Microsporidia and Cyclospora: Epidemiology and assessment of risk from the environment

Critical Reviews in Microbiology

Volumn 26, Issue 2, 2000, Pages 69-90

  Mota, Patricia ^a   Rauch, Carol A ^b,c   Edberg, Stephen C ^a,c  

^a YALE NEW HAVEN HOSPITAL   (United States)

^b BAYSTATE MEDICAL CENTER   (United States)

^c YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CYCLOSPORA; DISEASE TRANSMISSION; FOOD CONTAMINATION; GASTROINTESTINAL INFECTION; HOST PARASITE INTERACTION; HUMAN; INFECTION RISK; LIFE CYCLE; MICROSPORIDA; NONHUMAN; PREVALENCE; PRIORITY JOURNAL; PROTOZOAL INFECTION; RISK ASSESSMENT; TAXONOMY;

CRYPTOSPORIDIUM; CYCLOSPORA; CYCLOSPORA CAYETANENSIS; MICROSPORIDIA; PROTOZOA;

EID: 0033923026     PISSN: 1040841X     EISSN: None     Source Type: Journal    
DOI: 10.1080/10408410091154192     Document Type: Article

References (128)

1. The Microsporidia and Microsporidiosis, Wittner, M., Ed., ASM Press, Washington, DC, 1999, pp. 1-6, 225-257, 315-362, 502-516.
2. Chilmonczyk, S., Cox, W. T., and Hedrick, R. P., Enterocytozoon salmonis n. sp.: an intranuclear Microsporidium from salmonid fish, J. Protozool., 38(3), 264, 1991.
3. Wright, J. H. and Craighead, E. M., Infectious motor paralysis in young rabbits, J. Exp. Med., 36, 135, 1922.
4. Matsubayashi, N., Koike, T., Mikata, I., Takei, N., and Hagiwara, S., A case of Encephalitozoon-like body infection in man. Arch. Pathol., 67, 181, 1959.
5. Shadduck, J. A., Meccoli, R. A., Davis, R., and Font, R. L., Isolation of a microsporidian from a human patient, J. Inf. Dis., 162(3), 773, 1990.
6. Silveira, H. and Canning, E. U., Vittaforma corneae n. comb. for the human Microsporidium Nosema corneum. Shadduck, Meccoli, Davis and Font, 1990, based on its ultrastructure in the liver of experimentally-infected athymic mice, J. Eukaryot. Microbiol., 42(2), 158, 1995.
7. Desportes, I., Charpentier, Y. L., Galian, A., Bernard, F., Cochand-Priollet B., Lavergne, A., Ravisse, P., and Modigliani, R., Occurrence of a new microsporidian: Enterocytozoon bieneusi n. g., n. sp., in the enterocytes of a human patient with AIDS, J. Protozool., 32(2), 250, 1985.
8. Beaugerie, L., Teilhac, M. F., Deluol, A. M., Fritsch, J., Girard, P. M., Rozenbaum, W., Quintrec, Y. L., and Chartelet, F. P., Cholangiopathy associated with microsporidia infection of the common bile duct mucosa in a patient with HIV infection, Ann. Int. Med., 117, 401, 1992.
9. Hartskeerl, R. A., Schuitema, A. J., Gool, T., and Terpstra, J., Genetic evidence for the occurrence of extra-intestinal Enterocytozoon bieneusi infections, Nucl. Acid Res., 21, 4150, 1993.
10. Sobottka, I., Albrecht, H., Schttelius, J., Scchmetz, C., Bentfeld, M., Laufs, R., and Schwartz, D. A., Self-limited travellerís diarrhea due to a dual infection with Entemcytozzon bieneusi and Cryptosporidium parvum in an immunocompetent HIV-negative child, Eur. J. Clin. Microbiol. Infect. Dis. (Letter), 14, 919, 1995.
11. Fournier, S., Liguory, O., Garrait, V., Gangneux, J. P., Sarfati, C., Derouin, F., and Molina, J. M., Microsporidiosis due to Enterocytozoon bieneusi infection as a possible cause of traveller's diarrhea, Eur. J. Clin. Microbiol. Infect. Dis. 17, 743, 1998.
