Journal of Parasitology Research

Review Article

Epidemiology of Enterocytozoon bieneusi Infection in Humans

Table 1

Studies on prevalence of Enterocytozoon bieneusi infection in humans.


Continent	Country	Patient source	Major clinical presentation	Specimens analyzed	Diagnostic method	Prevalence (%) of infection	Reference

	USA	HIV+	Chronic diarrhea	Intestinal biopsies	LM, TEM	30% (20/67)	[16]
	USA	HIV+	Chronic diarrhea and other gastrointestinal complaints	Duodenal biopsies	TEM	33% (18/55) with chronic diarrhea; 25% (13/51) without chronic diarrhea	[83]
	USA	HIV+	Chronic diarrhea	Fecal samples, intestinal biopsies	LM, confirmed by EM	78% (14/18)	[36]
	USA	HIV+	Diarrhea, other complaints	Duodenal biopsies	PCR, confirmed by TEM	44% (30/68) with diarrhea; 2.3% (1/43) without diarrhea	[17]
	USA	HIV+	Diarrhea	Fecal samples	LM	8.8% (137/1,557) in 1993; 9.7% (193/1,991) in 1994; 6.6% (155/2,346) in 1995; 2.9% (73/2,545) in 1996	[70]
America	Peru	HIV+	Diarrhea	Fecal samples	LM, confirmed by PCR	3.9% (105/2,672)	[56]
	Peru	HIV+	Diarrhea and other gastrointestinal complaints	Fecal samples	LM, confirmed by PCR	2.2% (56/2506)	[48]
	Peru	Children apparently immunocompetent	Diarrhea, weight loss	Fecal samples	LM, confirmed by PCR, sequence analysis	8% (31/388)	[75]
	Colombia	HIV+	Diarrhea	Fecal samples	LM, PCR	2.9% (3/103)	[88]
	Brasil	HIV+	Chronic diarrhea	Fecal samples, intestinal biopsies	LM, TEM or PCR	27.5% (11/40)	[89]
	Cuba	HIV+ adults; HIV– adults	Diarrhea, other complaints	Fecal samples	LM	(0/67) in HIV+; (0/136) in HIV–	[90]

	Portugal	HIV+	Diarrhea	Fecal samples	LM, PCR	29% (20/69)	[38]
	Portugal	HIV+, HIV−; Adults and children	Gastrointestinal complaints	Fecal samples	PCR	6.3% (54/856)	[45]
	Spain	HIV+ children	58% with diarrhea	Fecal samples	LM, confirmed by PCR	1.2% (1/83); 2% (1/48) with diarrhea	[76]
	Spain	Returning travelers from tropical countries	Travelers’ diarrhea	Fecal samples	LM, confirmed by PCR	10% (4/40)	[6]
	Spain	HIV– elderly	Diarrhea	Fecal samples	LM, confirmed by PCR	17.0% (8/47)	[7]
	Spain	Immunocompetent	Diarrhea, pneumonia	Fecal, urine and sputum samples	LM, PCR, hybridization	11.54% (18/156) in feces; 16.22% (6/37) in sputa; 2.5% (1/40) in urine	[46]
	France	HIV+	Chronic diarrhea	Fecal samples and intestinal biopsies	LM, partially confirmed by EM	50% (9/18)	[41]
	France	HIV+	Diarrhea	Duodenal biopsies	LM	1.6% (1/61)	[37]
	France	HIV+	Chronic diarrhea	Fecal samples	LM	24% (11/46)	[91]
	France	HIV+; HIV–	Diarrhea	Fecal samples	LM, partially confirmed by EM, PCR-RFLP	88 HIV+ infected; 12 HIV– (10 immunocompromised and 2 immunocompetent) infected.	[92]
	Germany	HIV+	Diarrhea	Intestinal biopsies	PCR	21.7% (10/46)	[93]
	Germany	HIV+	Chronic diarrhea	Fecal samples	LM, PCR, sequence analysis	12 fecal samples from 8 patients	[94]
	Germany	HIV+	Diarrhea, other complaints	Fecal samples	LM	36% (18/50) with diarrhea; 4.3% (2/47) without diarrhea	[43]
Europe	Germany	Human patients	Diarrhea	Fecal samples	PCR, sequence analysis	7.7% (2/26)	[95]
	Germany	Returning travelers from tropical countries	Travelers’ diarrhea	Fecal samples	LM, PCR	0.7% (1/148); 4.7% (7/148)	[8]
	Switzerland	HIV+	Diarrhea, other gastrointestinal complaints	Fecal samples	LM, partially confirmed by EM and PCR	12.7% (20/164) in 1992–94; 5.8% (9/156) in 1994–96; 0.4% (4/949) without diarrhea	[71]
	Holland	HIV+	Diarrhea	Fecal samples	LM, confirmed by EM	7.7% (11/143)	[96]
	UK	HIV+	Diarrhea	Fecal samples, intestinal biopsies	LM, EM, confirmed by TEM	14.3% (9/63) in fecal samples; 7.9% (3/38) in biopsies	[40]
	UK	HIV+	Gastrointestinal complaints	Fecal samples	LM, PCR, qPCR, TEM	8.3% (14/168)	[97]
	Italy	HIV+	Chronic diarrhea	Intestinal biopsies	LM, TEM	4.2% (3/72)	[44]
	Czech Republic	Asymptomatic healthy people	NA	Fecal samples	PCR	6.0% (23/382);	[20]
	Russia	HIV+, adults	Diarrhea	Fecal samples	PCR	1.3% (2/159)	[87]
	Russia	HIV/AIDS patients	NA	Serum	IFAT	13.0% (6/46)	[98]

