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Trends Parasitol. Author manuscript; available in PMC 2016 April 02.
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Published in final edited form as:

Trends Parasitol. 2016 April ; 32(4): 336348. doi:10.1016/j.pt.2015.12.004.

Microsporidia Emergent Pathogens in the Global Food Chain

G.D. Stentiford1, J.J. Becnel2, L.M. Weiss3, P.J. Keeling4, E.S. Didier5, B.A.P. Williams6, S.
Bjornson7, M.L. Kent8, M.A. Freeman9, M.J.F. Brown10, E.R. Troemel11, K. Roesel12, Y.
Sokolova13, K.F. Snowden14, and L. Solter15,*
1Pathologyand Molecular Systematics Team, Centre for Environment, Fisheries and Aquaculture
Science (CEFAS), Barrack Road, Weymouth, Dorset DT4 8UB, UK
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2UnitedStates Department of Agriculture (USDA) Agricultural Research Center (ARS), Center for
Medical, Agricultural, and Veterinary Entomology (CMAVE), 1600 South West 23rd Drive,
Gainesville, FL, 32608, USA
3AlbertEinstein College of Medicine, 1300 Morris Park Avenue, Forchheimer 504, Bronx, NY
10641, USA
4Canadian Institute for Advanced Research, Botany Department, University of British Columbia,
3529-6270 University Boulevard, Vancouver, BC, V6T 1Z4 Canada
5Divisionof Microbiology, Tulane National Primate Research Center and Department of Tropical
Medicine, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street,
New Orleans, LA 70112, USA
6Biosciences,College of Life and Environmental Sciences, University of Exeter, Geoffrey Pope,
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Stocker Road, Exeter EX4 4QD, UK

7Department of Biology, Saint Marys University, 923 Robie Street, Halifax, Nova Scotia, Canada
8Departments of Microbiology and Biomedical Sciences, 220 Nash Hall, Oregon State University,
Corvallis, OR 97331, USA
9Ross University School of Veterinary Medicine, St. Kitts, West Indies
10School of Biological Sciences, Royal Holloway University of London, Egham, Surrey, TW20
0EX, UK
11University
of California, San Diego, 4202 Bonner Hall, 9500 Gilman Drive #0349, La Jolla, CA
92093-0349, USA
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12InternationalLivestock Research Institute, c/o Freie Universitt Berlin, Institute of Parasitology

and Tropical Veterinary Medicine, Robert-von-Ostertag-Strasse 7-13, Berlin, 14163 Germany
13Department of Comparative Biomedical Sciences, Louisiana State University, School of
Veterinary Medicine, 1909 Skip Bertman Drive, Baton Rouge LA 70803, USA
14Texas A&M University, College of Veterinary Medicine and Biomedical Sciences, Department of
Veterinary Pathobiology, Mailstop 4467, College Station, TX 77843-4467, USA

*
Correspondence: lsolter@illinois.edu (L. Solter).
 Stentiford et al. Page 2

15Illinois
Natural History Survey, Prairie Research Institute at the University of Illinois at Urbana-
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Champaign, 1816 South Oak Street, Champaign, IL 61820, USA

Abstract
Intensification of food production has the potential to drive increased disease prevalence in food
plants and animals. Microsporidia are diversely distributed, opportunistic, and density-dependent
parasites infecting hosts from almost all known animal taxa. They are frequent in highly managed
aquatic and terrestrial hosts, many of which are vulnerable to epizootics, and all of which are
crucial for the stability of the animalhuman food chain. Mass rearing and changes in global
climate may exacerbate disease and more efficient transmission of parasites in stressed or
immune-deficient hosts. Further, human microsporidiosis appears to be adventitious and primarily
associated with an increasing community of immune-deficient individuals. Taken together, strong
evidence exists for an increasing prevalence of microsporidiosis in animals and humans, and for
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sharing of pathogens across hosts and biomes.

Parasites in Food Chains

In high-income countries, approximately 70% of deaths in people over the age of 70 result
from non-communicable or chronic conditions. In low-income countries almost 40% of
deaths occur in children under the age of 15 and are generally associated with infectious
diseases (e.g., HIV/ AIDS, malaria, diarrhea, and tuberculosis). Many of these deaths are
caused by pathogens transmitted via food and water supplies [1]. Human food originating
from both plants and animals is produced, processed, and marketed in intricately linked
systems of primary producers (e.g., corn, cattle, fish), input and service providers (i.e.,
pesticides, water, veterinary drugs), transporters, processors, wholesalers, retailers,
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consumers, and end-users of byproducts (e.g., manure). Foodborne diseases comprise a

