Human microsporidiosis, a serious disease of immunocompetent and immunosuppressed people, can be due to zoonotic and environmental transmission of microsporidian spores. A survey utilizing conventional and molecular techniques for examining feces from 570 free-ranging, captive, and livestock birds demonstrated that 21 animals shed microsporidian spores of species known to infect humans, including Encephalitozoon hellem (20 birds; 3.5%) and Encephalitozoon intestinalis (1 bird; 0.2%). Of 11 avian species that shed E. hellem and E. intestinalis, 8 were aquatic birds (i.e., common waterfowl). The prevalence of microsporidian infections in waterfowl (8.6%) was significantly higher than the prevalence of microsporidian infections in other birds (1.1%) (P < 0.03); waterfowl fecal droppings contained significantly more spores (mean, 3.6 ؋ 10 5 spores/g) than nonaquatic bird droppings contained (mean, 4.4 ؋ 10 4 spores/g) (P < 0.003); and the presence of microsporidian spores of species known to infect humans in fecal samples was statistically associated with the aquatic status of the avian host (P < 0.001). We demonstrated that a single visit of a waterfowl flock can introduce into the surface water approximately 9.1 ؋ 10 8 microsporidian spores of species known to infect humans. Our findings demonstrate that waterborne microsporidian spores of species that infect people can originate from common waterfowl, which usually occur in large numbers and have unlimited access to surface waters, including waters used for production of drinking water.Microsporidians are obligate intracellular parasites that are emerging opportunistic pathogens that infect both immunocompromised and immunocompetent people (41,42,43). Microsporidians are on the Contaminant Candidate List of the U.S. Environmental Protection Agency because their transmission routes are unknown, spore identification, removal, and inactivation in drinking water are technologically challenging (27), and human infections are difficult to treat (11). Considerable evidence gathered to date indicates that water is involved in the epidemiology of human microsporidiosis (10,12,14,15,25,35,38); however, this epidemiological link has not been proved conclusively (16).
Identification of microsporidian spores of species known to infect humans (Encephalitozoon intestinalis, Encephalitozoon hellem, Encephalitozoon cuniculi, and Enterocytozoon bieneusi)is a challenge because microsporidians can infect a variety of nonhuman hosts and spore morphology does not provide enough information for species identification (39). This challenge is met by the multiplex fluorescence in situ hybridization (FISH) assay, which employs fluorescently labeled oligonucleotide probes targeted to species-specific sequences of 18S rRNA (19,20,22). By using various fluorochromes to label different oligonucleotide probes, spores of E. intestinalis, E. hellem, E. cuniculi, and E. bieneusi are stained red, green, orange, and yellow, respectively (19,20,22).E. hellem has been found most frequently in avian ho...