Skip to main content
NCBI home page
Clinical Microbiology Reviews logoLink to Clinical Microbiology Reviews
. 1997 Jan;10(1):67–85. doi: 10.1128/cmr.10.1.67

Waterborne protozoan pathogens.

M M Marshall 1, D Naumovitz 1, Y Ortega 1, C R Sterling 1
PMCID: PMC172915  PMID: 8993859

Abstract

Protozoan parasites were the most frequently identified etiologic agents in waterborne disease outbreak from 1991 to 1994. The waterborne parasites Giardia lamblia, Naegleria fowleri, Acanthamoeba spp., Entamoeba histolytica, Cryptosporidium parvum, Cyclospora cayetanesis, Isospora belli, and the microsporidia are reviewed. For each parasite, the review includes history, life cycle, incidence, symptoms, and therapy. Clinical detection methods are compared, and emerging technologies are discussed. Information on the association of these parasites with waterborne outbreaks is reviewed. Current information on protozoan parasites identified as etiological agents in waterborne outbreaks is discussed. Water industry issues related to recent disease outbreaks are examined in the context of water quality testing regulations for G. lamblia and those proposed for C. parvum. The review identifies the limitations of the American Society of Testing and Materials water-testing method for these parasites. An overview of federal regulations affecting the water industry and laboratories that test for water quality is also provided. The article highlights the importance of the clinical laboratory as a frontline defense for the detection of infectious organisms. The review points to the need for clinical laboratories, physicians, and public health personnel to cooperatively plan and assess the challenge of meeting this potential public health threat.

Full Text

The Full Text of this article is available as a PDF (297.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aarnaes S. L., Blanding J., Speier S., Forthal D., de la Maza L. M., Peterson E. M. Comparison of the ProSpecT and Color Vue enzyme-linked immunoassays for the detection of Cryptosporidium in stool specimens. Diagn Microbiol Infect Dis. 1994 Aug;19(4):221–225. doi: 10.1016/0732-8893(94)90035-3. [DOI] [PubMed] [Google Scholar]
  2. Abbaszadegan M., Gerba C. P., Rose J. B. Detection of Giardia cysts with a cDNA probe and applications to water samples. Appl Environ Microbiol. 1991 Apr;57(4):927–931. doi: 10.1128/aem.57.4.927-931.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Acuna-Soto R., Samuelson J., De Girolami P., Zarate L., Millan-Velasco F., Schoolnick G., Wirth D. Application of the polymerase chain reaction to the epidemiology of pathogenic and nonpathogenic Entamoeba histolytica. Am J Trop Med Hyg. 1993 Jan;48(1):58–70. doi: 10.4269/ajtmh.1993.48.58. [DOI] [PubMed] [Google Scholar]
  4. Adam R. D. The biology of Giardia spp. Microbiol Rev. 1991 Dec;55(4):706–732. doi: 10.1128/mr.55.4.706-732.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Addiss D. G., Mathews H. M., Stewart J. M., Wahlquist S. P., Williams R. M., Finton R. J., Spencer H. C., Juranek D. D. Evaluation of a commercially available enzyme-linked immunosorbent assay for Giardia lamblia antigen in stool. J Clin Microbiol. 1991 Jun;29(6):1137–1142. doi: 10.1128/jcm.29.6.1137-1142.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Albert M. J., Kabir I., Azim T., Hossain A., Ansaruzzaman M., Unicomb L. Diarrhea associated with Cyclospora Sp. in Bangladesh. Diagn Microbiol Infect Dis. 1994 May;19(1):47–49. doi: 10.1016/0732-8893(94)90050-7. [DOI] [PubMed] [Google Scholar]
  7. Aldras A. M., Orenstein J. M., Kotler D. P., Shadduck J. A., Didier E. S. Detection of microsporidia by indirect immunofluorescence antibody test using polyclonal and monoclonal antibodies. J Clin Microbiol. 1994 Mar;32(3):608–612. doi: 10.1128/jcm.32.3.608-612.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Alles A. J., Waldron M. A., Sierra L. S., Mattia A. R. Prospective comparison of direct immunofluorescence and conventional staining methods for detection of Giardia and Cryptosporidium spp. in human fecal specimens. J Clin Microbiol. 1995 Jun;33(6):1632–1634. doi: 10.1128/jcm.33.6.1632-1634.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Anderlini P., Przepiorka D., Luna M., Langford L., Andreeff M., Claxton D., Deisseroth A. B. Acanthamoeba meningoencephalitis after bone marrow transplantation. Bone Marrow Transplant. 1994 Sep;14(3):459–461. [PubMed] [Google Scholar]
  10. Arya S. C. Cryptosporidium antigen detection in human feces by reverse passive hemagglutination assay. J Clin Microbiol. 1995 Jun;33(6):1684–1685. doi: 10.1128/jcm.33.6.1684-1685.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Asbell P. A. Acanthamoeba keratitis: there and back again. Mt Sinai J Med. 1993 Sep;60(4):279–282. [PubMed] [Google Scholar]
  12. Ashford R. W. Occurrence of an undescribed coccidian in man in Papua New Guinea. Ann Trop Med Parasitol. 1979 Oct;73(5):497–500. doi: 10.1080/00034983.1979.11687291. [DOI] [PubMed] [Google Scholar]
  13. Asmuth D. M., DeGirolami P. C., Federman M., Ezratty C. R., Pleskow D. K., Desai G., Wanke C. A. Clinical features of microsporidiosis in patients with AIDS. Clin Infect Dis. 1994 May;18(5):819–825. doi: 10.1093/clinids/18.5.819. [DOI] [PubMed] [Google Scholar]
  14. Beaugerie L., Teilhac M. F., Deluol A. M., Fritsch J., Girard P. M., Rozenbaum W., Le Quintrec Y., Chatelet F. P. Cholangiopathy associated with Microsporidia infection of the common bile duct mucosa in a patient with HIV infection. Ann Intern Med. 1992 Sep 1;117(5):401–402. doi: 10.7326/0003-4819-117-5-401. [DOI] [PubMed] [Google Scholar]
  15. Beauvais B., Sarfati C., Molina J. M., Lesourd A., Lariviere M., Derouin F. Comparative evaluation of five diagnostic methods for demonstrating microsporidia in stool and intestinal biopsy specimens. Ann Trop Med Parasitol. 1993 Feb;87(1):99–102. doi: 10.1080/00034983.1993.11812742. [DOI] [PubMed] [Google Scholar]