broad range of illnesses caused by ingestion of pathogens, parasites, chemical contaminants,
and biotoxins that are either naturally present in food or can contaminate food at different
points in the production and preparation process [2]. Many of the 300 species of helminths
and over 70 species of protists known to infect humans are transmitted via food and water
[3]. Infectious life stages are acquired by ingesting tissues of infected mammals, fish, or
invertebrates, as well as from contaminated food and water supplies or via contaminated
fomites or fingers. Although traditionally associated with tropical outbreaks, perceptions of
risk in temperate regions are changing following large outbreaks of parasitic infections due
to agents such as Toxoplasma gondii [4] and Cryptosporidium spp. [5]. Globalized food
trade and travel clearly have the potential to increase the risk of imported parasitoses from
tropical countries [6]. Microsporidia, although not currently considered to be priority
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foodborne parasites, have the potential to enter the human food chain through waterborne
and foodborne routes, and via exposure to the environment. As such, natural hosts of human
infective microsporidia can be part of the human food chain (e.g., [7,8]). In this review we
consider members of the phylum Microsporidia as agents of emergent disease in hosts from
major global biomes and food production sectors (terrestrial, aquatic) and in human
consumers. Further, we combine phylogenetic, ecological and immunological perspectives
to propose unifying themes, under a One Health banner, which may explain the emergence
of these opportunists.

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Microsporidia What Are They and Where Did They Come From?
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Microsporidia are a hyper-diverse phylum of spore-forming parasites infecting hosts from all
major animal taxa in all global biomes (Box 1). The array of hosts is equally diverse,
ranging from protists (in some of which Microsporidia are hyperparasites) to vertebrates
including humans. Species in almost half the known microsporidian genera infect aquatic
hosts, and thousands of these pathogens remain undescribed [9]. Morphological approaches
to within-phylum taxonomy have generally been superseded (or at least augmented) by
sequence comparisons of the ribosomal rRNA genes (e.g., [10,11]). Debate over placement
of the Microsporidia within the tree of life has progressed from historical grouping with
spore-forming parasites to the current molecular phylogenetics-based view that they are
affiliated with the fungi [12,13]. Analysis of the first complete microsporidian genome
(Encephalitozoon cuniculi) [14] confirmed that the previous phylogenies showing a deeper
position, and which suggested that the microsporidia were an ancient primitive lineage, was
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an artifact of long branch attraction [15], a finding supported by the discovery of highly
reduced mitochondria (mitosomes) within the microsporidian cytoplasm [16]. While more
recent confirmation of a fungal relationship is now accepted by most, their specific
relationships and their branching either within the Fungi (e.g., [17]) or outside the group
[18,19] are a topic of further debate. Although phylogenetic comparison of known taxa from
within the Microsporidia or the Fungi has failed to resolve this issue, the recent discovery
(and phylogenetic placement) of three novel lineages, the Cryptomycota [20,21], the
aphelids [22,23], and the genus Mitosporidium [24] as intermediate between Fungi and the
rest of the eukaryotes has re-ignited interest. The Cryptomycota appear to branch at the base
of the Fungi and contain the Microsporidia as well as the aforementioned aphelids and
Mitosporidium. Discovery of the group is clarifying relationships between the
Microsporidia, parasites with intermediate characteristics (such as Mitosporidium), and all
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other eukaryotes, at the same time revealing how their peculiar infection machinery likely
evolved [25].

Opportunistic Pathogens in all Major Biomes

Based on the descriptive criteria defined by the International Committee of Zoological
Nomenclature (ICZN), the phylum Microsporidia currently comprises over 200 genera [26].
Phylogenetic analysis (based upon small subunit rRNA partial gene sequence) of 70 of these
genera reveals five apparent clades broadly classified into three major groups according to
predominant host and environment type, termed the Aquasporidia (clades 1 and 3), the
Terresporidia (clades 2 and 4), and the Marinosporidia (clade 5) [27]. It is noteworthy that
most of these clades contain exceptions, likely associated with either the pathogen or even
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the host switching to a new habitat. Host-switching may be more likely if the microsporidian
parasite is a generalist or where hosts move between habitats (e.g., freshwater to marine, or
freshwater to terrestrial). In the case of confirmed human-infecting taxa, representatives are
observed across the phylum and include the genera Enterocytozoon, Encephalitozoon, and
Vittaforma (clade 4, Terresporidia), Anncalia and Tubulinosema (clade 3, Aquasporidia),
and Pleistophora (clade 5, Marinosporidia) [27]. Although not inconceivable that Homo
sapiens serves as a type host for particular microsporidian taxa, given the spread of human-
infecting genera across known clades and the preponderance for infection to occur in

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immune-compromised patients (see below), it is perhaps more likely that these infections
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represents zoonotic transfer from hosts inhabiting terrestrial, freshwater,

andmarineenvironments.Transferinthiscasemayrelatetodirectexposuretotype host taxa (e.g.,
via the food chain) but also by contact with extra-hostparasite life-stages in the environment
in which they reside. In this respect, the potential for susceptibility of humans to infection by
other Microsporidia across the phylum appears to be significant.

