Enterocytozoon bieneusi

General Characteristics
Known as microsporidia, is a unicellular, obligate intracellular eukaryote.
Life cycle includes proliferative merogonic stage, sporogonic stage(small environmentally
resistant), infective spores(transmission mode).
Spores contain a long, coiled polar tub, which distinguishes them from all other organisms and
has a crucial role in host cell invasion.
The presence of E.bieneusi in swine was first detected in fecal samples in pigs in Zurich,
Switzerland.
First human case was described only in 1959 in a Japanese child. The rise in microsporidiosis is
associated with the arrival and spread of HIV; microsporidiasis is primarily found in patients with
AIDS or are otherwise immuno-compromised (like organ transplant patients)
Microsporidiosis is an emerging disease in hosts from aquatic and terrestrial biomes.
Human infections are often derived from contact with animals and the environment.
Common nodes of immune suppression allow opportunistic infection and disease.
Epidemiology
Microsporidia are extremely widespread. They infect nearly every organism on earth from honey-
bees and silkworm to mammals and birds. Relatively little is known about the epidemiology of
microsporidia, as transmission and infection pathways are still somewhat unclear. Though active
microsporidia spores have been found in water sources in developed and developing nations,
microsporidiosis remains primarily a disease of HIV and AIDS patients. Microsporidia has been
reported to infect 39% of AIDS patients with diarrhea and 30% of AIDS patients with
Cryptosporidium. Despite our relatively recent discovery of this pathogen, the infection among
AIDS patients is remarkable and the parasite will be of growing importance in the future as HIV
continues to spread and more research is undertaken to understand the role microsporidia play in
the human health.
In developed countries in North America, Europe, and Australia, studies involving HIV-
seropositive persons with diarrhea reported rates between 2% and 78%.
Lower infection rates (between 1.4% and 4.3%) were reported in HIV-seropositive persons
without diarrhea.
In industrialized nations, some studies reported E. bieneusi infection rates between 6.1 and 10%
in travelers who suffered from self-limited diarrhea and returned from tropical destinations.
A few prospective studies conducted in developed countries indicate that the prevalence of E.
bieneusi in HIV-seropositive patients is progressively decreasing, probably due to the use of
highly active antiretroviral therapy (HAART).
Geography
Microsporidia has a worldwide distribution, affecting both developing and developed nations, but
proper diagnosis remains difficult, especially in developing nations. Below is a map illustrating
the few countries where microsporidiosis has been formally documented.
In developing countries, E. bieneusi prevalence rates were reported between 2.5% and 51% in
HIV-seropositive adult patients with diarrhea, and in 4.6% of patients without diarrhea.
 Also, in HIV-seronegative persons with and without diarrhea, E. bieneusi was detected in 5.35%
to 58.1% of the fecal samples examined.
Life Cycle
The infective form of microsporidia is the resistant spore and it can survive for a long time in the
environment. It extrudes its polar tubule and infects the host cell injects the infective sporoplasm
into the eukaryotic host cell through the polar tubule. Inside the cell, sporoplasm undergoes
extensive multiplication either by merogonyor schizogony. This development can occur either in
direct contact with the host cell cytoplasm or inside a vacuole termed parasitophorous vacuole.
Either free in the cytoplasm or inside a parasitophorous vacuole, microsporidia develop by
sporogony 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

Pathology

Intestinal microsporidiosis
Acalculous cholecystitis
T/P/C