  16. Beckers P. J., Derks G. J., Gool T., Rietveld F. J., Sauerwein R. W. Encephalocytozoon intestinalis-specific monoclonal antibodies for laboratory diagnosis of microsporidiosis. J Clin Microbiol. 1996 Feb;34(2):282–285. doi: 10.1128/jcm.34.2.282-285.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Bell A., Guasparini R., Meeds D., Mathias R. G., Farley J. D. A swimming pool-associated outbreak of Cryptosporidiosis in British Columbia. Can J Public Health. 1993 Sep-Oct;84(5):334–337. [PubMed] [Google Scholar]
  18. Benator D. A., French A. L., Beaudet L. M., Levy C. S., Orenstein J. M. Isospora belli infection associated with acalculous cholecystitis in a patient with AIDS. Ann Intern Med. 1994 Nov 1;121(9):663–664. doi: 10.7326/0003-4819-121-9-199411010-00006. [DOI] [PubMed] [Google Scholar]
  19. Bendall R. P., Lucas S., Moody A., Tovey G., Chiodini P. L. Diarrhoea associated with cyanobacterium-like bodies: a new coccidian enteritis of man. Lancet. 1993 Mar 6;341(8845):590–592. doi: 10.1016/0140-6736(93)90352-h. [DOI] [PubMed] [Google Scholar]
  20. Berkelman R. L. Emerging infectious diseases in the United States, 1993. J Infect Dis. 1994 Aug;170(2):272–277. doi: 10.1093/infdis/170.2.272. [DOI] [PubMed] [Google Scholar]
  21. Berlin O. G., Novak S. M., Porschen R. K., Long E. G., Stelma G. N., Schaeffer F. W., 3rd Recovery of Cyclospora organisms from patients with prolonged diarrhea. Clin Infect Dis. 1994 Apr;18(4):606–609. doi: 10.1093/clinids/18.4.606. [DOI] [PubMed] [Google Scholar]
  22. Bottone E. J. Free-living amebas of the genera Acanthamoeba and Naegleria: an overview and basic microbiologic correlates. Mt Sinai J Med. 1993 Sep;60(4):260–270. [PubMed] [Google Scholar]
  23. Brown R. L. Successful treatment of primary amebic meningoencephalitis. Arch Intern Med. 1991 Jun;151(6):1201–1202. [PubMed] [Google Scholar]
  24. Bruckner D. A. Amebiasis. Clin Microbiol Rev. 1992 Oct;5(4):356–369. doi: 10.1128/cmr.5.4.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Bryan R. T., Pinner R. W., Berkelman R. L. Emerging infectious diseases in the United States, Improved surveillance, a requisite for prevention. Ann N Y Acad Sci. 1994 Dec 15;740:346–361. doi: 10.1111/j.1749-6632.1994.tb19892.x. [DOI] [PubMed] [Google Scholar]
  26. Butcher P. D., Cevallos A. M., Carnaby S., Alstead E. M., Swarbrick E. T., Farthing M. J. Phenotypic and genotypic variation in Giardia lamblia isolates during chronic infection. Gut. 1994 Jan;35(1):51–54. doi: 10.1136/gut.35.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Cali A., Meisler D. M., Lowder C. Y., Lembach R., Ayers L., Takvorian P. M., Rutherford I., Longworth D. L., McMahon J., Bryan R. T. Corneal microsporidioses: characterization and identification. J Protozool. 1991 Nov-Dec;38(6):215S–217S. [PubMed] [Google Scholar]
  28. Cali A., Orenstein J. M., Kotler D. P., Owen R. A comparison of two microsporidian parasites in enterocytes of AIDS patients with chronic diarrhea. J Protozool. 1991 Nov-Dec;38(6):96S–98S. [PubMed] [Google Scholar]
  29. Canning E. U., Hollister W. S. Enterocytozoon bieneusi (Microspora): prevalence and pathogenicity in AIDS patients. Trans R Soc Trop Med Hyg. 1990 Mar-Apr;84(2):181–186. doi: 10.1016/0035-9203(90)90247-c. [DOI] [PubMed] [Google Scholar]
  30. Carraway M., Tzipori S., Widmer G. Identification of genetic heterogeneity in the Cryptosporidium parvum ribosomal repeat. Appl Environ Microbiol. 1996 Feb;62(2):712–716. doi: 10.1128/aem.62.2.712-716.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Casemore D. P. Cyclospora: another "new" pathogen. J Med Microbiol. 1994 Oct;41(4):217–219. doi: 10.1099/00222615-41-4-217. [DOI] [PubMed] [Google Scholar]
  32. Clark C. G., Cunnick C. C., Diamond L. S. Entamoeba histolytica: is conversion of "nonpathogenic" amebae to the "pathogenic" form a real phenomenon? Exp Parasitol. 1992 May;74(3):307–314. doi: 10.1016/0014-4894(92)90154-3. [DOI] [PubMed] [Google Scholar]
  33. Clark C. G., Diamond L. S. Differentiation of pathogenic Entamoeba histolytica from other intestinal protozoa by riboprinting. Arch Med Res. 1992;23(2):15–16. [PubMed] [Google Scholar]
  34. Clark C. G., Diamond L. S. Entamoeba histolytica: an explanation for the reported conversion of "nonpathogenic" amebae to the "pathogenic" form. Exp Parasitol. 1993 Dec;77(4):456–460. doi: 10.1006/expr.1993.1106. [DOI] [PubMed] [Google Scholar]
  35. Clarridge J. E., 3rd, Karkhanis S., Rabeneck L., Marino B., Foote L. W. Quantitative light microscopic detection of Enterocytozoon bieneusi in stool specimens: a longitudinal study of human immunodeficiency virus-infected microsporidiosis patients. J Clin Microbiol. 1996 Mar;34(3):520–523. doi: 10.1128/jcm.34.3.520-523.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Comin C. E., Santucci M. Submicroscopic profile of Isospora belli enteritis in a patient with acquired immune deficiency syndrome. Ultrastruct Pathol. 1994 Sep-Oct;18(5):473–482. doi: 10.3109/01913129409023222. [DOI] [PubMed] [Google Scholar]
  37. Connor B. A., Shlim D. R., Scholes J. V., Rayburn J. L., Reidy J., Rajah R. Pathologic changes in the small bowel in nine patients with diarrhea associated with a coccidia-like body. Ann Intern Med. 1993 Sep 1;119(5):377–382. doi: 10.7326/0003-4819-119-5-199309010-00005. [DOI] [PubMed] [Google Scholar]
  38. Croppo G. P., Gomez Morales M. A., Pozio E. Infezioni da microsporidi in soggetti immunocompetenti ed immunodepressi. Parassitologia. 1991 Dec;33(2-3):209–218. [PubMed] [Google Scholar]
  39. Croppo G. P., Leitch G. J., Wallace S., Visvesvara G. S. Immunofluorescence and western blot analysis of microsporidia using anti-Encephalitozoon hellem immunoglobulin G monoclonal antibodies. J Eukaryot Microbiol. 1994 Sep-Oct;41(5):31S–31S. [PubMed] [Google Scholar]
  40. Current W. L. Cryptosporidium parvum: household transmission. Ann Intern Med. 1994 Mar 15;120(6):518–519. doi: 10.7326/0003-4819-120-6-199403150-00012. [DOI] [PubMed] [Google Scholar]