12. Weber, R., Kuster, H., Keller, R., Bachi, T., Spycher, M. A., Briner, J., Russi, E., and Luthy, R., Pulmonary and intestinal microsporidiosis in a patient with the acquired immunodeficiency syndrome, Am. Rev. Respir. Dis., 146(6), 1603, 1992.
13. Weber, R., Sauer, B., Luthy, R., and Nadal, D., Intestinal co-infection with Enterocytozoon bieneusi and Cryptosporidium parvum in a human immunodeficiency virus-infected child with chronic diarrhea, Clin. Infect. Dis., 17, 480, 1993.
14. Call, A., Kotler, D. P., and Orenstein, J. M., Septata intestinalis N. G., N. Sp., an intestinal microsporidian associated with chronic diarrhea and dissemination in AIDS patients, J. Eukaryot. Microbiol. 40, 101, 1993.
15. Hartskeerl, R. A., Gool, T. V., Schuitema, A. J., Didier, E. S., and Terpstra, W. J., Genetic and immunological characterization of the microsporidian Septata intestinalis Cali, Kotler and Orenstein, 1993: reclassification to Encephalitozoon intestinalis, Parasitology, 110, 277, 1995.
16. Weiss, L. M., And now microsporidiosis, Ann. Int. Med., 123, 954, 1995.
17. Gool, T. V., Hollister, W. S., Schattenkerk, J. K. M. E., Weerman, M. A., Terpstra, W. J., Ketel, R. J., Reiss, P., and Canning, E. U., Diagnosis of Enterocytozoon bieneusi microsporidiosis in AIDS patients by recovery of spores from feces, Lancet, 336, 607, 1990.
18. Schattenkerk, J. K. M. E. and Gool, T. V., Clinical and microbiological aspects of microsporidiosis, Trop. Geo. Med., 44, 287, 1992.
19. Dowd, S. E., Gerba, C. P., and Pepper, I. L., Confirmation of the human-pathogenic microsporidia Enterocytozoon bieneusi, Encephalitozoon intestinalis, and Vittaforma cornea in water, Appl. Environ. Microbiol., 64(9), 3332, 1998.
20. Sparfel, J. M., Sarfati, C., Liguory, O., Caroff, B., Dumoutier, N., Gueglio, B., Billaud, E., Raffi, F., Molina, J. M., Miegeville, M., and Derouin, F., Detection of microsporidia and identification of Enterocytozoon bieneusi in surface water by filtration followed by specific PCR, J. Eukaryot. Microbiol., 44(6), 78S, 1997.
21. Cotte, L., Rabodonirina, M., Chapuis, F., Bailly, F., Bissuel, F., Raynal, C., Gelas, P., Persat, F., Piens, M. A., and Trepo, C., Waterborne outbreak of intestinal microsporiosis in persons with and without human immunodeficiency virus infection, J. Infect. Dis., 180(6), 2003, 1999.
22. Hutin, Y. J., Sombardier, M. N., Liguory, O., Sarfati, C., Derouin, F., Mondai, J., and Molina, J. M., Risk factors for intestinal microsporidiosis in patients with human immunodeficiency virus infection: a case-control study, J. Infect. Dis., 178(3), 904, 1998.
23. Sprague, V., Becnel, J. J., and Hazard, E. I., Taxonomy of phylum Microspora, Crit. Rev. Microbiol., 18(5-6), 285, 1992.
24. Keeling, P. J. and McFadden, G. I., Origins of microsporidia, Trends Microbiol., 6(1), 19, 1998.
25. Franzen, C. and Muller, A., Molecular techniques for detection, species differentiation, and phylogenetic analysis of microsporidia, Clin. Microbiol. Rev., 12(2), 243, 1999.
26. Raynaud, L., Delbac, F., Broussolle, V., Rabodonirina, M., Girault, V., Wallon, M., Cozon, G., Vivares, C. P., and Peyron, F., Identification of Encephalitozoon intestinalis in travellers with chronic diarrhea by specific PCR amplification, J. Clin. Microbiol., 36(1), 37, 1998.
27. Weber, R., Bryan, R. T., Schwartz, D. A., and Owen, R. L., Human microsporidiosis, Clin. Microbiol. Rev., 7(4), 426, 1994.
