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A comparative analysis of blood and faecal-based laboratory methods in the diagnosis of extraintestinal microsporidia infection

Mohamed Yusoff PS, Arifin N, Periyasamy P, Tumian NR, Ismail F, Raja Sabudin RZA, et al.

Malays J Pathol, 2024 Aug;46(2):299-306.
PMID: 39207007

Diagnosis of extraintestinal microsporidiosis is always hampered due to non-specific symptoms and difficulty in diagnosis. This study aimed to compare the diagnostic utility of blood and faecal-based polymerase chain reaction (PCR) to detect microsporidiosis in immunocompromised patients. A total of 42 immunocompromised patients consisting of HIV-infected and chemotherapy-treated patients were enrolled. Paired faecal and blood samples were collected and subjected to PCR to detect Enterocytozoon bieneusi and Encephalitozoon spp. Faecal samples were microscopically screened for microsporidia spores. Overall, 42.9% (18/42) of patients were positive for microsporidiosis. Of this, 19.0% (8/42) and 4.8% (2/42) were positive by blood and stool PCR respectively. Meanwhile, 33.3% (14/42) of the faecal specimens were microscopically positive. Among the positive patients, 22.2% (4/18) had microsporidia confirmed by blood PCR and stool microscopy, suggestive of dissemination. Interestingly, the stool specimen in which microsporidia spores were detected via microscopy is not positive via PCR method. This highlights the limitation of the faecal-based detection method and the important use of blood samples for diagnosing extraintestinal microsporidiosis. Only E. bieneusi species were detected in all PCR-positive samples. This study highlights the diagnostic value of blood PCR in diagnosing extraintestinal microsporidiosis infections.

Matched MeSH terms: Microsporidia/isolation & purification
Fulltext New insights of Microsporidial infection among asymptomatic aboriginal population in Malaysia

Shahrul Anuar T, M Al-Mekhlafi H, Md Salleh F, Moktar N

PLoS One, 2013;8(8):e71870.
PMID: 24014078 DOI: 10.1371/journal.pone.0071870

Studies on microsporidial infection mostly focus on immunodeficiency or immunosuppressive individuals. Therefore, this cross-sectional study describes the prevalence and risk factors of microsporidiosis among asymptomatic individuals in Malaysia.

Matched MeSH terms: Microsporidia/isolation & purification
Incidence of microsporidia in cancer patients

Lono AR, Kumar S, Chye TT

J Gastrointest Cancer, 2008;39(1-4):124-9.
PMID: 19459072 DOI: 10.1007/s12029-009-9065-z

INTRODUCTION: Microsporidia are considered opportunistic pathogens as evidenced by the significant detection in immunocompromised HIV/AIDS population. Cancer patients receiving chemotherapy are considered to be immunosuppressed.
MATERIALS AND METHODS: Stool samples were collected from 311 cancer patients in the Klang Valley. Each sample underwent water-ether concentration and staining with modified trichrome stain.
RESULTS AND DISCUSSION: Sixty-eight samples were positive by oil immersion examination. Polymerase chain reaction amplification with specific primers on those samples amplified Encephalitozoon intestinalis from two of the samples and Encephalitozoon hellem from one sample.

Matched MeSH terms: Microsporidia/isolation & purification*
Intestinal microsporidial infections among Orang Asli (aborigine) children from Malaysia

Norhayati M, Al-Mekhlafi HM, Azlin M, Nor Aini U, Shaik A, Sa'iah A, et al.