  41. Current W. L., Garcia L. S. Cryptosporidiosis. Clin Microbiol Rev. 1991 Jul;4(3):325–358. doi: 10.1128/cmr.4.3.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Dagan R., Fraser D., El-On J., Kassis I., Deckelbaum R., Turner S. Evaluation of an enzyme immunoassay for the detection of Cryptosporidium spp. in stool specimens from infants and young children in field studies. Am J Trop Med Hyg. 1995 Feb;52(2):134–138. doi: 10.4269/ajtmh.1995.52.134. [DOI] [PubMed] [Google Scholar]
  43. De Groote M. A., Visvesvara G., Wilson M. L., Pieniazek N. J., Slemenda S. B., daSilva A. J., Leitch G. J., Bryan R. T., Reves R. Polymerase chain reaction and culture confirmation of disseminated Encephalitozoon cuniculi in a patient with AIDS: successful therapy with albendazole. J Infect Dis. 1995 May;171(5):1375–1378. doi: 10.1093/infdis/171.5.1375. [DOI] [PubMed] [Google Scholar]
  44. DeGirolami P. C., Ezratty C. R., Desai G., McCullough A., Asmuth D., Wanke C., Federman M. Diagnosis of intestinal microsporidiosis by examination of stool and duodenal aspirate with Weber's modified trichrome and Uvitex 2B strains. J Clin Microbiol. 1995 Apr;33(4):805–810. doi: 10.1128/jcm.33.4.805-810.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Desportes I., Le Charpentier Y., Galian A., Bernard F., Cochand-Priollet B., Lavergne A., Ravisse P., Modigliani R. Occurrence of a new microsporidan: Enterocytozoon bieneusi n.g., n. sp., in the enterocytes of a human patient with AIDS. J Protozool. 1985 May;32(2):250–254. doi: 10.1111/j.1550-7408.1985.tb03046.x. [DOI] [PubMed] [Google Scholar]
  46. Didier E. S., Orenstein J. M., Aldras A., Bertucci D., Rogers L. B., Janney F. A. Comparison of three staining methods for detecting microsporidia in fluids. J Clin Microbiol. 1995 Dec;33(12):3138–3145. doi: 10.1128/jcm.33.12.3138-3145.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. DuPont H. L., Chappell C. L., Sterling C. R., Okhuysen P. C., Rose J. B., Jakubowski W. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med. 1995 Mar 30;332(13):855–859. doi: 10.1056/NEJM199503303321304. [DOI] [PubMed] [Google Scholar]
  48. Eeftinck Schattenkerk J. K., van Gool T., van Ketel R. J., Bartelsman J. F., Kuiken C. L., Terpstra W. J., Reiss P. Clinical significance of small-intestinal microsporidiosis in HIV-1-infected individuals. Lancet. 1991 Apr 13;337(8746):895–898. doi: 10.1016/0140-6736(91)90215-b. [DOI] [PubMed] [Google Scholar]
  49. Elder M. J., Kilvington S., Dart J. K. A clinicopathologic study of in vitro sensitivity testing and Acanthamoeba keratitis. Invest Ophthalmol Vis Sci. 1994 Mar;35(3):1059–1064. [PubMed] [Google Scholar]
  50. Farrington M., Winters S., Walker C., Miller R., Rubenstein D. Cryptosporidium antigen detection in human feces by reverse passive hemagglutination assay. J Clin Microbiol. 1994 Nov;32(11):2755–2759. doi: 10.1128/jcm.32.11.2755-2759.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Fedorko D. P., Hijazi Y. M. Application of molecular techniques to the diagnosis of microsporidial infection. Emerg Infect Dis. 1996 Jul-Sep;2(3):183–191. doi: 10.3201/eid0203.960304. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Field A. S., Hing M. C., Milliken S. T., Marriott D. J. Microsporidia in the small intestine of HIV-infected patients. A new diagnostic technique and a new species. Med J Aust. 1993 Mar 15;158(6):390–394. [PubMed] [Google Scholar]
  53. Franzen C., Müller A., Hegener P., Salzberger B., Hartmann P., Fätkenheuer G., Diehl V., Schrappe M. Detection of microsporidia (Enterocytozoon bieneusi) in intestinal biopsy specimens from human immunodeficiency virus-infected patients by PCR. J Clin Microbiol. 1995 Sep;33(9):2294–2296. doi: 10.1128/jcm.33.9.2294-2296.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Fraser D. Epidemiology of Giardia lamblia and Cryptosporidium infections in childhood. Isr J Med Sci. 1994 May-Jun;30(5-6):356–361. [PubMed] [Google Scholar]
  55. Garcia L. S., Shum A. C., Bruckner D. A. Evaluation of a new monoclonal antibody combination reagent for direct fluorescence detection of Giardia cysts and Cryptosporidium oocysts in human fecal specimens. J Clin Microbiol. 1992 Dec;30(12):3255–3257. doi: 10.1128/jcm.30.12.3255-3257.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Gardner H. A., Martinez A. J., Visvesvara G. S., Sotrel A. Granulomatous amebic encephalitis in an AIDS patient. Neurology. 1991 Dec;41(12):1993–1995. doi: 10.1212/wnl.41.12.1993. [DOI] [PubMed] [Google Scholar]
  57. Gascón J., Corachan M., Valls M. E., Gene A., Bombi J. A. Cyanobacteria-like body (CLB) in travellers with diarrhea. Scand J Infect Dis. 1993;25(2):253–257. doi: 10.3109/00365549309008493. [DOI] [PubMed] [Google Scholar]
  58. Glaser C. A., Angulo F. J., Rooney J. A. Animal-associated opportunistic infections among persons infected with the human immunodeficiency virus. Clin Infect Dis. 1994 Jan;18(1):14–24. doi: 10.1093/clinids/18.1.14. [DOI] [PubMed] [Google Scholar]
  59. González-Dominguez J., Roldán R., Villanueva J. L., Kindelán J. M., Jurado R., Torre-Cisneros J. Isospora belli reactive arthritis in a patient with AIDS. Ann Rheum Dis. 1994 Sep;53(9):618–619. doi: 10.1136/ard.53.9.618-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Graczyk T. K., Cranfield M. R., Fayer R. Evaluation of commercial enzyme immunoassay (EIA) and immunofluorescent antibody (FA) test kits for detection of Cryptosporidium oocysts of species other than Cryptosporidium parvum. Am J Trop Med Hyg. 1996 Mar;54(3):274–279. doi: 10.4269/ajtmh.1996.54.274. [DOI] [PubMed] [Google Scholar]
  61. Hale D., Aldeen W., Carroll K. Diarrhea associated with Cyanobacterialike bodies in an immunocompetent host. An unusual epidemiological source. JAMA. 1994 Jan 12;271(2):144–145. [PubMed] [Google Scholar]
  62. Hansen J. S., Ongerth J. E. Effects of time and watershed characteristics on the concentration of Cryptosporidium oocysts in river water. Appl Environ Microbiol. 1991 Oct;57(10):2790–2795. doi: 10.1128/aem.57.10.2790-2795.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  63. Haque R., Neville L. M., Hahn P., Petri W. A., Jr Rapid diagnosis of Entamoeba infection by using Entamoeba and Entamoeba histolytica stool antigen detection kits. J Clin Microbiol. 1995 Oct;33(10):2558–2561. doi: 10.1128/jcm.33.10.2558-2561.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Haque R., Neville L. M., Wood S., Petri W. A., Jr Short report: detection of Entamoeba histolytica and E. dispar directly in stool. Am J Trop Med Hyg. 1994 May;50(5):595–596. doi: 10.4269/ajtmh.1994.50.595. [DOI] [PubMed] [Google Scholar]