28. Weber, R., Bryan, R. T., Schwartz, D. A., Owen, R. L., Wilcox, C. M., Gorelkin, L., and Visvesvara, G. S., Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The enteric opportunistic infections working group, N. Engl. J. Med., 326(3), 161, 1992.
29. Visvesvara, G. S., Leitch, G. J., Moura, H., Weber, R., and Bryan, R. T., Culture, electron microscopy, and immunoblot studies on a microsporidian parasite isolated from the urine of a patient with AIDS, J. Protozool., 38(6), 105S, 1991.
30. Ryan, N. J., Sutherland, G., Coughlan, K., Globan, M., Doultree, J., Marshall, J., Baird, R. W., Pendersen, J., and Dwyer, B., A new trichrome-blue stain for detection of microsporidial species in urine, stool, and nasopharyngeal specimens, J. Clin. Microbiol., 31(12), 3264, 1993.
31. Ignatius, R., Lehmann, M., Miksits, K., Regnath, T., Arvand, M., Engelmann, E., Futh, U., Hahn, H., and Wagner, J., A new acid-fast trichrome stain for simultaneous detection of Cryptosporidium parvum and microsporidial species in stools specimens, J. Clin. Microbiol., 35(2), 446, 1997.
32. Aldras, A. M., Orenstein, J. M., Kotler, D. P., Shadduck, J. A., and Didier, E. S., Detection of microsporidia by indirect immunofluorescence antibody test using polyclonal and monoclonal antibodies, J. Clin. Microbiol., 32(3), 608, 1994.
33. Accoceberry, I., Thellier, M., Desportes-Livage, I., Achbarou, A., Biligui, S., Danis, M., and Dairy, A., Production of monoclonal antibodies directed against the Microsporidium Enterocytozoon bieneusi, J. Clin Microbiol., 37(12), 4107, 1999.
34. Weiss, L. M., Zhu, X., Cali, A., Tanowitz, H. B., and Wittner, M., Utility of microsporidian rRNA in diagnosis and phylogeny: a review, Folia Parasitology, 41(2), 81, 1994.
35. Coyle C. M., Wittner, M., Kotler, D. P., Noyer, C., Orenstein, J. M., Tanowitz, H. B., and Weiss, L. M., Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon (Septata) intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene, Clin. Infect. Dis., 23(5), 1002, 1996.
36. Franzen, C., Muller, A., Hegener, P., Salzberger, B., Hartmann, P., Fatkenheuer, G., Diehl, V., and Schrappe, M., Detection of microsporidia (Enterocytozzon bieneusi) in intestinal biopsy specimens from human immunodeficiency virus-infected patients by PCR, J. Clin. Microbiol., 33(9), 2294, 1995.
37. Gool, T. V., Vetter, J. M., Weinmayr, B., Dam, A. D., Derouin, F., and Dankert, J., High seroprevalence of Encephalitozoon species in immunocompetent subjects, J. Infect. Dis., 175(April), 1020, 1997.
38. Conteas, C. N., George, O., Berlin, W., Lariviere, M. J., Pandhumas, S. S., Speck, C. E., Forschen, Z. R., and Nakaya, T., Examination of the prevalence and seasonal variation of intestinal microsporidiosis in the stools of persons with chronic diarrhea and human immunodeficiency virus infection, Am. J. Med. Trop. Hyg., 58(5), 559, 1998.
39. Didier, E. S., Snowden, K. F., and Shadduck, J. A., Biology of microsporidian species infecting mammals. Advan. Parasitology, 40, 283, 1998,
40. Avery, S. W. and Undeen, A. H., The isolation of microsporidia and other pathogens from concentrated ditch water, J. Am. Mosq. Control Assoc., 3(1), 54, 1987.
41. Birthistle, K., Phillippa, M., and Phillip, H., Microsporidia: a new sexually transmissable cause of urethritis, Genitourinary Med., 72(6), 445, 1996.
42. Hunt, R. D., King, N. W., and Foster, H. L., Encephalitozoonosis: evidence for vertical transmission, J. Infect. Dis., 126(2), 212, 1972.
43. Snowden, K. F., Didier, E. S., Orenstein, J. M., and Schadduck, J. A., Animal models of human microsporidial infections, Lab. Anim. Sci., 48(6), 589, 1998.
