Microsporidiosis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Laboratory findings consistent with the diagnosis of microsporidiosis include microscopic identification of the organism in fecal smears using chromotrope 2R or quick hot gram chromotrope, positive PCR, and positive serology using indrirect immunofluorescence.

Lab findings

Microscopic identification of the organism

Identification of the organism in the stool specimens is a quick and cheap method for diagnosis.

• Special stains must be used because spores are not visible with ordinary stains.
• Using chromotrope 2R method, spores appear pink with belt like stripes in the middle of the spores.
• Chromotrope 2R staining technique takes about 90 minutes.
• Using Quick hot gram chromotrope, organism appears dark violet and the belt-like stripes are enhanced.
• Quick hot gram provides better visualization of the organism and cuts down the time needed for staining to 10 minutes.
• Enterocytozoon bieneusi spores measure 0.8 - 1.4 mcm while Anncaliia algerae, Encephalitozoon spp., Vittaforma corneae, and Nosema spp spores measure 1.5 - 4 mcm.
• Fecal smears shows no WBCs nor blood unless concamitant infection is present.

Unidentified microsporidia stained with Chromotrope 2R	Enterocytozoon bieneusi spores stained with Chromotrope 2R	Encephalitozoon cuniculi spores stained with Gram Chromotrope

Serologic assays:

• IgM or IgG anti microsporidial antibodies can be detected in serum using indirect immunofluorescence assays.

Monoclonal antibody-based immunofluorescence identification of Encephalitozoon hellem.

PCR

• Molecular identification of Enterocytozoon bieneusi, Encephalitozoon intestinalis, Encephalitozoon hellem and Encephalitozoon cuniculi using PCR is available.
• PCR is the most sensitive and specific method for diagnosing microsporidiosis yet it is expensive and not recommended for routine diagnosis.