Microsporidia and Immune Competence

In nature, microsporidia typically develop a balanced interaction with their host, leading to
long-term subclinical infections [28]. When the immune condition of the host is
compromised, infection can lead to overt signs of clinical disease, highlighting the key role
of immune competence in mitigating individual- and population-level health effects of
microsporidiosis [29]. Human immune deficiencies can be categorized into primary and
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secondary types. Primary immune deficiencies (PID) are derived from intrinsic and inherited
defects in the immune system. Although PID cases are rare (an estimated 250 000 cases are
currently diagnosed in the USA) (Immune Deficiency Foundation; http://
primaryimmune.org/about/), microsporidian infections have been occasionally reported in
PID patients [30]. More common are secondary immune deficiencies (SID) which are
acquired from an array of causes including chemotherapy and/or radiation treatments for
malignancies, immune-suppressive therapies (to prevent transplant rejection), malnutrition,
poor sanitation, aging, and infectious diseases such as HIV/AIDS (www.uptodate.com/
contents/secondary-immunodeficiency-due-to-underlying-disease-states-environmental-
exposures-and-miscellaneous-causes). Prior to the HIV/AIDS pandemic in the mid-1980s,
microsporidiosis was rarely reported in human patients [31]. The pandemic brought to light
the opportunistic capability of microsporidia to infect humans and produce disease in
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virtually all organs [32,33] (Figure 1). Before common use of anti-retroviral therapies,
microsporidiosis was reported in at least 15% (and up to 85%) of HIV/AIDS patients [34].
However, although prevalence declined with improved therapy, an increase in newly
diagnosed cases of HIV in people over 50 years of age, coupled with an aging population of
patients living with HIV, is leading to so-called HIV-associated non-AIDS (HANA)
conditions that accelerate the onset of diseases normally observed in the elderly. These
patients show accelerated immune senescence, leaving them susceptible to opportunistic
infections, including microsporidia. Reactivation of latent microsporidian infections with
age, or with subsequent use of chemotherapy or immune-suppressive treatments, has also
been reported [35]. Although at least ten microsporidian genera have been associated with
human patients (Table 1), the most frequently detected species is the gut-infecting
Enterocytozoon bieneusi in patients with HIV/AIDS, in whom it produces chronic diarrhea
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[32] (Box 2).

Age, both young and old, has been associated with elevated burden of microsporidiosis. In
very young children (below age six) immune immaturity coupled with inadequate hygiene
practices and malnutrition have revealed surprising levels of infection (e.g., 18.2% of
children in one study from Spain) [36]. Epidemiological studies of E. bieneusi specifically
have revealed background prevalence ranging from 4.4% to 22.5% in HIV-negative children
[37]. In the elderly, immune senescence and declining numbers of nave T cells lead to

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weakened response to new infections. In one study of HIV-negative individuals with a mean
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age of 73.5 years, 17% of patients presenting with symptoms of diarrhea were infected with
E. bieneusi [38]. Given a growing human global population aged 65 years and over (16% by
2050), immune senescence-associated microsporidiosis is likely to increase [39].

Microsporidia in Food and Water

Ingestion of contaminated food and water, either directly or indirectly (via exposure to the
environment) offers the most likely route of transmission of microsporidian spores to
humans [40]. To this end, the majority of human-pathogenic microsporidia detailed in Table
1 have been detected in water. Comprehensively reviewed by Fayer and Santin [34], it is
considered that water, either consumed directly by drinking or indirectly via irrigating or
washing foods, bathing, washing, or for recreation, provides a crucial medium for spore
survival and transmission. Excretion of spores from infected humans and animals via urine
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and feces is the primary route of water contamination. Recalcitrance within freshwater and
marine environments at a range of temperatures contributes to retention of infectivity and the
potential for wide dispersal from point-sources [41]. Surveys of surface, drinking, waste, and
recreational waters have consistently demonstrated the presence of microsporidian parasites.
In some cases, filter-feeding molluscs have been deployed as sentinels for detection of
microsporidia in surface waters, specifically demonstrating the presence of the human
pathogens E. bieneusi, Encephalitozoon intestinalis, and Encephalitozoon hellem [42,43].
However, given that over 200 genotypes of E. bieneusi have so far been identified (some
exclusively in human or animal hosts, and others infecting both), accurate typing of isolates
detected in the water sources used by humans is an important step in understanding the true
risk of exposure [44]. Furthermore, because E. bieneusi resides within a family of
microsporidia otherwise exclusively infecting fish and crustacean hosts [45], future studies
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to investigate the potential for genotypes of E. bienuesi (or closely related taxa) to exist in a
replicative form within aquatic environments are required [9].