44. Trammer, T., Dombrowski, F., Doehring, M., Maier, W. A., and Sitz, H. M., Opportunistic properties of Nosema algerae (Microspora), a mosquito parasite, in immunocopromised mice., J. Eukaryot. Microbiol., 44(3), 258, 1997.
45. Shadduck, J. A. and Pakes, S. P., Encephalitozoonosis (nosematosis) and toxoplasmosis, Am. J. Pathol., 64(3), 657, 1971.
46. Ashton, N., Cook, C., and Clegg, F., Encephalitozoonosis (nosematosis) causing bilateral cataract in a rabbit, Brit. J. Ophtalmol., 60(9), 618, 1976.
47. Schadduck, J. A. and Greeley, E., Microsporidia and human infections, Clin. Microbiol. Rev., 2(2), 158, 1989.
48. Mathis, A., Breitenmoser, A. C., and Deplazes, P., Detection of new Enterocytozoon genotypes in faecal samples of farm dogs and a cat. Parasite, 6(2), 189, 1999.
49. Breitenmoser, A. C., Mathis, A., Burgi, E., Weber, R., and Deplazes, P., High prevalence of Enterocytozoon bieneusi in swine with four genotypes that differ from those identified in humans, Parasitology, 118, 447, 1999.
50. Mansfield, G. K., Carville, A., Shvetz, D., Mackey, J., Tzipori, S., and Lackner, A. A., Identification of an Enterocutozoon bieneusilike microsporidian parasite in simian-immunodeficiency-virus-inoculated macaquee with hepatobiliary disease, Am. J. Pathol., 150(4), 1395, 1997.
51. Schmidt, W., Schneider, T., Heise, W., Schulzke, J., Weinke, T., Ignatius, R., Owen, R., Zeitz, M., Riecken, E., and Ullrich, R, Mucosal abnormalities in microsporidiosis, AIDS, 11, 1589, 1997.
52. Ehrenpreis, E., Chronic diarrhea and weight loss in HIV-infected patients, JAIDS, 21(4), 351, 1999.
53. Kotler, D. P., Francisco, A., Clayton, F., Scholes, J. V., and Orenstein, J. M., Small intestinal injury and parasitic diseases in AIDS, Ann. Int. Med., 113(6), 444, 1990.
54. Orenstein, J. M., Microsporidiosis in the acquired immunodeficiency syndrome. J. Parasitology, 77(6), 843, 1991.
55. Field, A. S., Hing, M. C., Milliken, S. T., and Marriott, D. J., Microsporidia in the small intestine of HIV-infected patients, Med. J. Australia, 158, 390, 1993.
56. Kotler, D. P., Reka, S., Chow, K., and Orenstein, J. M., Effects of enteric parasitoses and HIV infection upon small intestinal structure and function in patients with AIDS, J. Clin. Gastroenterol., 16(1), 10, 1993.
57. McDougall, R. J., Tandy, M. W., Boreham, R. E., Stenzel, D. J., and O'Donoghue, P. J., Incidental finding of a microporidian parasite from an AIDS patient. J. Clin. Microbiol., 31(2), 436, 1993.
58. Didier, E. S. and Shadduck, J. A., IFN-gamma and LPS induce murine macrophages to kill Encephalitozoo cuniculi in vitro, J. Eukaryot. Microbiol., 41(5), 34S, 1994.
59. Liu, J. J., Greeley, E. H., and Shadduck, J. A., Murine encephalitozoonosis: the effect of age and mode of transmission on occurrence of infection. Lab. Anim. Sci., 8(6), 5, 1988.
60. Wanke, C. A., DeGirolami, P., and Federman, M., Enterocytozoon bieneusi infection and diarrheal disease in patients who were not infected with human immunodeficiency virus: case report and review. Clin. Infect. Dis., 23, 816, 1996.
61. Pinnolis, M., Egbert, P. R., Font, R. L., and Winter, F. C., Nosematosis of the cornea. Case report, including electron microscopic studies, Arch. Ophthalmol., 99(6) 1044, 1981.
62. Sax, P. E., Rich, J. D., Pieciak, W. S., and Trnka, Y. M., Intestinal microsporidiosis occurring in a liver transplant recipient. Transplantation, 60(5), 617, 1995.