  65. Hart A. S., Ridinger M. T., Soundarajan R., Peters C. S., Swiatlo A. L., Kocka F. E. Novel organism associated with chronic diarrhoea in AIDS. Lancet. 1990 Jan 20;335(8682):169–170. doi: 10.1016/0140-6736(90)90042-4. [DOI] [PubMed] [Google Scholar]
  66. Hartskeerl R. A., Van Gool T., Schuitema A. R., Didier E. S., Terpstra W. J. Genetic and immunological characterization of the microsporidian Septata intestinalis Cali, Kotler and Orenstein, 1993: reclassification to Encephalitozoon intestinalis. Parasitology. 1995 Apr;110(Pt 3):277–285. doi: 10.1017/s0031182000080860. [DOI] [PubMed] [Google Scholar]
  67. Herwaldt B. L., Craun G. F., Stokes S. L., Juranek D. D. Waterborne-disease outbreaks, 1989-1990. MMWR CDC Surveill Summ. 1991 Dec;40(3):1–21. [PubMed] [Google Scholar]
  68. Hoge C. W., Shlim D. R., Ghimire M., Rabold J. G., Pandey P., Walch A., Rajah R., Gaudio P., Echeverria P. Placebo-controlled trial of co-trimoxazole for Cyclospora infections among travellers and foreign residents in Nepal. Lancet. 1995 Mar 18;345(8951):691–693. doi: 10.1016/s0140-6736(95)90868-4. [DOI] [PubMed] [Google Scholar]
  69. Hoge C. W., Shlim D. R., Rajah R., Triplett J., Shear M., Rabold J. G., Echeverria P. Epidemiology of diarrhoeal illness associated with coccidian-like organism among travellers and foreign residents in Nepal. Lancet. 1993 May 8;341(8854):1175–1179. doi: 10.1016/0140-6736(93)91002-4. [DOI] [PubMed] [Google Scholar]
  70. Hollister W. S., Canning E. U., Willcox A. Evidence for widespread occurrence of antibodies to Encephalitozoon cuniculi (Microspora) in man provided by ELISA and other serological tests. Parasitology. 1991 Feb;102(Pt 1):33–43. doi: 10.1017/s0031182000060315. [DOI] [PubMed] [Google Scholar]
  71. Joce R. E., Bruce J., Kiely D., Noah N. D., Dempster W. B., Stalker R., Gumsley P., Chapman P. A., Norman P., Watkins J. An outbreak of cryptosporidiosis associated with a swimming pool. Epidemiol Infect. 1991 Dec;107(3):497–508. doi: 10.1017/s0950268800049190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Johns K. J., Head W. S., Robinson R. D., Williams T. E., O'Day D. M. Examination of the contact lens with light microscopy: an aid in diagnosis of Acanthamoeba keratitis. Rev Infect Dis. 1991 Mar-Apr;13 (Suppl 5):S425–S425. doi: 10.1093/clind/13.supplement_5.s425. [DOI] [PubMed] [Google Scholar]
  73. Johnson D. W., Pieniazek N. J., Griffin D. W., Misener L., Rose J. B. Development of a PCR protocol for sensitive detection of Cryptosporidium oocysts in water samples. Appl Environ Microbiol. 1995 Nov;61(11):3849–3855. doi: 10.1128/aem.61.11.3849-3855.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Junod C., Deluol A. M., Cosnes J., Bauer P. Cyclospora, nouvelle coccidie agent de diarrhées des voyageurs. 11 observations. Presse Med. 1994 Sep 24;23(28):1312–1312. [PubMed] [Google Scholar]
  75. Kappus K. D., Lundgren R. G., Jr, Juranek D. D., Roberts J. M., Spencer H. C. Intestinal parasitism in the United States: update on a continuing problem. Am J Trop Med Hyg. 1994 Jun;50(6):705–713. doi: 10.4269/ajtmh.1994.50.705. [DOI] [PubMed] [Google Scholar]
  76. Katzwinkel-Wladarsch S., Loscher T., Rinder H. Direct amplification and differentiation of pathogenic and nonpathogenic Entamoeba histolytica DNA from stool specimens. Am J Trop Med Hyg. 1994 Jul;51(1):115–118. doi: 10.4269/ajtmh.1994.51.115. [DOI] [PubMed] [Google Scholar]
  77. Kehl K. S., Cicirello H., Havens P. L. Comparison of four different methods for detection of Cryptosporidium species. J Clin Microbiol. 1995 Feb;33(2):416–418. doi: 10.1128/jcm.33.2.416-418.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  78. Kilvington S., Beeching J. Development of a PCR for identification of Naegleria fowleri from the environment. Appl Environ Microbiol. 1995 Oct;61(10):3764–3767. doi: 10.1128/aem.61.10.3764-3767.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  79. Kilvington S., Beeching J. Identification and epidemiological typing of Naegleria fowleri with DNA probes. Appl Environ Microbiol. 1995 Jun;61(6):2071–2078. doi: 10.1128/aem.61.6.2071-2078.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Kotler D. P., Orenstein J. M. Prevalence of intestinal microsporidiosis in HIV-infected individuals referred for gastroenterological evaluation. Am J Gastroenterol. 1994 Nov;89(11):1998–2002. [PubMed] [Google Scholar]
  81. Kramer M. H., Herwaldt B. L., Craun G. F., Calderon R. L., Juranek D. D. Surveillance for waterborne-disease outbreaks--United States, 1993-1994. MMWR CDC Surveill Summ. 1996 Apr 12;45(1):1–33. [PubMed] [Google Scholar]
  82. La Via W. V., B1P6 Parasitic gastroenteritis. Pediatr Ann. 1994 Oct;23(10):556–560. doi: 10.3928/0090-4481-19941001-10. [DOI] [PubMed] [Google Scholar]
  83. Laxer M. A., D'Nicuola M. E., Patel R. J. Detection of Cryptosporidium parvum DNA in fixed, paraffin-embedded tissue by the polymerase chain reaction. Am J Trop Med Hyg. 1992 Oct;47(4):450–455. doi: 10.4269/ajtmh.1992.47.450. [DOI] [PubMed] [Google Scholar]
  84. Laxer M. A., Timblin B. K., Patel R. J. DNA sequences for the specific detection of Cryptosporidium parvum by the polymerase chain reaction. Am J Trop Med Hyg. 1991 Dec;45(6):688–694. doi: 10.4269/ajtmh.1991.45.688. [DOI] [PubMed] [Google Scholar]