	Tunisia	HIV+HIV−	Diarrhea, other gastrointestinal complaints	Fecal samples	PCR	20% (7/35) in HIV+ 5.35% (3/56) in HIV−	[62]
	Mali	HIV+, and HIV–	80% with chronic diarrhea	Fecal samples	LM, partially confirmed by TEM	32% (28/88) in HIV+; 27% (3/11) in HIV–	[51]
	Mali	HIV+ adults;HIV– children	Diarrhea	Fecal samples	LM, IFAT, PCR	13.1% (8/61) in HIV+; (0/71) in HIV–	[47]
	Niger	HIV+ (227 adults, 1 child)	NA	Fecal samples	LM, RT-PCR, sequence analysis	10.5% (24/228), all but one were adults	[76]
	Niger	HIV+ adults; HIV– children	Diarrhea, other gastrointestinal complaints	Fecal samples	LM, partially confirmed by EM	In adults 7% (4/60) with diarrhea; in children 1% (6/593) with diarrhea, 0.5% (2/397) without diarrhea	[49]
	Nigeria	HIV− children	Diarrheic and nondiarrheic children	Fecal samples	PCR, sequence analysis	9.3% (4/43)	[67]
	Nigeria	HIV+ children	Diarrheic and nondiarrheic children	Fecal samples	LM, IFAT, PCR, sequence analysis	2.6% (193)	[68]
	Cameroon	HIV+	Diarrhea, other complaints	Fecal samples	LM, PCR-RFLP	6.5% (3/46) with diarrhea; 4.6% (5/108) without diarrhea	[55]
	Cameroon	Villagers <1 to 80 years;	NA	Fecal samples	IFAT-MAb, confirmed by PCR, sequence analysis	2.9% (22/758) in HIV– 0.5% (4/758) HIV+	[99]
	Cameroon	HIV+ with TB; HIV– with TB; apparently immunocompetent persons	Diarrheic and asymptomatic persons	Fecal samples	LM, IFAT-MAb	35.7% (10/28) in HIV+ with TB; 24,0% (6/25) in HIV– with TB; 67.5% (85/126) in immunocompetent persons	[53]
Africa	Gabon	HIV+ > 16 years	Diarrhea, other gastrointestinal complaints	Fecal samples	IFAT-MAb, confirmed by PCR, sequence analysis	3.0% (25/822)	[99]
	Democratic Republic of the Congo	AIDS patients, >15 years	Diarrhea, other gastrointestinal complaints	Fecal samples	PCR	5.1% (9/175) in hospital patients	[60]
	Uganda	Children (immune status not determined)	Diarrhea, other complaints	Fecal samples	LM, confirmed by PCR, sequence analysis	17.4% (310/1,779) with diarrhea; 16.8% (112/667) without diarrhea	[18]
	Uganda	HIV+ children;HIV– children	Persistent diarrhea, dehydration	Fecal samples	PCR	Ovelall 32.9% (80/243); 76.9% (70/91) in HIV+; 6.6% (10/152) in HIV–	[64]
	Ethiopia	HIV+ and HIV– > 14 years	Diarrhea	Fecal samples	LM, PCR	12.3% (30/243) in HIV+; (0/29) in HIV–	[82]
	Tanzania	In patients HIV+ adults; HIV+ and HIV– children	Chronic diarrhea, other complaints	Fecal samples	LM, TEM	3.5% (3/86) adults; 3.4% (2/59) children with diarrhea; 20% (4/20) control children	[77]
	Zambia	HIV+	Chronic diarrhea	Fecal samples	LM	23% (16/69)	[100]
	Zimbabwe	HIV+	Persistent diarrhea	Fecal samples	LM	10% (13/129)	[57]
	Zimbabwe	HIV+	Diarrhea	Formalin-fixed fecal samples	PCR	46% (34/74)	[101]
	Zimbabwe	HIV+	Diarrhea	Fecal samples	LM, PCR	18% (10/55) by LM; 51% (28/55) by PCR	[50]
	Zimbabwe	HIV−	Diarrhea, other gastrointestinal complaints	Fecal samples	LM, confirmed by PCR	33% (2/6)	[61]
	South Africa	Hospital patients, HIV+ and HIV–; school children	Diarrhea	Fecal samples	LM, PCR-RFLP, confirmed by RT-PCR	12.9% (33/255) in hospital patients; 4.5% (3/67) of school children; 21.6% in HIV+ and 9% in HIV– with diarrhea	[54]