Ann Trop Med Parasitol, 2007 Sep;101(6):547-50.
PMID: 17716439
Matched MeSH terms: Microsporidia/isolation & purification
Prevalence of microsporidia in an indigenous Orang Asli community in Pahang, Malaysia

Lono A, Kumar GS, Chye TT

Trans R Soc Trop Med Hyg, 2010 Mar;104(3):214-8.
PMID: 19716577 DOI: 10.1016/j.trstmh.2009.07.006

Microsporidia are ubiquitous parasites thought to be closely related to fungi. Their presence in the environment means that humans are frequently exposed to infection. Stool samples were collected from 151 indigenous villagers from the eastern state of Pahang in 2005. The samples were concentrated with water-ether sedimentation, stained with modified trichrome stain and examined under oil-immersion microscopy. Thirty-two specimens (21.2%) were positive for microsporidia. Microsporidia were observed as ovoid or rounded ovoid shapes measuring approximately 1mum, with a bright pink outline containing a central or posterior vacuole. PCR amplification with specific primers on microscopy-positive specimens amplified Encephalitozoon intestinalis DNA from five of the ten specimens used.

Matched MeSH terms: Microsporidia/isolation & purification
A preliminary study on the prevalence of intestinal microsporidiosis in patients with and without gastrointestinal symptoms in Malaysia

Norhayati M, Azlin M, Al-Mekhlafi MH, Anisah N, Nor Aini U, Fatmah MS, et al.

Trans R Soc Trop Med Hyg, 2008 Dec;102(12):1274-8.
PMID: 18602128 DOI: 10.1016/j.trstmh.2008.05.019

An observational study was carried out to establish the existence of intestinal microsporidiosis among patients with and without gastrointestinal symptoms in Hospital Universiti Kebangsaan Malaysia, Malaysia. A total of 893 faecal specimens from hospitalized patients were examined for microsporidia using a modification of the usual Gram-chromotrope stain technique. One hundred and sixteen (13.0%) patients were positive for microsporidia: 84 (72.4%), 27 (23.3%) and 5 (4.3%) were low, moderate and high excreters of microsporidia spores, respectively. Of the 91 patients with available medical records, microsporidiosis was commonly observed in children aged 0-6 years (26.4%) and adults aged >or=31 years (57.2%). About one-third of this infection was observed in immunocompetent individuals. Among the immunosuppressive group, microsporidia were observed to be more prevalent in patients with haematological malignancy or a combination of malignancy and diabetes mellitus. About 74% of the patients who had microsporidia in their faeces had gastrointestinal symptoms, which could be related to infections or induced by immunosuppressive therapy. The role of microsporidia in causing gastrointestinal symptoms in this population is as yet unclear.

Matched MeSH terms: Microsporidia/isolation & purification
Detection of microsporidia in local HIV-positive population in Malaysia

Lono A, Kumar S, Chye TT

Trans R Soc Trop Med Hyg, 2011 Jul;105(7):409-13.
PMID: 21596411 DOI: 10.1016/j.trstmh.2011.03.006

The HIV-positive population, due to their immuno-compromised nature, is considered more susceptible to parasitic infections than other populations. However despite the reports of other opportunistic pathogens such as Cryptosporidium and tuberculosis reported in vulnerable communities, microsporidia have not been highlighted in the local HIV-positive population in Malaysia. This study aimed to provide preliminary information on the prevalence of microsporidia in the local HIV-population. Microsporidia were detected in 21/247 (8.5%) stool samples from the HIV-infected individuals, a significantly higher (P-value <0.05) prevalence than in the control group, in which 5/173 (2.9%) were positive. HIV patients were 3x more at risk for acquiring microspordium (OR: 3.12; 95% CI 1.15-8.44). Spores were ellipsoid in shape with outlines that stained dark pink with the interior a lighter shade. Approximately 21% of the positive specimens were from individuals in the 40-49 years age group. Ten individuals who were positive for microsporidia were also positive for other enteric parasites such as Blastocystis hominis and Giardia lamblia. We detected Encephalitozoon intestinalis DNA following nested PCR from three of 10 samples analysed, as demonstrated by an amplicon of 370bp. From the findings reported, it appears that microsporidial infection in humans may actually be more common than reported. We strongly advocate greater emphasis on personal hygiene through public education on personal hygiene and the consumption of boiled or filtered water.

Matched MeSH terms: Microsporidia/isolation & purification*