Microsporidia have also been detected directly in food destined for human consumption.
Soft fruits, vegetables, and herbs collected from markets in Poland were contaminated with
E. bieneusi and En. intestinalis [46]. Milk contaminated with human pathogenic genotypes
of E. bieneusi has been reported originating from herds in Korea [47]. A foodborne outbreak
of gastrointestinal illness in over 100 people was associated with consumption of E.
bieneusi-contaminated cucumbers in Sweden [48].

Although not directly related to food consumption, the propensity for insect-infecting
microsporidia to be vectored to humans either by bite, sting, or contamination of the skin by
feces of the insect host has been demonstrated. Examples include Anncalia algerae
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infections in the eye and musculature [49], Tubulinosema sp. infection of the tongue [50],
and Trachipleistophora sp. infections of the skeletal muscle and organs [51]. Increasing
contact with infected insects mass-reared for human consumption may pose a future
occupational and consumption risk. Similar contact-related risks have been identified for
aquatic animals associated with infections by Pleistophora sp. in the musculature of
immune-suppressed patients with or without HIV/AIDS [52,53]. Furthermore,
microsporidiosis has been widely reported in livestock, including infection of chickens.

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Genotypes of E. bieneusi [54] and Encephalitozoon spp. [55] occur in pigs and cows in
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China, some infected with the same genotypes of E. bieneusi that infect humans living in
close proximity [56]. Contact between humans and companion animals (pets) has also
revealed potential for zoonotic transfer of E. bieneusi between guinea pigs and children [57]
and potentially from a human AIDS patient (infected with En. intestinalis) to a cat [58].
Clearly, the environment offers ample potential for food-, water- and contact-driven
transmission of microsporidian parasites from animals to susceptible human hosts (Box 1).

Microsporidia in Major Food Production Chains

In addition to the direct risk to humans associated with consuming contaminated water or
food, it is appropriate to consider how microsporidia may directly interact with hosts mass-
produced for food and for use in food production chains (e.g., biological control agents), or
with pollinators that provide ecosystem services to enable food production.
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Microsporidia infecting terrestrial invertebrates directly impact their natural host

populations, and can devastate mass-reared colonies of insects used as human or animal
food, as biological control agents of agricultural pests, or agricultural pest species used to
produce biological control agents. Microsporidia are known to infect more than 30 species
of field-collected and mass-reared beneficial invertebrates including parasitoids, predatory
insects and mites, phytophagous insects used for weed control, and beneficial nematodes.
They decrease food consumption in their hosts, prolong development, impart physical
deformations, reduce fecundity and longevity, and increase mortality [59]. For example,
Muscidifurax raptor, a parasitoid found naturally occurring on dairy farms where they
provide effective house- and stable-fly control, is mass-reared for inundative release.
However, overcrowding and stress in commercial insectaries leads to high prevalence (86
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100%) of Nosema muscidifuracis, a microsporidium that reduces both the lifespan and
fecundity of the parasitoid and heavily impacts on fly control on the farm. Pathogen
prevalence is also high (up to 84%) on farms where infected parasitoids are released [60,61].
Because microsporidian infections are typically cryptic, they may be overlooked initially in
mass-reared colonies [59]. However, with increasing recognition of the potential of insects
as a source of protein for the burgeoning global population [62], more controlled mass-
rearing conditions, including the development of pathogen-free brood lines and appropriate
legal frameworks for their trade, are now required.

Insects play pivotal roles in global food production, with wild and managed bees providing
critical pollination services [63]. Apparent gaps between global crop pollination needs and
the availability of large-scale pollinator populations (e.g., domesticated honeybee colonies)
are due (at least in part) to the highly publicized syndromic condition termed colony
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collapse disorder (CCD), which has prompted focus on research about bee health and
disease in recent years [64]. Despite the fact that infections by Nosema apis and Nosema
ceranae have specifically been correlated to losses of honeybee colonies [65,66], definitively
linking microsporidian infections per se to colony declines, in either the USA or in Europe,
has not been possible [67,68]. In addition to potential shortfalls in pollination by managed
pollinator populations, a global decline in wild pollinator populations has also been reported
[69]. Spillover of infectious diseases from domesticated pollinator populations to wild

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pollinators has been highlighted as a significant potential source of emerging infectious

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disease (EID) in wildlife [70]. Specifically, the propensity for honeybees to host a wide
range of infectious agents (including microsporidia) [71], and the detection of parasites such
as N. ceranae in bumblebees occurring in close proximity to managed honeybee colonies
(e.g., [72]), provides at least some evidence for such spillover. However, lack of historical
information, inconsistent application of accurate diagnostics to honeybee and bumblebee
infections, and a paucity of well-designed studies to examine possible spillover make
confirmation of this effect difficult [73]. Recent application of managed bumblebee colonies
for greenhouse pollination has also raised questions about the potential for similar spillover
effects to surrounding wildlife [74] (Box 3).