	China	Children	Diarrhea	Fecal samples	PCR	22.5% (9/40)	[30]
	India	HIV+	Diarrhea	Fecal samples	LM	2.5% (3/120)	[55]
	Thailand	HIV+	Chronic diarrhea	Fecal samples	LM, TEM	27.2% (18/66)	[58]
	Thailand	HIV+	Diarrhea	Fecal samples	LM, confirmed by TEM	11% (32/288)	[59]
	Thailand	HIV+ children; HIV– children	Diarrhea	Fecal samples	LM confirmed by TEM	25.3% (24/95) in HIV+; 14.9% (13/87) in HIV–	[65]
Asia	Thailand	HIV+ and HIV– children from an orphanage	Asymptomatic	Fecal samples	LM, confirmed by TEM	Overall 4.1% (12/290); 2.6% (1/39) in HIV+; 4.4% (11/251) in HIV–	[5]
	Thailand	HIV+ adults	NA	Fecal samples	LM, PCR	5.6% (5/90)	[102]
	Thailand	73 HIV+, 463 HIV−; children (<11 years) and child care workers	533 asymptomatic and 7 patients with diarrhea.	Fecal samples	LM, PCR	1.3%−6.5% overall 13.9% (75/540)	[19]
	Vietnam	HIV+	NA	Fecal samples	LM, RT-PCR, sequence analysis	7.1% (3/42)	[76]
	Australia	HIV+	Diarrhea and other gastrointestinal complaints	Duodenal biopsies	LM, confirmed by EM	30% (33/109) with diarrhea; 1.4% (1/71) without diarrhea	[39]

Oceania	Australia	HIV+	Diarrhea	Fecal samples	LM	3.6% (5/139)	[103]

LM: light microscopy, EM: electron microscopy, TEM: transmission electron microscopy, IFAT-MAb: indirect immunofluorescent assay with monoclonal antibodies, NA: not available, TB: tuberculosis, Pts: patients.