  85. LeChevallier M. W., Norton W. D., Lee R. G. Giardia and Cryptosporidium spp. in filtered drinking water supplies. Appl Environ Microbiol. 1991 Sep;57(9):2617–2621. doi: 10.1128/aem.57.9.2617-2621.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  86. LeChevallier M. W., Norton W. D., Lee R. G. Occurrence of Giardia and Cryptosporidium spp. in surface water supplies. Appl Environ Microbiol. 1991 Sep;57(9):2610–2616. doi: 10.1128/aem.57.9.2610-2616.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  87. LeChevallier M. W., Norton W. D., Siegel J. E., Abbaszadegan M. Evaluation of the immunofluorescence procedure for detection of Giardia cysts and Cryptosporidium oocysts in water. Appl Environ Microbiol. 1995 Feb;61(2):690–697. doi: 10.1128/aem.61.2.690-697.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  88. Lebbad M., Linder E. Nyupptäckt organism bakom diarrésjukdom. Samtliga drabbade hade nyligen varit utomlands. Lakartidningen. 1993 Mar 10;90(10):951–952. [PubMed] [Google Scholar]
  89. Lewis D. J., Freedman A. R. Giardia lamblia as an intestinal pathogen. Dig Dis. 1992;10(2):102–111. doi: 10.1159/000171348. [DOI] [PubMed] [Google Scholar]
  90. Lom J. Introductory remarks on microsporidia in the AIDS era. Folia Parasitol (Praha) 1993;40(4):255–256. [PubMed] [Google Scholar]
  91. Long E. G., Ebrahimzadeh A., White E. H., Swisher B., Callaway C. S. Alga associated with diarrhea in patients with acquired immunodeficiency syndrome and in travelers. J Clin Microbiol. 1990 Jun;28(6):1101–1104. doi: 10.1128/jcm.28.6.1101-1104.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  92. Long E. G., White E. H., Carmichael W. W., Quinlisk P. M., Raja R., Swisher B. L., Daugharty H., Cohen M. T. Morphologic and staining characteristics of a cyanobacterium-like organism associated with diarrhea. J Infect Dis. 1991 Jul;164(1):199–202. doi: 10.1093/infdis/164.1.199. [DOI] [PubMed] [Google Scholar]
  93. Lukes J., Vávra J. Microsporidium aedium n. sp., from the mosquito Aedes cantans. J Invertebr Pathol. 1991 Sep;58(2):274–276. doi: 10.1016/0022-2011(91)90072-x. [DOI] [PubMed] [Google Scholar]
  94. Lumb R., Swift J., James C., Papanaoum K., Mukherjee T. Identification of the microsporidian parasite, Enterocytozoon bieneusi in faecal samples and intestinal biopsies from an AIDS patient. Int J Parasitol. 1993 Sep;23(6):793–801. doi: 10.1016/0020-7519(93)90077-c. [DOI] [PubMed] [Google Scholar]
  95. Ma P., Visvesvara G. S., Martinez A. J., Theodore F. H., Daggett P. M., Sawyer T. K. Naegleria and Acanthamoeba infections: review. Rev Infect Dis. 1990 May-Jun;12(3):490–513. doi: 10.1093/clinids/12.3.490. [DOI] [PubMed] [Google Scholar]
  96. Mac Kenzie W. R., Hoxie N. J., Proctor M. E., Gradus M. S., Blair K. A., Peterson D. E., Kazmierczak J. J., Addiss D. G., Fox K. R., Rose J. B. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med. 1994 Jul 21;331(3):161–167. doi: 10.1056/NEJM199407213310304. [DOI] [PubMed] [Google Scholar]
  97. MacKenzie W. R., Schell W. L., Blair K. A., Addiss D. G., Peterson D. E., Hoxie N. J., Kazmierczak J. J., Davis J. P. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: recurrence of illness and risk of secondary transmission. Clin Infect Dis. 1995 Jul;21(1):57–62. doi: 10.1093/clinids/21.1.57. [DOI] [PubMed] [Google Scholar]
  98. Madico G., Gilman R. H., Miranda E., Cabrera L., Sterling C. R. Treatment of Cyclospora infections with co-trimoxazole. Lancet. 1993 Jul 10;342(8863):122–123. doi: 10.1016/0140-6736(93)91330-o. [DOI] [PubMed] [Google Scholar]
  99. Mahbubani M. H., Bej A. K., Perlin M., Schaefer F. W., 3rd, Jakubowski W., Atlas R. M. Detection of Giardia cysts by using the polymerase chain reaction and distinguishing live from dead cysts. Appl Environ Microbiol. 1991 Dec;57(12):3456–3461. doi: 10.1128/aem.57.12.3456-3461.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  100. Mannheimer S. B., Soave R. Protozoal infections in patients with AIDS. Cryptosporidiosis, isosporiasis, cyclosporiasis, and microsporidiosis. Infect Dis Clin North Am. 1994 Jun;8(2):483–498. [PubMed] [Google Scholar]
  101. Marciano-Cabral F. Biology of Naegleria spp. Microbiol Rev. 1988 Mar;52(1):114–133. doi: 10.1128/mr.52.1.114-133.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  102. Markus M. B., Frean J. A. Occurrence of human Cyclospora infection in sub-Saharan Africa. S Afr Med J. 1993 Nov;83(11):862–863. [PubMed] [Google Scholar]
  103. Markus M. B. Origin of extra-intestinal stages of Isospora belli in the acquired immune deficiency syndrome (AIDS). Med Hypotheses. 1991 Jul;35(3):278–278. doi: 10.1016/0306-9877(91)90246-u. [DOI] [PubMed] [Google Scholar]
  104. Martinez A. J. Free-living amebas: infection of the central nervous system. Mt Sinai J Med. 1993 Sep;60(4):271–278. [PubMed] [Google Scholar]
  105. Martinez A. J., Visvesvara G. S. Laboratory diagnosis of pathogenic free-living amoebas: Naegleria, Acanthamoeba, and Leptomyxid. Clin Lab Med. 1991 Dec;11(4):861–872. [PubMed] [Google Scholar]
  106. McAnulty J. M., Fleming D. W., Gonzalez A. H. A community-wide outbreak of cryptosporidiosis associated with swimming at a wave pool. JAMA. 1994 Nov 23;272(20):1597–1600. [PubMed] [Google Scholar]
  107. McDougall R. J., Tandy M. W., Boreham R. E., Stenzel D. J., O'Donoghue P. J. Incidental finding of a microsporidian parasite from an AIDS patient. J Clin Microbiol. 1993 Feb;31(2):436–439. doi: 10.1128/jcm.31.2.436-439.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  108. McDougall R. J., Tandy M. W. Coccidian/cyanobacterium-like bodies as a cause of diarrhea in Australia. Pathology. 1993 Oct;25(4):375–378. doi: 10.3109/00313029309090862. [DOI] [PubMed] [Google Scholar]
  109. Michiels J. F., Hofman P., Saint Paul M. C., Loubière R., Bernard E., LeFichoux Y. Pathological features of intestinal microsporidiosis in HIV positive patients. A report of 13 new cases. Pathol Res Pract. 1993 May;189(4):377–383. doi: 10.1016/S0344-0338(11)80322-5. [DOI] [PubMed] [Google Scholar]
  110. Moore A. C., Herwaldt B. L., Craun G. F., Calderon R. L., Highsmith A. K., Juranek D. D. Surveillance for waterborne disease outbreaks--United States, 1991-1992. MMWR CDC Surveill Summ. 1993 Nov 19;42(5):1–22. [PubMed] [Google Scholar]
  111. Muscat I. Human microsporidiosis. J Infect. 1990 Sep;21(2):125–129. doi: 10.1016/0163-4453(90)91545-o. [DOI] [PubMed] [Google Scholar]