In terms of aquatic hosts, microsporidia may directly impact on the production of animals
destined for human consumption, or may alter prey populations on which animals destined
for human consumption (e.g., fish) rely. As mentioned above, aquatic hosts support almost
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half the known microsporidian genera [9]. In terms of wild (fished) populations,
microsporidian epizootics have been historically associated with collapse of commercial
fisheries (e.g., the North American ocean pout fishery in the 1940s) [75], while in
aquaculture, species from numerous micro-sporidian taxa have impacted on production
during the hatchery, grow-out (netpen), processing, and marketing phases (see [75] for
context) Recently, an emergent disease condition termed emaciative syndrome was shown
to be caused by infection with Enterospora nucleophila in farmed seabream (Sparus aurata)
from the Mediterranean. Disease associated with infection by this parasite is apparently
associated with immune suppression in its host [76], a feature shared with several other
members of the Enterocytozoon clade in which this parasite resides. Previously, immune
suppression has been associated with increased severity of microsporidiosis in model fish
hosts (e.g., zebrafish infected with Pseudoloma neurophilia [77]) while, in other scenarios,
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infections by microsporidian parasites have directly impaired immunity, presumably making

their hosts more susceptible to infection by other pathogens (e.g., Nucleospora salmonis
infection of salmonids [78]). It appears likely that an association between suboptimal
environmental conditions, relative immune suppression, and host proximity in aquaculture
settings can encourage microsporidiosis and will lead to further emergence of yield-limiting
diseases in farmed fish.

Other high-profile examples exist in wild and farmed aquatic invertebrates destined for
human consumption. Although parasitism is known to occur across most aquatic invertebrate
phyla, the aquatic arthropods in particular, hosting over 50 known genera, appear to be the
most affected by microsporidiosis [9]. In the context of the human food chain, the group
containing the decapod crustaceans (shrimp, crabs, lobsters etc.) support a major economy,
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amounting to almost 40 billion dollars per annum from wild fisheries and aquaculture [79].
Those pathogens that target the edible musculature of crustacean hosts have the potential to
render marketable meats inedible [80], while those infecting connective tissues can blight
the visual esthetics and marketing of high-value captured hosts such as king crabs [81]. In
aquaculture settings, farmed penaeid shrimp represent one of the highest-value traded
seafood commodities (see [79]). Historically low-prevalence microsporidian infections such
as Enterocytozoon hepatopenaeii have been associated with slow growth syndromes in
Penaeus monodon [82]. However, increasingly intensive farming of the congeneric penaeid

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Penaeus vannamei in Asia, which now dominates the global market with first sale values
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exceeding 10 billion dollars per annum, has led to host-switching of E. hepatopenaeii to P.

vannamei, with accompanying high prevalence and high-intensity infections being observed
in both hosts in association with the recently emergent and devastating syndromic condition
early mortality syndrome (EMS) [83] (Figure 2). Phylogenetic analysis placed the parasite
within the Enterocytozoon clade, closest to the human gut pathogen E. bieneusi and to
another intranuclear pathogen, Enterospora canceri, that infects the hepatopancreas of the
European edible crab(Cancer pagurus) [84]. The rapid emergence of this microsporidian has
prompted high-profile warnings to industry from regional bodies such as the Network of
Aquaculture Centers in the Asia Pacific (NACA; www.enaca.org) advising that E.
hepatopenaei should be added to list of pathogens screened for during production of post-
larvae for eventual stocking of commercial farms. Once again, the link between
microsporidiosis and either suboptimal environmental conditions within the farm, or
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population immune suppression associated with inbreeding, may have played a role in recent
and rapid emergence across major shrimp-farming regions [85].

Terrestrial farm animals can also be infected with microsporidia. Although no clinical cases
of microsporidiosis have been reported in cows or pigs, E. bieneusi, including human-
pathogenic genotypic strains, are commonly detected in the feces of dairy and beef herds
[86] and swine with diarrhea [87]. En. cuniculi and En. intestinalis have also been detected
in pigs, again without apparent clinical outcome for the infected host [88]. Similar
associations apparently exist between En. cuniculi, goats [89], and horses [90]. Human
pathogenic strains of E. bieneusi have also been detected in feces of goats [91]. The first
case of non-mammalian E. bieneusi infection was detected in chickens destined for human
consumption [54], and subsequently other avian hosts were shown to be susceptible [88].
Although published epidemiological studies determining zoonotic transfer of microsporidia
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from farm animals to humans are rare, evidence for shared genotypes in humans, cows, and
pigs have been reported from rural communities in China [56]. Zoonotic transfer between
region-specific food animals and humans have been reported, including guinea pig to human
transfer in Peru [57] and rabbit to human transfer in New Zealand [92].

