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


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].


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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Literature review current through: Oct 2017. | This topic last updated: Nov 03, 2017.
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