  112. Newman R. D., Jaeger K. L., Wuhib T., Lima A. A., Guerrant R. L., Sears C. L. Evaluation of an antigen capture enzyme-linked immunosorbent assay for detection of Cryptosporidium oocysts. J Clin Microbiol. 1993 Aug;31(8):2080–2084. doi: 10.1128/jcm.31.8.2080-2084.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  113. Nieminski E. C., Schaefer F. W., 3rd, Ongerth J. E. Comparison of two methods for detection of Giardia cysts and Cryptosporidium oocysts in water. Appl Environ Microbiol. 1995 May;61(5):1714–1719. doi: 10.1128/aem.61.5.1714-1719.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  114. Ooi W. W., Zimmerman S. K., Needham C. A. Cyclospora species as a gastrointestinal pathogen in immunocompetent hosts. J Clin Microbiol. 1995 May;33(5):1267–1269. doi: 10.1128/jcm.33.5.1267-1269.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  115. Orenstein J. M. Microsporidiosis in the acquired immunodeficiency syndrome. J Parasitol. 1991 Dec;77(6):843–864. [PubMed] [Google Scholar]
  116. Orenstein J. M., Tenner M., Cali A., Kotler D. P. A microsporidian previously undescribed in humans, infecting enterocytes and macrophages, and associated with diarrhea in an acquired immunodeficiency syndrome patient. Hum Pathol. 1992 Jul;23(7):722–728. doi: 10.1016/0046-8177(92)90339-5. [DOI] [PubMed] [Google Scholar]
  117. Orrell M. W., O'Dwyer A. M. Dementia, ageing, and the stress control system. Lancet. 1995 Mar 18;345(8951):666–667. doi: 10.1016/s0140-6736(95)90862-5. [DOI] [PubMed] [Google Scholar]
  118. Ortega Y. R., Gilman R. H., Sterling C. R. A new coccidian parasite (Apicomplexa: Eimeriidae) from humans. J Parasitol. 1994 Aug;80(4):625–629. [PubMed] [Google Scholar]
  119. Ortega Y. R., Sheehy R. R., Cama V. A., Oishi K. K., Sterling C. R. Restriction fragment length polymorphism analysis of Cryptosporidium parvum isolates of bovine and human origin. J Protozool. 1991 Nov-Dec;38(6):40S–41S. [PubMed] [Google Scholar]
  120. Ortega Y. R., Sterling C. R., Gilman R. H., Cama V. A., Díaz F. Cyclospora species--a new protozoan pathogen of humans. N Engl J Med. 1993 May 6;328(18):1308–1312. doi: 10.1056/NEJM199305063281804. [DOI] [PubMed] [Google Scholar]
  121. Pape J. W., Verdier R. I., Boncy M., Boncy J., Johnson W. D., Jr Cyclospora infection in adults infected with HIV. Clinical manifestations, treatment, and prophylaxis. Ann Intern Med. 1994 Nov 1;121(9):654–657. doi: 10.7326/0003-4819-121-9-199411010-00004. [DOI] [PubMed] [Google Scholar]
  122. Parisi M. T., Tierno P. M., Jr Evaluation of new rapid commercial enzyme immunoassay for detection of Cryptosporidium oocysts in untreated stool specimens. J Clin Microbiol. 1995 Jul;33(7):1963–1965. doi: 10.1128/jcm.33.7.1963-1965.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  123. Piales I., Coursin T., Deluol A. M., Poirot J. L., Tandeau de Marsac N. Search for cyanobacterium-like bodies in the stools of travellers with diarrhoeal illness. J Eukaryot Microbiol. 1994 Sep-Oct;41(5):58S–58S. [PubMed] [Google Scholar]
  124. Pol S., Romana C., Richard S., Carnot F., Dumont J. L., Bouche H., Pialoux G., Stern M., Pays J. F., Berthelot P. Enterocytozoon bieneusi infection in acquired immunodeficiency syndrome-related sclerosing cholangitis. Gastroenterology. 1992 May;102(5):1778–1781. doi: 10.1016/0016-5085(92)91743-n. [DOI] [PubMed] [Google Scholar]
  125. Pollok R. C., Bendall R. P., Moody A., Chiodini P. L., Churchill D. R. Traveller's diarrhoea associated with cyanobacterium-like bodies. Lancet. 1992 Aug 29;340(8818):556–557. doi: 10.1016/0140-6736(92)91759-2. [DOI] [PubMed] [Google Scholar]
  126. Pratdesaba R. A., Veláquez T., Torres M. F. Occurrence of Isopora belli and cyanobacterium-like bodies in Guatemala. Ann Trop Med Parasitol. 1994 Aug;88(4):449–450. doi: 10.1080/00034983.1994.11812888. [DOI] [PubMed] [Google Scholar]
  127. Rabeneck L., Gyorkey F., Genta R. M., Gyorkey P., Foote L. W., Risser J. M. The role of Microsporidia in the pathogenesis of HIV-related chronic diarrhea. Ann Intern Med. 1993 Nov 1;119(9):895–899. doi: 10.7326/0003-4819-119-9-199311010-00005. [DOI] [PubMed] [Google Scholar]
  128. Rabold J. G., Hoge C. W., Shlim D. R., Kefford C., Rajah R., Echeverria P. Cyclospora outbreak associated with chlorinated drinking water. Lancet. 1994 Nov 12;344(8933):1360–1361. doi: 10.1016/s0140-6736(94)90716-1. [DOI] [PubMed] [Google Scholar]
  129. Reed S. L. Amebiasis: an update. Clin Infect Dis. 1992 Feb;14(2):385–393. doi: 10.1093/clinids/14.2.385. [DOI] [PubMed] [Google Scholar]
  130. Rijpstra A. C., Laarman J. J. Repeated findings of unidentified small Isospora-like coccidia in faecal specimens from travellers returning to The Netherlands. Trop Geogr Med. 1993;45(6):280–282. [PubMed] [Google Scholar]
  131. Rodgers M. R., Flanigan D. J., Jakubowski W. Identification of algae which interfere with the detection of Giardia cysts and Cryptosporidium oocysts and a method for alleviating this interference. Appl Environ Microbiol. 1995 Oct;61(10):3759–3763. doi: 10.1128/aem.61.10.3759-3763.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  132. Rosberger D. F., Serdarevic O. N., Erlandson R. A., Bryan R. T., Schwartz D. A., Visvesvara G. S., Keenan P. C. Successful treatment of microsporidial keratoconjunctivitis with topical fumagillin in a patient with AIDS. Cornea. 1993 May;12(3):261–265. doi: 10.1097/00003226-199305000-00013. [DOI] [PubMed] [Google Scholar]
  133. Rosenblatt J. E., Sloan L. M. Evaluation of an enzyme-linked immunosorbent assay for detection of Cryptosporidium spp. in stool specimens. J Clin Microbiol. 1993 Jun;31(6):1468–1471. doi: 10.1128/jcm.31.6.1468-1471.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  134. Rosoff J. D., Sanders C. A., Sonnad S. S., De Lay P. R., Hadley W. K., Vincenzi F. F., Yajko D. M., O'Hanley P. D. Stool diagnosis of giardiasis using a commercially available enzyme immunoassay to detect Giardia-specific antigen 65 (GSA 65). J Clin Microbiol. 1989 Sep;27(9):1997–2002. doi: 10.1128/jcm.27.9.1997-2002.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  135. Rutherford I., Katanik M. T., Meisler D. M. Efficacy of a chlorhexidine tablet system for disinfection of soft contact lenses against Acanthamoeba species. Rev Infect Dis. 1991 Mar-Apr;13 (Suppl 5):S416–S417. doi: 10.1093/clind/13.supplement_5.s416. [DOI] [PubMed] [Google Scholar]