63. Guerard, A., Rabodonirina, M., Cotte, L., Liuory, O., Piens, M. A., Daoud, S., Picot, S., and Touraine, J. L., Intestinal microsporidiosis occurring in two renal transplant recipients treated with mycophenolate mofetil, Transplantation, 68(5), 699, 1999.
64. Rabodonirina, M., Bertocchi, M., DesportesLivage, I., Cotte, L., Levrey, H., Piens, M. A., Monneret, G., Celard, M., Mornex, J. F., and Mojon, M., Enierocytozoon bieneusi as a cause of chronic diarrhea in a heart-lung transplant recipient who was seronegative for human immunodeficiency virus. Clin. Infect. Dis., 23, 114, 1996.
65. Kelkar, R., Sastry, P. K., Kulkarni, S. S., Saikia, T. K., Parikh, P. M., and Advani, S. H., Pulmonary microsporidial infection in a patient with CML undergoing allogeneic marrow transplant, Bone Marrow Transplantation, 19, 179, 1997.
66. Scaglia, M., Gatti, S., Sacchi, L., Corona, S., Chichino, G., Bernuzzi, A. M., Barbarini, G., Croppo, G. P., Da Silva, A. J., Pieniazek, N. J., and Visvesvara, G. S., Asymptomatic respiratory tract microsporidiosis due to Encephalitozoon hellem in three patients with AIDS. Clin. Infect. Dis., 26, 174, 1998.
67. Franzen, C., Schwartz, D. A., Visvesvara, G. S., Muller, A., Schwenk, A., Salzberger, B., Fatkenheuer, G., Hartmann, P., Mahrle, G., and Diehl, V., Immunologically confirmed disseminated, asymptomatic Encephalitozoon cuniculi infection of the gastroentestinal tract in a patient with AIDS, Clin. Infect. Dis., 21(6), 1480, 1995.
68. Schwartz, D. A., Visvesvara, G. S., Leiten, G. J., Tashjian, L., Pllack, M., Holden, J., and Brayan, R., Pathology of symptomatic microsporidial (Encephalitozoon hellem) bronchiolitis in the acquired immunodeficiency syndrome: a new respiratory pathogen diagnosed from lung biopsy, brochoalveolar lavage, sputum, and tissue culture, Hum. Pathol., 24, 937, 1993.
69. Willson, R., Harrington, R., Stewart, B., and Pritsche, T., Human immunodeficiency virus 1-associated necrotizing cholangitis caused by infection with Septata intestinalis, Gastroenterology, 108(1), 247, 1995.
70. Soule, J. B., Halverson, A. L., Becker, R. B., Pistole, M. C., and Orenstein, J. M., A patient with acquired immunodeficiency syndrome and untreated Encephalitozoon (Septata) intestinalis microsporidiosis leading to small bowel perforation. Response to albendazole, Arch. Pathol. Lab. Med., 121(8), 880, 1997.
71. Didier, E., Shadduck, J. A., Diddier, P. J., Millichamp, N., and Vossbrinck, C. R., Studies on ocular microsporidia, J. Protozool., 38(6), 635, 1991.
72. Schwartz, D. A., Visvesvara, G. S., Diesenhouse, M. C., Weber, R., Font, R. L., Wilson. L. A., Corrent, G., Serdarevic, O. N., Rosberger, D. F., and Keenen, P. C., Pathologic features and immunofluorescent antibody demonstration of ocular microsporidiosis (Encephalitozoon hellem) in seven patients with acquired immunodeficiency sydrome, Am. J. Ophthalmol., 115(3), 285, 1993.
73. Katiyar, S. K. and Edlind, T. D., In vitro susceptibilities of the AIDS-associated microsporidian Encephalitozoon intestinalis to albendazole, its sulfoxide metabolite, and 12 additional benzimidazole derivatives, Antim. Ag. Chemoth., 41(12), 2729, 1997.
74. Molina, J., Goguel, J., Sarfati, C., Chastang, C., Desportes-Livage, I., Michiels, J., Maslo, C., Katlama, C., Cotte, L., Leport, C., Raffi, F., Derouin, F., and Modai, J., Potential efficacy of fumagillin in intestinal microspodiosis due to Enterocytozoon bieneusi in patients with HIV infection: results of a drug screening study, AIDS, 11, 1603, 1997.
