo L, Drancourt M. Monoclonal antibodies for specific detection of Encephalitozoon cuniculi. Clin Diagn Lab Immunol 2004; 11:1060.
  102. Sheoran AS, Feng X, Singh I, et al. Monoclonal antibodies against Enterocytozoon bieneusi of human origin. Clin Diagn Lab Immunol 2005; 12:1109.
  103. Al-Mekhlafi MA, Fatmah MS, Anisah N, et al. Species identification of intestinal microsporidia using immunofluorescence antibody assays. Southeast Asian J Trop Med Public Health 2011; 42:19.
  104. Molina JM, Chastang C, Goguel J, et al. Albendazole for treatment and prophylaxis of microsporidiosis due to Encephalitozoon intestinalis in patients with AIDS: a randomized double-blind controlled trial. J Infect Dis 1998; 177:1373.
  105. Dionisio D, Manneschi LI, Di Lollo S, et al. Persistent damage to Enterocytozoon bieneusi, with persistent symptomatic relief, after combined furazolidone and albendazole in AIDS patients. J Clin Pathol 1998; 51:731.
  106. Maggi P, Larocca AM, Quarto M, et al. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur J Clin Microbiol Infect Dis 2000; 19:213.
  107. Gross U. Treatment of microsporidiosis including albendazole. Parasitol Res 2003; 90 Supp 1:S14.
  108. Costa SF, Weiss LM. Drug treatment of microsporidiosis. Drug Resist Updat 2000; 3:384.
  109. Tremoulet AH, Avila-Aguero ML, París MM, et al. Albendazole therapy for Microsporidium diarrhea in immunocompetent Costa Rican children. Pediatr Infect Dis J 2004; 23:915.
  110. Goguel J, Katlama C, Sarfati C, et al. Remission of AIDS-associated intestinal microsporidiosis with highly active antiretroviral therapy. AIDS 1997; 11:1658.
  111. Carr A, Marriott D, Field A, et al. Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet 1998; 351:256.
  112. Conteas CN, Berlin OG, Ash LR, Pruthi JS. Therapy for human gastrointestinal microsporidiosis. Am J Trop Med Hyg 2000; 63:121.
  113. Conteas CN, Berlin OG, Speck CE, et al. Modification of the clinical course of intestinal microsporidiosis in acquired immunodeficiency syndrome patients by immune status and anti-human immunodeficiency virus therapy. Am J Trop Med Hyg 1998; 58:555.
  114. Miao YM, Awad-El-Kariem FM, Franzen C, et al. Eradication of cryptosporidia and microsporidia following successful antiretroviral therapy. J Acquir Immune Defic Syndr 2000; 25:124.
  115. Asmuth DM, DeGirolami PC, Federman M, et al. Clinical features of microsporidiosis in patients with AIDS. Clin Infect Dis 1994; 18:819.
  116. Molina JM, Goguel J, Sarfati C, et al. Potential efficacy of fumagillin in intestinal microsporidiosis due to Enterocytozoon bieneusi in patients with HIV infection: results of a drug screening study. The French Microsporidiosis Study Group. AIDS 1997; 11:1603.
  117. Molina JM, Goguel J, Sarfati C, et al. Trial of oral fumagillin for the treatment of intestinal microsporidiosis in patients with HIV infection. ANRS 054 Study Group. Agence Nationale de Recherche sur le SIDA. AIDS 2000; 14:1341.
  118. Molina JM, Tourneur M, Sarfati C, et al. Fumagillin treatment of intestinal microsporidiosis. N Engl J Med 2002; 346:1963.
  119. Desoubeaux G, Maakaroun-Vermesse Z, Lier C, et al. Successful treatment with fumagillin of the first pediatric case of digestive microsporidiosis in a liver-kidney transplant. Transpl Infect Dis 2013; 15:E250.
  120. Didier ES. Effects of albendazole, fumagillin, and TNP-470 on microsporidial replication in vitro. Antimicrob Agents Chemother 1997; 41:1541.
  121. Didier ES, Maddry JA, Kwong CD, et al. Screening of compounds for antimicrosporidial activity in vitro. Folia Parasitol (Praha) 1998; 45:129.
  122. Coyle C, Kent M, Tanowitz HB, et al. TNP-470 is an effective antimicrosporidial agent. J Infect Dis 1998; 177:515.
  123. Didier ES, Maddry JA, Brindley PJ, et al. Therapeutic strategies for human microsporidia infections. Expert Rev Anti Infect Ther 2005; 3:419.
  124. Bicart-Sée A, Massip P, Linas MD, Datry A. Successful treatment with nitazoxanide of Enterocytozoon bieneusi microsporidiosis in a patient with AIDS. Antimicrob Agents Chemother 2000; 44:167.
  125. Benson CA, Kaplan JE, Masur H, et al. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR Recomm Rep 2004; 53:1.
  126. Davis RM, Font RL, Keisler MS, Shadduck JA. Corneal microsporidiosis. A case report including ultrastructural observations. Ophthalmology 1990; 97:953.
  127. Drugs for Parasitic Infections, 3rd Ed, The Medical Letter, New Rochelle, NY 2013.
  128. Khandelwal SS, Woodward MA, Hall T, et al. Treatment of microsporidia keratitis with topical voriconazole monotherapy. Arch Ophthalmol 2011; 129:509.
  129. Loh RS, Chan CM, Ti SE, et al. Emerging prevalence of microsporidial keratitis in Singapore: epidemiology, clinical features, and management. Ophthalmology 2009; 116:2348.
  130. Weiss LM, Schwartz DA. Microsporidiosis. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, 3rd ed, Guerrant RL, Walker DH, Weller PF (Eds), Saunders Elsevier, Philadelphia 2011. p.714.