Concluding Remarks
Microsporidia are ubiquitous inhabitants of all major biomes. As hyper-diverse opportunists,
they exhibit differing degrees of host specificity, life cycle complexity, and ability to infect
and cause disease in almost all known invertebrate and numerous vertebrate phyla, including
humans. The diseases that they impart impact upon managed pollinators, on mass-reared fish
and invertebrates for food, and on hosts used in biological control of pests. The presence of
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free- and host-associated parasite life-stages in water, soil, and food appear to offer ample
opportunity for exposure of humans to animal-infecting forms. Even though the
phylogenetic range of human-infecting forms extends to only 10 of the known 200 genera at
present, increasingly consistent application of molecular diagnostics to animal and human
infections will undoubtedly reveal an increased potential zoonotic range, particularly as new
taxa are described from terrestrial and aquatic systems. Conversely, the application of
environmental DNA approaches [93] not only has the potential to uncover hitherto unknown

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parasite diversity but will enable research on the identification of reservoirs for human-
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pathogenic taxa in terrestrial and aquatic wildlife hosts.

Definitive confirmation of emergence, or even increased prevalence, of microsporidiosis has

been difficult to establish for wild populations in absence of long-term monitoring programs.
However, well-publicized cases of emergence, increased pathogenesis, and morbidity
associated with microsporidian infections exist for widely-divergent host groups, ranging
from farmed shrimp to human patients with underlying infections such as with HIV. In all
such cases, emergence (including potential for host switching) appears to center on a
common node of altered immune competence in these diverse host groups. In essence, the
prevalence of microsporidian infection and the intensity of the diseases they cause provide a
living sentinel of host immune competence that traverses both host taxonomy and the biome
in which these hosts exist. Climate change and other biome-level stressors (e.g., ocean
acidification, intensification of farming) may associate to impart greater disease burden on
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hosts from all biomes, and thus increase the contact rate between infected animals and
humans. Coupled with an increasing global population of immune-compromised individuals
(associated with age, those undergoing treatment for malignancies and other infectious
diseases such as produced by HIV), microsporidiosis may be expected to rise in both
prevalence and severity. The major transmission route between host groups is via the food
chain. Broader consideration of plant/animal/ human diseases associated with environmental
pressures under the One Health agenda will be increasingly required as a means to address
the grand challenges associated with global sustainability (http://www.cdc.gov/onehealth)
and to manage microsporidian infections in wildlife, food animals, and humans (see
Outstanding Questions).

Acknowledgments
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This review is an output from a symposium sponsored by the Organisation for Economic Cooperation and
Development (OECD) Cooperative Research Programme (CRP) on Biological Resource Management for
Sustainable Agricultural Systems and the Society for Invertebrate Pathology (SIP), held on 9th August 2015 at the
University of British Columbia, Vancouver, BC, Canada. The symposium was entitled Microsporidia in the Animal
to Human Food Chain: An International Symposium To Address Chronic Epizootic Disease. We acknowledge the
generous funding provided by the OECD CRP and the SIP to speakers at this event. The lead author (G.D.S.) would
like to acknowledge funding by DG SANCO of the European Commission (under contract C5473) and the UK
Department for Environment, Food, and Rural Affairs (DEFRA) (under contract FB002).

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Box 1
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Microsporidia Form and Function

Microsporidia are single-celled, eukaryotic, spore-forming parasites, and both generalist
and specialist species are found in invertebrate and vertebrate hosts. There are two main
clades of microsporidia: the typical (or advanced) and atypical (or primitive)
microsporidia [94]. The atypical microsporidia are a small group composed of
approximately 13 genera and 42 species [95]. The majority of known microsporidia are
of the typical variety, with ~190 genera and an estimated 13001500 species [28]. This
group contains the opportunistic taxa that have simple to complex developmental
sequences and life cycles. Spores of the typical microsporidia contain one or two nuclei
(the diplokaryon), are most commonly oval or pyriform in shape, and average 28
microns in size, but can be as small as 1 micron or as large as 30 microns in length. The
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spore has a very complex structure that contains the extrusion apparatus for infecting the
host cell. The spore wall is composed of two layers: an electron-lucent endospore layer
that contains chitin, and an electron-dense exospore that is often layered. The unique
infection apparatus is composed of three main parts: a long, thread-like polar filament, a
multilayered polaroplast, which is a highly membranous structure that occupies the
anterior half of the spore, and a posterior vacuole (Figure I). When the spore is in the
appropriate host and environment, the spore germinates and the polar filament is everted
to become a hollow tube. The sporoplasm travels through this tube and is inoculated into
the cytoplasm of the host cell to begin replication [94,96]. Generalist species of
microsporidia have a broad host-range and the ability to infect both invertebrate and
vertebrate hosts [28]. Generalists are often responsible for opportunistic infections in
vertebrates. Some notable genera containing species capable of infecting and developing
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in both arthropod and vertebrate hosts are Anncaliia, Tubulinosema, Trachipleistophora,

and Encephalitozoon, although other genera have been implicated by molecular data with
species in arthropod and vertebrate hosts (e.g., Enterocytozoon, Endoreticulatus) [29].
Specialists are restricted to infecting and developing within a narrow range of closely
related hosts, or some species require an obligate two-host system with a definitive host
and intermediate host (e.g., Amblyospora).