75. Sobottka, I., Albrecht, H., Schafer, H., Schottelius, J., Visvesvara, G., Laufs, R., and Schwartz, D. A., Disseminated Encephalitozoon (Septata) intestinalis infection in a patient with AIDS: novel diagnostic approaches and autopsy-confirmed parasitological cure following treatment with albendazole. J. Clin. Microbiol., 33, 2948, 1995.
76. Dieterich, D. T., Lew, E. A., Kotler, D. P., Poles, M. A., and Orenstein J. M., Treatment with albendazole for intestinal disease due to Enterocytozoon bienuesi in patients with AIDS, J. Infect. Dis., 169(1), 178, 1994.
77. Blanshard, C., Ellis, D. S., Dowell, S. P., Tovey, G., and Gazzard, B. G., Electron microscopic changes in Enterocytozoon bieneusi following treatment with albendazole, J. Clin. Pathol., 46(10), 898, 1993.
78. Canning, E. U. and Hollister, W. S., In vitro and in vivo investigations of human microsporidiosis, J. Protozool., 38, 631, 1991.
79. Blanshard, C., Ellis, D. S., Dowell, S. P., Tovey, G., and Gazzard, B. G., Treatment of intestinal microsporidiosis with albendazole in patients with AIDS, AIDS, 6(3), 311, 1992.
80. Carr, A., Marriott, D., Field, A., Vasak, E., and Cooper, D., Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet, 351, 256, 1998.
81. Sobottka, I., Schwartz, D. A., Schottelius, J., Visvesvara, G. S., Pieniazek, N. J., Schmelz, C., Kock, N. P., Laufs, R., and Albrecht, H., Prevalence and clinical significance of intestinal microsporidiosis in human immunodeficiency virus-infected patients with or without diarrhea in Germany: a prospective coprodiagnostic study. Clin. Infect. Dis., 26, 475, 1998.
82. Haustvast, J. A., Tolboom, J. M., Derks, T. M., Beckers, P., and Sauerwein, R. W., Asymptomatic intestinal microsporidiosis in a human immunodeficiency virus-seronegative, immunocompetent Zambian child, J. Ped. Inf. Dis., 16(4), 415, 1997.
83. Clarridge, J.E., III, Karkhanis, S., Rabeneck, L., Marino, B., and Foote, L. W., Quantitative light microscopic detection of Enterocytozoon bieneusi in stools specimens: a longitudinal study of human immunodeficiency virus-infected microsporidosis patients, J. Clin. Microbiol., 34(3), 520, 1996.
84. Waller, T., Sensitivity of Encephalitozoon cuniculi to various temperatures, disisnfectants and drugs, Lab. Anim., 13(3), 227, 1979.
85. Shadduck, J. A. and Policy, M. B., Some factors influencing the in vitro infectivity and replication of Encephalitozoon cuniculi, J. Protozool., 25(4), 491, 1978.
86. Haas, C. N. and Aturaliye, D., Semiquantitative characterization of electroporation-assisted disinfection processes for inactivation of Giardia and Cryptosporidium, J. Appl. Microbiol., 86, 899, 1999.
87. Labeau, B., Pinel, C., Grillot, R., and Ambroise-Thomas, P., Fungal and parasitic nosocomial infections: importance and limitations of disinfection methods, Pathol. Biol. 46(5), 335, 1998.
88. Marshall, M. M., Naumovitz, D., Ortega, Y., and Sterling, C. R., Waterborne protozoan pathogens. Clin. Microbiol. Rev., 10(1), 67, 1997.
89. Ashford, R. W., Occurrence of an undescribed coccidian in man in Papua, New Guinea, Ann. Trop. Med. Parasitology, 73(5), 497, 1979.
90. Long, E. G., Ebrahimzadeh, A., White, E. H., Swisher, B., and Callaway, C. S., Alga associated with diarrhea in patients with acquired immunodeficiency syndrome and travelers, J. Clin. Microbiol., 28(6), 1101, 1990.
91. Wurtz, R. M., Kocka, F. E., Peters, C. S., Weldon-Linne, C. M., Kuritza, A., and Yungbluth, P., Clinical characteristics of seven case of diarrhea associated with a novel acid-fast organism in the stool. Clin. Infect. Dis., 16(1), 136, 1993.