  136. Saito M., Sekiguchi K., Yajima R., Hina M., Doss R. C., Kanno H. Immunological detection of penicillin-binding protein 2' of methicillin-resistant staphylococci by using monoclonal antibodies prepared from synthetic peptides. J Clin Microbiol. 1995 Sep;33(9):2498–2500. doi: 10.1128/jcm.33.9.2498-2500.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  137. Sarabia-Arce S., Salazar-Lindo E., Gilman R. H., Naranjo J., Miranda E. Case-control study of Cryptosporidium parvum infection in Peruvian children hospitalized for diarrhea: possible association with malnutrition and nosocomial infection. Pediatr Infect Dis J. 1990 Sep;9(9):627–631. [PubMed] [Google Scholar]
  138. Sargeaunt P. G., Williams J. E., Grene J. D. The differentiation of invasive and non-invasive Entamoeba histolytica by isoenzyme electrophoresis. Trans R Soc Trop Med Hyg. 1978;72(5):519–521. doi: 10.1016/0035-9203(78)90174-8. [DOI] [PubMed] [Google Scholar]
  139. Scaglia M., Gatti S., Bassi P., Viale P. L., Novati S., Ranieri S. Intestinal co-infection by Cyclospora sp. and Cryptosporidium parvum: first report in an AIDS patient. Parasite. 1994 Dec;1(4):387–390. doi: 10.1051/parasite/1994014387. [DOI] [PubMed] [Google Scholar]
  140. Scheffler E. H., Van Etta L. L. Evaluation of rapid commercial enzyme immunoassay for detection of Giardia lamblia in formalin-preserved stool specimens. J Clin Microbiol. 1994 Jul;32(7):1807–1808. doi: 10.1128/jcm.32.7.1807-1808.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  141. Schwartz D. A., Sobottka I., Leitch G. J., Cali A., Visvesvara G. S. Pathology of microsporidiosis: emerging parasitic infections in patients with acquired immunodeficiency syndrome. Arch Pathol Lab Med. 1996 Feb;120(2):173–188. [PubMed] [Google Scholar]
  142. Seal D., Stapleton F., Dart J. Possible environmental sources of Acanthamoeba spp in contact lens wearers. Br J Ophthalmol. 1992 Jul;76(7):424–427. doi: 10.1136/bjo.76.7.424. [DOI] [PMC free article] [PubMed] [Google Scholar]
  143. Shadduck J. A., Greeley E. Microsporidia and human infections. Clin Microbiol Rev. 1989 Apr;2(2):158–165. doi: 10.1128/cmr.2.2.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  144. Shadduck J. A., Orenstein J. M. Comparative pathology of microsporidiosis. Arch Pathol Lab Med. 1993 Dec;117(12):1215–1219. [PubMed] [Google Scholar]
  145. Shlim D. R., Cohen M. T., Eaton M., Rajah R., Long E. G., Ungar B. L. An alga-like organism associated with an outbreak of prolonged diarrhea among foreigners in Nepal. Am J Trop Med Hyg. 1991 Sep;45(3):383–389. doi: 10.4269/ajtmh.1991.45.383. [DOI] [PubMed] [Google Scholar]
  146. Smith P. M. Traveller's diarrhoea associated with a cyanobacterium-like body. Med J Aust. 1993 May 17;158(10):724–724. doi: 10.5694/j.1326-5377.1993.tb121948.x. [DOI] [PubMed] [Google Scholar]
  147. Soave R. Waterborne cryptosporidiosis--setting the stage for control of an emerging pathogen. Clin Infect Dis. 1995 Jul;21(1):63–64. doi: 10.1093/clinids/21.1.63. [DOI] [PubMed] [Google Scholar]
  148. Sorvillo F. J., Fujioka K., Nahlen B., Tormey M. P., Kebabjian R., Mascola L. Swimming-associated cryptosporidiosis. Am J Public Health. 1992 May;82(5):742–744. doi: 10.2105/ajph.82.5.742. [DOI] [PMC free article] [PubMed] [Google Scholar]
  149. Sparagano O. Differentiation of Naegleria fowleri and other Naegleriae by polymerase chain reaction and hybridization methods. FEMS Microbiol Lett. 1993 Jul 1;110(3):325–330. doi: 10.1111/j.1574-6968.1993.tb06343.x. [DOI] [PubMed] [Google Scholar]
  150. Sparagano O., Drouet E., Brebant R., Manet E., Denoyel G. A., Pernin P. Use of monoclonal antibodies to distinguish pathogenic Naegleria fowleri (cysts, trophozoites, or flagellate forms) from other Naegleria species. J Clin Microbiol. 1993 Oct;31(10):2758–2763. doi: 10.1128/jcm.31.10.2758-2763.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  151. Stopak S. S., Roat M. I., Nauheim R. C., Turgeon P. W., Sossi G., Kowalski R. P., Thoft R. A. Growth of acanthamoeba on human corneal epithelial cells and keratocytes in vitro. Invest Ophthalmol Vis Sci. 1991 Feb;32(2):354–359. [PubMed] [Google Scholar]
  152. Tee G. H., Moody A. H., Cooke A. H., Chiodini P. L. Comparison of techniques for detecting antigens of Giardia lamblia and Cryptosporidium parvum in faeces. J Clin Pathol. 1993 Jun;46(6):555–558. doi: 10.1136/jcp.46.6.555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  153. Vesey G., Hutton P., Champion A., Ashbolt N., Williams K. L., Warton A., Veal D. Application of flow cytometric methods for the routine detection of Cryptosporidium and Giardia in water. Cytometry. 1994 May 1;16(1):1–6. doi: 10.1002/cyto.990160102. [DOI] [PubMed] [Google Scholar]
  154. Villard O., Himy R., Brogard C., Kremer M. Syndrome diarrhéique associé à la présence de Cyanobacterium-like bodies. Gastroenterol Clin Biol. 1993;17(5):401–402. [PubMed] [Google Scholar]
  155. Visvesvara G. S. Classification of Acanthamoeba. Rev Infect Dis. 1991 Mar-Apr;13 (Suppl 5):S369–S372. doi: 10.1093/clind/13.supplement_5.s369. [DOI] [PubMed] [Google Scholar]
  156. Visvesvara G. S. Epidemiology of infections with free-living amebas and laboratory diagnosis of microsporidiosis. Mt Sinai J Med. 1993 Sep;60(4):283–288. [PubMed] [Google Scholar]
  157. Visvesvara G. S., Leitch G. J., da Silva A. J., Croppo G. P., Moura H., Wallace S., Slemenda S. B., Schwartz D. A., Moss D., Bryan R. T. Polyclonal and monoclonal antibody and PCR-amplified small-subunit rRNA identification of a microsporidian, Encephalitozoon hellem, isolated from an AIDS patient with disseminated infection. J Clin Microbiol. 1994 Nov;32(11):2760–2768. doi: 10.1128/jcm.32.11.2760-2768.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  158. Visvesvara G. S., Martinez A. J., Schuster F. L., Leitch G. J., Wallace S. V., Sawyer T. K., Anderson M. Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J Clin Microbiol. 1990 Dec;28(12):2750–2756. doi: 10.1128/jcm.28.12.2750-2756.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  159. Visvesvara G. S., Stehr-Green J. K. Epidemiology of free-living ameba infections. J Protozool. 1990 Jul-Aug;37(4):25S–33S. doi: 10.1111/j.1550-7408.1990.tb01142.x. [DOI] [PubMed] [Google Scholar]