Figure I. The Features of a Typical Microsporidian Spore. (A) Diagram. (B)

Transmission electron micrograph. The rigid spore wall is composed of the exospores,
the endospore, and a sophisticated extrusion apparatus containing the polar filament,
polaroplast, and the posterior vacuole.
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Box 2
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Enterocytozoon bieneusi - A Zoonotic Pathogen of Humans

Enterocytozoon bieneusi was originally described in 1985 as a cause of gastrointestinal
infection presenting as chronic diarrhea in humans with advanced HIV-1 infection (i.e.,
AIDS) [32]. Spores are smaller (1.0 x 1.5 m) than those of Encephalitozoon spp. (1.2 x
2.2 m) and more difficult to find in tissue sections. E. bieneusi shows interesting
intracellular developmental involving multinucleated plasmodia with characteristic
electron-lucent lamellar inclusions. Inclusions associate with the nuclear envelope, the
endoplasmic reticulum, or both. E. bieneusi appears to be widely distributed in both
mammals and birds; it has been reported in pigs, dogs, cows, chickens, pigeons, falcons,
and various primates. Family-level relatives exist in fish and other aquatic animals.
Zoonotic transmission of E. bieneusi has been confirmed [57]. Infection of the epithelium
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of the gastrointestinal tract is the most frequent presentation of microsporidiosis, and over
90% of these infections are caused by E. bieneusi, with the remainder mostly being
caused by En. intestinalis. Infection does not produce active enteritis or ulceration,
although infection results in variable degrees of villous blunting and crypt hyperplasia.
Infection is associated with malabsorption, perhaps as a consequence of increased villous
epithelial cell turnover leading to functional immaturity of the villous epithelial cells. In
humans with AIDS, E. bieneusi infection has also been associated with infection of the
biliary tract and sclerosing cholangitis [33]. Hepatitis with infection of the biliary system
(including the gallbladder) caused by E. bieneusi has also been described in monkeys and
pigs; although systemic dissemination is rare, spores have been associated with
proliferative serositis (peritonitis) in macaques (Macaca mulatta) and in the nasal mucosa
of humans [123]. There are also reports of pulmonary involvement associated with
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chronic diarrhea, persistent cough, dyspnea, wheezing, and chest radiographs showing
interstitial infiltrates, with spores being found in stool, bronchoalveolar lavage fluid, and
transbronchial biopsy specimens [124], as well as a report of this organism being found
in the urine of renal transplant patients.
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Box 3
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Nosema disease in bumblebees and honeybees

Nosema species infecting honeybees and bumblebees (Apidae) belong to the
phylogenetic clade Nosema/Vairimorpha, the microsporidian taxon most frequently
isolated from the Lepidoptera. Nosema bombi, reported from more than 50 species of
bumblebees, is a systemic pathogen that appears to be specific to the genus Bombus.
Effects of chronic infections on these essential native pollinators include reduced colony
size, males with reduced sperm, decreased hibernation survival and colony establishment,
fewer reproductive females, and reduced female mating capability (e.g., [125]). Some
Bombus species appear to be more susceptible to N. bombi infection than others, and,
although cause and effect has not been established, higher prevalences of this
microsporidian infection have been reported in several North American bee species with
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apparently declining populations [69]. Concerns that exotic strains of N. bombi have been
released into North American Bombus populations via managed pollination services have
not been substantiated, but Nosema pressure on susceptible species could potentially
lower resistance to other pathogens. The annual value of pollination services and hive
products of the western honeybee, Apis mellifera, is estimated to exceed $200 billion
globally, but anthropogenic global distribution of this species has resulted in a significant
increase of parasites and pathogens that may have host-switched from other
hymenopteran species. Among the most invasive is Nosema ceranae, thought to have
originated from the Asian honeybee, Apis cerana [66]. Similar to Nosema apis, which is
naturally occurring in A. mellifera, N. ceranae infects adult bees and has chronic effects,
but this pathogen appears to be dominant and has nearly completely displaced N. apis,
particularly in honey bee populations below the 50th parallel north in Europe and North
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America. Nosemosis now figures in many reports of colony loss. Unlike N. bombi and
most other Nosema spp., both N. apis and N.ceranae are pathogens ofthe honeybee
midgut tissues; however, N. apis appears to bespecific to A. mellifera while N. ceranae
has been reported from three other Apis spp. and at least 14 Bombus spp. N. ceranae
causes energy stress, longer and less-frequent foraging flights, and shortens the lifespan
of bees (e.g., [126]). It has been reported to synergize with the deleterious effects of
viruses and a variety of agricultural and apicultural pesticides, while low levels of
fumagillin, used to treat nosemosis, may synergize with N. ceranae [127].
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Trends
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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.