92. Soave, R., Dubey, J. P., Ramos, L. J., and Tummings, M., A new intestinal pathogen?, Clin. Res., 34, 533A, 1986.
93. Shlim, D. R., Cohen, M. T., Eaton, M., Rajah, R., Long, E. G., and Ungar, B. P., An algalike organism associated with diarrhea among foreigners in Nepal, Am. J. Trop. Med. Hyg., 45(3), 383, 1991.
94. Hoge, C. W., Shlim, D. R., Rajah, R., Triplett, J., Shear, M., Rabold, J. G., and Echeverria, P., Epidemiology of diarrhoeal illness associated with coccidian-like organism among travellers and foreign residents in Nepal. Lancet. 341 (8854), 1175, 1993.
95. Hart, A. S., Ridinger, M. T., Soundarajan, R., Peters, C. S., Swiatlo, A. L., and Kocka, F. E., Novel organism associated with chronic diarrhea in AIDS, Lancet, 335, 169, 1990.
96. Hoge, C. W., Shlim, D. R., Ghimire, M., Rabold, J. G., Pandey, P., Walch, A., Rajah, R., Gaudio, P., and Echeverria, P., Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travellers and foreign residents in Nepal, Lancet, 345, 691, 1995.
97. Outbreaks of diarrheal illness associated with cyanobacteria (blue-green algae)-like bodies-Chicago and Nepal, 1989 and 1990, Morb. Mort. Wkly. Kept., 40(19), 325, 1991.
98. Huang, P., Weber, J. T., Sosin, D. M., Griffin, P. M., Long, E. G., Murphy, J. J., Kocka, F., Peters, C., and Kallick, C., The first reported outbreak of diarrheal illness associated with Cyclospora in the United States, Ann. Intern. Med., 123(6), 409, 1995.
99. Hale, D., Aldeen, W., and Carroll, K., Diarrhea associated with cyanobacteria-like bodies in an immunocompetent host, JAMA, 271(2), 144, 1994.
100. Rabold, J. G., Hoge, C. W., and Shlim, D. R., Cyclospora outbreak associated with chlorinated drinking water, Lancet, 344, 1360, 1994.
101. Connor, B. A. and Shlim, D. R., Foodborne transmission of Cyclospora, Lancet. 346, 1634, 1995.
102. Herwaldt, B. L. and Ackers, M. L., An outbreak in 1996 of cyclosporiasis associated with imported raspberries, N. Engl. J. Med., 336, 1548, 1997.
103. Update: Outbreaks of Cyclosporiasis - United States and Canada, 1997, Morb. Mort. Wkly. Rept., 46(23), 521, 1997.
104. Colley, D. G., Widespread foodborne cyclosporiasis outbreaks present major challenges, Emerg. Infect. Dis., 2(4), 354, 1996.
105. Outbreak of cyclosporiasis - northern Virginia-Washington, D.C.-Baltimore, Maryland, metropolitan area. 1997, Morb. Mort. Wkly. Rept., 46(30), 689, 1997.
106. Outbreaks of pseudo-infection with Cyclospora and Cryptosporidium - Florida and New York City, 1995, Morb. Mort. Wkly. Rept., 46(16), 354, 1997.
107. Ortega, Y. R., Roxas, C. R., Gilman, R. H., Miller, N. J., Cabrera, L., Taquiri, C., and Sterling, C. R., Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru, Am. J. Trop. Med. Hyg., 57(6), 683, 1997.
108. Marquardt, W. C., The taxonomy of Cyclospora, Emerg. Infect. Dis., 3(4)Letter, 2, 1998.
109. Sterling, C. R. and Ortega, Y. R., Cyclospora: an enigma worth unraveling, Emerg. Infect. Dis., 5(1), 48, 1999.
110. Ortega, Y. R., Sterling, C. R., Gilman, R. H., Cama, V. A., and Diaz, F., Cyclospora cayetanensis: a new protozoa pathogen of humans, N. Engl. J. Med., 328(18), 1308, 1993.
