microsporidiosis
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Microsporidiosis is an opportunistic intestinal infection that causes
diarrhea Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...
and
wasting In medicine, wasting, also known as wasting syndrome, refers to the process by which a debilitating disease causes muscle and fat tissue to "waste" away. Wasting is sometimes referred to as "acute malnutrition" because it is believed that epis ...
in
immunocompromised Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that affe ...
individuals (
HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the im ...
, for example). It results from different species of
microsporidia Microsporidia are a group of spore-forming unicellular parasites. These spores contain an extrusion apparatus that has a coiled polar tube ending in an anchoring disc at the apical part of the spore.Franzen, C. (2005). How do Microsporidia inva ...
, a group of microbial (unicellular) fungi. In
HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the im ...
-infected individuals, microsporidiosis generally occurs when
CD4 In molecular biology, CD4 (cluster of differentiation 4) is a glycoprotein that serves as a co-receptor for the T-cell receptor (TCR). CD4 is found on the surface of immune cells such as helper T cells, monocytes, macrophages, and dendritic c ...
+
T cell T cells (also known as T lymphocytes) are an important part of the immune system and play a central role in the adaptive immune response. T cells can be distinguished from other lymphocytes by the presence of a T-cell receptor (TCR) on their cell ...
counts fall below 150. ''Microsporidia'' have emerged with significant mortality risk in
immunocompromised Immunodeficiency, also known as immunocompromise, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that affe ...
individuals. These are small, single-celled, obligately
intracellular parasite Intracellular parasites are microparasites that are capable of growing and reproducing inside the cells of a host. They are also called intracellular pathogens. Types There are two main types of intracellular parasites: Facultative and Obligate ...
s linked to water sources as well as wild, and domestic animals. They were once considered
protozoa Protozoa (: protozoan or protozoon; alternative plural: protozoans) are a polyphyletic group of single-celled eukaryotes, either free-living or parasitic, that feed on organic matter such as other microorganisms or organic debris. Historically ...
ns or
protist A protist ( ) or protoctist is any eukaryotic organism that is not an animal, land plant, or fungus. Protists do not form a natural group, or clade, but are a paraphyletic grouping of all descendants of the last eukaryotic common ancest ...
s, but are now known to be
fungi A fungus (: fungi , , , or ; or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and mold (fungus), molds, as well as the more familiar mushrooms. These organisms are classified as one ...
, or a sister group to fungi. The most common causes of microsporidiosis is ''Enterocytozoon bieneusi'' and ''Encephalitozoon intestinalis.''


Cause

At least 15 microsporidian species have been recognized as human
pathogen In biology, a pathogen (, "suffering", "passion" and , "producer of"), in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a Germ theory of d ...
s, spread across nine genera: * '' Anncaliia'' ** '' A. algerae'', ''A. connori'', ''A. vesicularum'' * '' Encephalitozoon'' ** '' E. cuniculi'', ''E. hellem'', '' E. intestinalis'' * Enterocytozoon ** '' E. bieneusi'' * '' Microsporidium'' ** ''M. ceylonensis'', ''M. africanum'' * '' Nosema'' ** ''N. ocularum'' * '' Pleistophora sp.'' * '' Trachipleistophora'' ** ''T. hominis'', ''T. anthropophthera'' * '' Vittaforma'' ** ''V. corneae.'' * ''Tubulinosema'' ** ''T. acridophagus'' The primary causes are '' Enterocytozoon bieneusi'' and '' Encephalitozoon intestinalis''.