The animalhuman food chain provides a portal for transmission and emergence.
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Outstanding Questions
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Are appropriate phylogenetic tools available to allow detailed molecular epidemiology of

known and novel members of the phylum Microsporidia?

Can humans be infected with a broader range of microsporidian taxa than is currently
recognized?

What are the conditions that allow microsporidia to cross between species, and what
allows emergent infections in this phylum?
Is Enterocytozoon bieneusi able to replicate in aquatic vertebrate or invertebrate host
taxa?

Is there a common node of interaction (immunological, biochemical) among

microsporidia from across the phylum and their broad range of hosts?
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Can common nodes of interaction be exploited to evade infection or to mitigate

pathogenic outcomes in infected hosts?

Can techniques be developed to allow genetic manipulation of the microsporidia that

would facilitate experiments aimed at understanding the biology of these organisms?
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Figure 1. Microsporidiosis in Humans

(A) Encephalitozoon hellem keratoconjunctivitis. Areas of corneal damage due to
microsporidiosis (arrow). (B) Corneal scraping from a case of microsporidian
keratoconjunctivitis demonstrating spores (arrow) of E. hellem. (C) Conjunctival biopsy in a
case of microsporidian keratoconjunctivitis demonstrating microsporidian spores in cross-
section (arrows point to polar tubes, the infective structures). The arrangement of the polar
tubes is consistent with Encephalitozoon. (D) Intestinal biopsy from a patient with
gastrointestinal microsporidiosis and diarrhea due to Enterocytozoon bieneusi (arrows point
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to spores in the apical region of an intestinal epithelial cell). (E) Stool stained with modified
trichrome stain (arrows point to spores). PCR confirmed that this infection was due to E.
bieneusi. (F) Intestinal biopsy from a patient with gastrointestinal microsporidiosis and
diarrhea due to Encephalitozoon intestinalis.
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Figure 2. Microsporidiosis in Shrimp Farming

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Routine health-checking of shrimp stock throughout the production cycle (A,B) and the
application of sensitive and specific diagnostics for known and emergent shrimp pathogens
has revealed a host-switching event and emergence of clinical disease caused by the
microsporidian parasite Enterocytozoon hepatopenaeii in Penaeus vannamei from in Asia.
The parasite, congeneric with the human pathogen Enterocytozoon bieneusi, undergoes
similar development within the gut of infected shrimp and is implicated in the multi-billion
dollar yield-limiting condition known as early mortality syndrome (EMS).

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Table 1

Confirmed Infections of Humans by Members of the Phylum Microsporidia

Conditions of Immune-Deficiency or Immune-Suppression Refs

Taxon HIV Transplant Cancer Other Conditions and

Stentiford et al.

Risk Factors
Anncaliia (syn. Nosema, N/ra Kidney Yes Rheumatoid arthritis, [97,98]
Brachiola) algerae ocular infection,
steroids, Crohns
disease, diabetes

Anncaliia (syn. Nosema) N/r N/r N/r Athymic child [99,100]

connori
Anncaliia (syn. Brachiola) Yes N/r N/r N/r [99,101]
vesicularum
Encephalitozoon cuniculi Yes Kidney, Yes Children, Primary [29,35,102105]
bone Immune Deficiency,
marrow diabetes, heart disease,
ocular infection,
steroids

Encephalitozoon hellem Yes N/r Yes Ocular infection, [106108]

steroids

Encephalitozoon intestinalis Yes Bone Yes Children, ocular [29,106,108114]

marrow infection, steroids

Encephalitozoon sp. N/r Pancreas, Yes Diabetes [115]

(undetermined) kidney

Endoreticulatus spp. N/r N/r N/r Ocular infection, [108]

steroids

Enterocytozoon bieneusi Yes Kidney, Yes Children [33,36,110,111,116,117]

liver,
heart,

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lung

Microsporidium ceylonensis, N/r N/r N/r Ocular infection, trauma [108]

M. africanum
Nosema ocularum N/r N/r N/r Ocular infection, trauma [118]

Pleistophora ronneafiei Yes N/r N/r N/r [52]

Trachipleistophora Yes N/r N/r Ocular infection, [51,119]

anthropopthera steroids

Trachipleistophora hominis Yes N/r N/r Ocular infection, [51,108]

steroids
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Conditions of Immune-Deficiency or Immune-Suppression Refs

Taxon HIV Transplant Cancer Other Conditions and

Risk Factors
Tubulinosema acridophagus Yes Bone N/r N/r [120]
marrow
Stentiford et al.

Vittaforma corneae Yes N/r N/r Children, ocular [35,108,121]

infection, steroids,
trauma

Unidentified species N/r N/r Yes Sjgrens disease, [122]

ocular infection,
immune-suppressive
treatment

a
N/r not recorded.

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