111. Soave, R., Cyclospora: an overview, Clin. Infect. Dis., 23, 429, 1996.
112. Gumbo, T., Gordon, S. M., and Adal, K. A., Cyclospora: update on an emerging pathogen, Clevel. Clin. J. Med., 64(6), 299, 1997.
113. Garza, M., Use of discontinuous Percoll gradients to isolate Cyclospora oocysts, Ann. Trop. Med. Parasitology, 91(3), 319, 1997.
114. Eberhard, M. L., Pieniazek, N. J., and Arrowood, M. J., Laboratory diagnosis of Cyclospora infections, Arch. Pathol. Lab. Med., 121, 792, 1997.
115. Garcia-Lopez, H. L., Rodriguez-Tovar, L. E., and Garza, C. E. M., Identification of Cyclospora in poultry, Emerg. Infect. Dis., 2(4), 356, 1996.
116. Ortega, Y. R., Oilman, R. H., and Sterling, C. R., A new coccidian parasite (Apicomplexa: Eimeriidae) from humans, J. Parasitology, 80(4), 625, 1994.
117. Long, E. G., White, E. H., Carmichael, W. W., Quinlisk, P. M., Raja, R., Swisher, B. L., Daugharty, H., and Cohen, M. T., Morphologic and staining characteristics of a Cyanobacterium-like organism associated with diarrhea, J. Infect. Dis., 164, 199, 1991.
118. Smith, H. V., Panton, C. A., Mitambo, M. M., and Girdwood, R. W., Sporulation of Cyclospora sp. oocysts, Appl. Environ. Microbiol., 63(4), 1631, 1997.
119. Zerpa, R., Uchima, N., and Huicho, L., Cyclospora cayetanensis associated with watery diarrhea in Peruvian patients, Am. J. Trop. Med. Hyg., 98, 325, 1995.
120. Connor, B. A., Reidy, J., and Soave, R., Cyclosporiasis: clinical and histopathologic correlates, Clin. Infect. Dis., 28, 1216, 1999.
121. Ortega, Y. R., Nagle, R., Gilman, R. H., Watanabe, J., Miyagui, J., Quispe, H., Kanagusuku, P., Roxas, C., and Sterling, C. R., Pathologic and clinical findings in patients with cyclosporiasis and a description of intracellular parasite life-cycle stages, J. Infect. Dis., 176, 1584, 1997.
122. Connor, B. A., Shlim, D. R., Scholes, J. V., Rayburn, J. L., Reidy, J., and Rajah, R., Pathologic changes in the small bowel in nine patients with diarrhea associated with a coccidia-like body, Ann. Intern. Med., 119, 377, 1993.
123. Jelinek, T., Lotze, M., Eichenlaub, S., Loscher. T., and Nothdurft, H. D., Prevalence of infection with Cryptosporidium parvuin and Cyclospora cayetanensis among international travellers, GUT, 41, 801, 1997.
124. Fryauff, D. J., Krippner, R., Prodjodipuro, P., Ewald, C., Kawengian, S., Pegelow, K., Yun, T., Heydwolff-Wehnert, C., Oyofo, B., and Gross, R., Cyclospora cayetanensis among expatriate and indigenous populations of West Java, Indonesia, Emerg. Infect. Dis., 5(4), 585, 1999.
125. Madico, G., McDonald, J., Gilman, R. H., Cabrera, L., and Sterling, C. R., Epidemiology and treatment of Cyclospora cayetanensis infection in Peruvian children, Clin. Infect. Dis., 24, 977, 1997
126. Ooi, W. W., Zimmerman, S. K., and Needham, C. A., Cyclospora species as a gastrointestnal pathogen in immunocompetent hosts, J. Clin. Microbiol., 33(5), 1267, 1995.
127. Pape, J. W., Verdier, R. I., Boncy, M., Boncy, J., and Johnson, W. D., Cyclospora infection in adults infected with HIV. Clinical manifestations, treatment and prophylaxis, Ann. Intern. Med., 121(9), 654, 1994.
128. Sifuentes-Osornio, J., Porras-Cortes, G., Bendal, R. P., Morales-Villarreal, F., Reyes-Teran, G., and Ruiz-Palacios, G. M, Cyclospora cayetanensis infection in patients with and without AIDS: biliary disease as another clinical manifestation, Clin. Infect. Dis., 21(5), 1092, 1995.