Life cycle

''(Coded to
image An image or picture is a visual representation. An image can be Two-dimensional space, two-dimensional, such as a drawing, painting, or photograph, or Three-dimensional space, three-dimensional, such as a carving or sculpture. Images may be di ...
at right).'' # The infective form of microsporidia is the resistant
spore In biology, a spore is a unit of sexual reproduction, sexual (in fungi) or asexual reproduction that may be adapted for biological dispersal, dispersal and for survival, often for extended periods of time, in unfavourable conditions. Spores fo ...
and it can survive for an extended period of time in the environment. # The spore extrudes its polar tubule and infects the host cell. # The spore injects the infective sporoplasm into the
eukaryotic The eukaryotes ( ) constitute the Domain (biology), domain of Eukaryota or Eukarya, organisms whose Cell (biology), cells have a membrane-bound cell nucleus, nucleus. All animals, plants, Fungus, fungi, seaweeds, and many unicellular organisms ...
host cell through the polar tubule. # Inside the cell, the sporoplasm undergoes extensive multiplication either by
merogony Apicomplexans, a group of intracellular parasites, have life cycle stages that allow them to survive the wide variety of environments they are exposed to during their complex life cycle. Each stage in the life cycle of an apicomplexan organism ...
(binary fission) or
schizogony Fission, in biology, is the division of a single entity into two or more parts and the regeneration of those parts to separate entities resembling the original. The object experiencing fission is usually a cell, but the term may also refer to ho ...
(multiple fission). # This development can occur either in direct contact with the host cell
cytoplasm The cytoplasm describes all the material within a eukaryotic or prokaryotic cell, enclosed by the cell membrane, including the organelles and excluding the nucleus in eukaryotic cells. The material inside the nucleus of a eukaryotic cell a ...
('' E. bieneusi'') or inside a
vacuole A vacuole () is a membrane-bound organelle which is present in Plant cell, plant and Fungus, fungal Cell (biology), cells and some protist, animal, and bacterial cells. Vacuoles are essentially enclosed compartments which are filled with water ...
called a parasitophorous vacuole ('' E. intestinalis''). Either free in the cytoplasm or inside a parasitophorous vacuole, microsporidia develop by
sporogony Apicomplexans, a group of intracellular parasites, have life cycle stages that allow them to survive the wide variety of environments they are exposed to during their complex life cycle. Each stage in the life cycle of an apicomplexan organis ...
to mature spores. # During sporogony, a thick wall is formed around the spore, which provides resistance to adverse environmental conditions. When the spores increase in number and completely fill the host cell cytoplasm, the cell membrane is disrupted and releases the spores to the surroundings. # These free mature spores can infect new cells thus continuing the cycle.


Diagnosis

The best option for diagnosis is using PCR. Diagnosis with Microsporidia can be done through
gram The gram (originally gramme; SI unit symbol g) is a Physical unit, unit of mass in the International System of Units (SI) equal to one thousandth of a kilogram. Originally defined in 1795 as "the absolute Mass versus weight, weight of a volume ...
- positive,
acid-fast Acid-fastness is a physical property of certain bacterial and eukaryotic cells, as well as some sub-cellular structures, specifically their resistance to decolorization by acids during laboratory staining procedures. Once stained as part of a sa ...
spores in stool and biopsy material with morphologic demonstration of the organism. Initial detection through light microscopic examination of tissue sections, stools, duodenal aspirates, nasal discharges,
bronchoalveolar lavage Bronchoalveolar lavage (BAL), also known as bronchoalveolar washing, is a diagnostic method of the lower respiratory system in which a bronchoscope is passed through the mouth or nose into an appropriate airway in the lungs, with a measured amou ...
fluids, and conjunctival smears. Definitive diagnosis can also be achieved through fluorescein-tagged antibody
immunofluorescence Immunofluorescence (IF) is a light microscopy-based technique that allows detection and localization of a wide variety of target biomolecules within a cell or tissue at a quantitative level. The technique utilizes the binding specificity of anti ...
or electron microscopy, and species identification can be done through PCR.


Classification

Although it is classified as a protozoal disease in
ICD-10 ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social cir ...
, their phylogenetic placement has been resolved to be within the
Fungi A fungus (: fungi , , , or ; or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and mold (fungus), molds, as well as the more familiar mushrooms. These organisms are classified as one ...
, and some sources classify microsporidiosis as a
mycosis Fungal infection, also known as mycosis, is a disease caused by fungi. Different types are traditionally divided according to the part of the body affected: superficial, subcutaneous, and systemic. Superficial fungal infections include common ...
, however, they are highly divergent and rapidly evolving.


Treatment

Fumagillin has been used in the treatment. Another agent used is
albendazole Albendazole is a broad-spectrum antihelmintic and antiprotozoal agent of the benzimidazole type. It is used for the treatment of a variety of intestinal parasite infections, including ascariasis, pinworm infection, hookworm infection, trichuri ...
. Because of its severe mortality risk in immunocompromised individuals, two main agents are used:
Albendazole Albendazole is a broad-spectrum antihelmintic and antiprotozoal agent of the benzimidazole type. It is used for the treatment of a variety of intestinal parasite infections, including ascariasis, pinworm infection, hookworm infection, trichuri ...
, which inhibits
tubulin Tubulin in molecular biology can refer either to the tubulin protein superfamily of globular proteins, or one of the member proteins of that superfamily. α- and β-tubulins polymerize into microtubules, a major component of the eukaryotic cytosk ...
, and Fumagillin, which inhibits methionine aminopeptidase type two.


References


External links

* CDC'
microsporidiosis
info page. {{Mycoses Gastrointestinal tract disorders Animal fungal diseases