  160. Visvesvara G. S., da Silva A. J., Croppo G. P., Pieniazek N. J., Leitch G. J., Ferguson D., de Moura H., Wallace S., Slemenda S. B., Tyrrell I. In vitro culture and serologic and molecular identification of Septata intestinalis isolated from urine of a patient with AIDS. J Clin Microbiol. 1995 Apr;33(4):930–936. doi: 10.1128/jcm.33.4.930-936.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  161. Vodkin M. H., Howe D. K., Visvesvara G. S., McLaughlin G. L. Identification of Acanthamoeba at the generic and specific levels using the polymerase chain reaction. J Protozool. 1992 May-Jun;39(3):378–385. doi: 10.1111/j.1550-7408.1992.tb01467.x. [DOI] [PubMed] [Google Scholar]
  162. Vávra J., Nohýnková E., Machala L., Spála J. An extremely rapid method for detection of microsporidia in biopsy materials from AIDS patients. Folia Parasitol (Praha) 1993;40(4):273–274. [PubMed] [Google Scholar]
  163. Weber R., Sauer B., Lüthy R., Nadal D. Intestinal coinfection with Enterocytozoon bieneusi and Cryptosporidium in a human immunodeficiency virus-infected child with chronic diarrhea. Clin Infect Dis. 1993 Sep;17(3):480–483. doi: 10.1093/clinids/17.3.480. [DOI] [PubMed] [Google Scholar]
  164. Webster K. A., Pow J. D., Giles M., Catchpole J., Woodward M. J. Detection of Cryptosporidium parvum using a specific polymerase chain reaction. Vet Parasitol. 1993 Oct;50(1-2):35–44. doi: 10.1016/0304-4017(93)90005-8. [DOI] [PubMed] [Google Scholar]
  165. Weiser J. Early experiences with microsporidia of man and mammals. Folia Parasitol (Praha) 1993;40(4):257–260. [PubMed] [Google Scholar]
  166. Weiss J. B. DNA probes and PCR for diagnosis of parasitic infections. Clin Microbiol Rev. 1995 Jan;8(1):113–130. doi: 10.1128/cmr.8.1.113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  167. Weiss L. M., Cali A., Levee E., LaPlace D., Tanowitz H., Simon D., Wittner M. Diagnosis of Encephalitozoon cuniculi infection by western blot and the use of cross-reactive antigens for the possible detection of microsporidiosis in humans. Am J Trop Med Hyg. 1992 Oct;47(4):456–462. doi: 10.4269/ajtmh.1992.47.456. [DOI] [PubMed] [Google Scholar]
  168. White A. C., Jr, Chappell C. L., Hayat C. S., Kimball K. T., Flanigan T. P., Goodgame R. W. Paromomycin for cryptosporidiosis in AIDS: a prospective, double-blind trial. J Infect Dis. 1994 Aug;170(2):419–424. doi: 10.1093/infdis/170.2.419. [DOI] [PubMed] [Google Scholar]
  169. Wittner M., Tanowitz H. B., Weiss L. M. Parasitic infections in AIDS patients. Cryptosporidiosis, isosporiasis, microsporidiosis, cyclosporiasis. Infect Dis Clin North Am. 1993 Sep;7(3):569–586. [PubMed] [Google Scholar]
  170. Wolfe M. S. Giardiasis. Clin Microbiol Rev. 1992 Jan;5(1):93–100. doi: 10.1128/cmr.5.1.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  171. Woods G. L., Walker D. H. Detection of infection or infectious agents by use of cytologic and histologic stains. Clin Microbiol Rev. 1996 Jul;9(3):382–404. doi: 10.1128/cmr.9.3.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  172. Wurtz R. M., Kocka F. E., Peters C. S., Weldon-Linne C. M., Kuritza A., Yungbluth P. Clinical characteristics of seven cases of diarrhea associated with a novel acid-fast organism in the stool. Clin Infect Dis. 1993 Jan;16(1):136–138. doi: 10.1093/clinids/16.1.136. [DOI] [PubMed] [Google Scholar]
  173. Wurtz R. Cyclospora: a newly identified intestinal pathogen of humans. Clin Infect Dis. 1994 Apr;18(4):620–623. doi: 10.1093/clinids/18.4.620. [DOI] [PubMed] [Google Scholar]
  174. Yee R. W., Tio F. O., Martinez J. A., Held K. S., Shadduck J. A., Didier E. S. Resolution of microsporidial epithelial keratopathy in a patient with AIDS. Ophthalmology. 1991 Feb;98(2):196–201. doi: 10.1016/s0161-6420(91)32331-5. [DOI] [PubMed] [Google Scholar]
  175. Zhu X., Wittner M., Tanowitz H. B., Cali A., Weiss L. M. Ribosomal RNA sequences of Enterocytozoon bieneusi, Septata intestinalis and Ameson michaelis: phylogenetic construction and structural correspondence. J Eukaryot Microbiol. 1994 May-Jun;41(3):204–209. doi: 10.1111/j.1550-7408.1994.tb01498.x. [DOI] [PubMed] [Google Scholar]
  176. Zhu X., Wittner M., Tanowitz H. B., Kotler D., Cali A., Weiss L. M. Small subunit rRNA sequence of Enterocytozoon bieneusi and its potential diagnostic role with use of the polymerase chain reaction. J Infect Dis. 1993 Dec;168(6):1570–1575. doi: 10.1093/infdis/168.6.1570. [DOI] [PubMed] [Google Scholar]
  177. Zierdt C. H., Gill V. J., Zierdt W. S. Detection of microsporidian spores in clinical samples by indirect fluorescent-antibody assay using whole-cell antisera to Encephalitozoon cuniculi and Encephalitozoon hellem. J Clin Microbiol. 1993 Nov;31(11):3071–3074. doi: 10.1128/jcm.31.11.3071-3074.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  178. Zimmerman S. K., Needham C. A. Comparison of conventional stool concentration and preserved-smear methods with Merifluor Cryptosporidium/Giardia Direct Immunofluorescence Assay and ProSpecT Giardia EZ Microplate Assay for detection of Giardia lamblia. J Clin Microbiol. 1995 Jul;33(7):1942–1943. doi: 10.1128/jcm.33.7.1942-1943.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  179. van Gool T., Luderhoff E., Nathoo K. J., Kiire C. F., Dankert J., Mason P. R. High prevalence of Enterocytozoon bieneusi infections among HIV-positive individuals with persistent diarrhoea in Harare, Zimbabwe. Trans R Soc Trop Med Hyg. 1995 Sep-Oct;89(5):478–480. doi: 10.1016/0035-9203(95)90073-x. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Microbiology Reviews are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES