World Health Organization Cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed April 5, 2021.
Akinosoglou KS , Karkoulias K , Marangos M , 2013. Infectious complications in patients with lung cancer. Eur Rev Med Pharmacol Sci 17: 8–18.
Seo SK , 2005. Infectious complications of lung cancer. Oncology (Williston Park) 19: 185–194.
Addeo A , Obeid M , Friedlaender A , 2020. COVID-19 and lung cancer: risks, mechanisms and treatment interactions. J Immunother Cancer 8: e000892.
Sameer Nasir S , Muthiah M , Ryder K , Clark K , Niell H , Weir A , 2017. ICU deaths in patients with advanced cancer: reasonable criteria to decrease potentially inappropriate admissions and lack of benefit of advance planning discussions. Am J Hosp Palliat Care 34: 173–179.
Zembower TR , 2014. Epidemiology of infections in cancer patients. Cancer Treat Res 161: 43–89.
Didier ES , Weiss LM , 2006. Microsporidiosis: current status. Curr Opin Infect Dis 19: 485–492.
Didier ES , Weiss LM , 2011. Microsporidiosis: not just in AIDS patients. Curr Opin Infect Dis 24: 490–495.
Franzen C , Müller A , 2001. Microsporidiosis: human diseases and diagnosis. Microbes Infect 3: 389–400.
Orenstein JM , Russo P , Didier ES , Bowers C , Bunin N , Teachey DT , 2005. Fatal pulmonary microsporidiosis due to Encephalitozoon cuniculi following allogeneic bone marrow transplantation for acute myelogenous leukemia. Ultrastruct Pathol 29: 269–276.
Kicia M , Wesolowska M , Kopacz Z , Kvác M , Sak B , Sokulska M , Cebulski K , Hendrich AB , Pozowski A , 2018. Disseminated infection of Encephalitozoon cuniculi associated with osteolysis of hip periprosthetic tissue. Clin Infect Dis 67: 1228–1234.
Wagnerová P , Sak B , Květoňová D , Maršálek M , Langrová I , Kváč M , 2013. Humoral immune response and spreading of Encephalitozoon cuniculi infection in experimentally infected ponies. Vet Parasitol 197: 1–6.
Weiss LM , Becnel JJ , 2014. Microsporidia: Pathogens of Opportunity. Ames, IA: Wiley Blackwell.
Wasson K , Peper RL , 2000. Mammalian microsporidiosis. Vet Pathol 37: 113–128.
Botterel F , Minozzi C , Vittecoq D , Bourée P , 2002. Pulmonary localization of Enterocytozoon bieneusi in an AIDS patient: case report and review. J Clin Microbiol 40: 4800–4801.
Teachey DT , Russo P , Orenstein JM , Didier ES , Bowers C , Bunin N , 2004. Pulmonary infection with microsporidia after allogeneic bone marrow transplantation. Bone Marrow Transplant 33: 299–302.
Kotkova M , Sak B , Kvetonova D , Kvac M , 2013. Latent microsporidiosis caused by Encephalitozoon cuniculi in immunocompetent hosts: a murine model demonstrating the ineffectiveness of the immune system and treatment with albendazole. PLoS One 8: e60941.
Didier ES , Weiss LM , 2011. Microsporidiosis. Curr Opin Infect Dis 24: 490–495.
Ghoyounchi R , Mahami-Oskouei M , Rezamand A , Spotin A , Aminisani N , Nami S , Pirestani M , Berahmat R , Madadi S , 2019. Molecular phylodiagnosis of Enterocytozoon bieneusi and Encephalitozoon intestinalis in children with cancer: microsporidia in malignancies as an emerging opportunistic infection. Acta Parasitol 64: 103–111.
Kicia M et al., 2019. Symptomatic respiratory Encephalitozoon cuniculi infection in renal transplant recipients. Int J Infect Dis 79: 21–25.
Nagpal A , Pritt BS , Lorenz EC , Amer H , Nasr SH , Cornell LD , Iqbal S , Wilhelm MP , 2013. Disseminated microsporidiosis in a renal transplant recipient: case report and review of the literature. Transpl Infect Dis 15: 526–532.
Lobo ML , Xiao L , Antunes F , Matos O , 2012. Microsporidia as emerging pathogens and the implication for public health: a 10-year study on HIV-positive and -negative patients. Int J Parasitol 42: 197–205.
Scaglia M et al., 1997. Pulmonary microsporidiosis due to Encephalitozoon hellem in a patient with AIDS. J Infect 34: 119–126.
Visvesvara GS et al., 1994. 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 32: 2760–2768.
Hamamcı B , Çetinkaya Ü , Berk V , Kaynar L , Kuk S , Yazar S , 2015. Prevalence of Encephalitozoon intestinalis and Enterocytozoon bieneusi in cancer patients under chemotherapy. Mikrobiyol Bul 49: 105–113.
Ghosh K , Schwartz D , Weiss LM , Weiss LM & Becnel JJ Microsporidia. Chichester, United Kingdom: John Wiley & Sons, Inc., 421–456.
Joseph J , Sharma S , Murthy SI , Krishna PV , Garg P , Nutheti R , Kenneth J , Balasubramanian D , 2006. Microsporidial keratitis in India: 16S rRNA gene-based PCR assay for diagnosis and species identification of microsporidia in clinical samples. Invest Ophthalmol Vis Sci 47: 4468–4473.
Da Silva AJ , Slemenda SB , Visvesvara GS , Schwartz DA , Wilcox CM , Wallace S , Pieniazek NJ , 1997. Detection of Septata intestinalis (microsporidia) Cali et al. 1993 using polymerase chain reaction primers targeting the small subunit ribosomal RNA coding region. Mol Diagn 2: 47–52.
Karimi K , Mirjalali H , Niyyati M , Haghighi A , Pourhoseingholi MA , Sharifdini M , Naderi N , Zali MR , 2020. Molecular epidemiology of Enterocytozoon bieneusi and Encephalitozoon sp., among immunocompromised and immunocompetent subjects in Iran. Microb Pathog 141: 103988.
Lono A , Kumar GS , Chye TT , 2010. Prevalence of microsporidia in an indigenous Orang Asli community in Pahang, Malaysia. Trans R Soc Trop Med Hyg 104: 214–218.
Yazar S , Eser B , Yalcin S , Sahin I , Koc AN , 2003. A case of pulmonary microsporidiasis in an acute myeloblastic leukemia (AML)-M3 patient. Yonsei Med J 44: 146–149.
Özkoç S , Bayram Delibaş S , Akisü C , 2016. Evaluation of pulmonary microsporidiosis in iatrogenically immunosuppressed patients. Tuberk Toraks 64: 9–16.
Kicia M , Wesolowska M , Kopacz Z , Jakuszko K , Sak B , Květonová D , Krajewska M , Kváč M , 2016. Prevalence and molecular characteristics of urinary and intestinal microsporidia infections in renal transplant recipients. Clin Microbiol Infect 22: 462.e5–462.e9.
Mena CJ et al., 2021. Microscopic and PCR-based detection of microsporidia spores in human stool samples. Rev Argent Microbiol 53: 124–128.
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Infections are still among the most important causes of morbidity and mortality in patients with lung cancer, which has the highest rate of cancer-related deaths in the world. Microsporidia, which are opportunistic parasitic fungi, primarily localize to the intestine by ingestion but can disseminate to the respiratory tract or can be acquired by spore inhalation. Cancer patients are at higher risk for microsporidia, a life-threatening infection, than the normal population is. We aimed to characterize the prevalence of microsporidia infection for the first time by evaluating the intestinal and respiratory tracts of patients with lung cancer. In this study, we investigated 98 patients with lung cancer and 103 healthy individuals for microsporidia infection and evaluated the clinical findings of patients who were found to be positive. Sputum and stool samples were tested by microscopic examination, in addition to pan-microsporidia and genus-specific polymerase chain reactions. Nine patients with lung cancer had positive results for microsporidia (9.2%), which was significantly higher than the rate in healthy individuals (P = 0.008), and most of them had clinical findings. Among these positive patients, polymerase chain reaction revealed microsporidia in the sputum samples of seven patients, the stool sample of one patient, and both the sputum and stool samples of one patient. Encephalitozoon cuniculi was identified as the predominant pathogen in 87.5% (7/8) of positive sputum samples. Microsporidia infection was significantly associated with advanced stages of cancer. However, in the control group, Encephalitozoon intestinalis was detected in the stool sample of an individual without clinical symptoms. Microsporidia, especially E. cuniculi, should be considered as a cause of respiratory tract infection as well as intestinal infection in cancer patients and should be screened in respiratory samples of these patients when they have pulmonary symptoms.
Disclosure: The study was approved by the ethics committees of Izmir Dr. Suat Seren Hospital, number 2020-KAEK-139 and Ege University, number 19-9T/66.
Authors’ addresses: Ozlem Ulusan Bagci, Ataturk Training and Research Hospital, Microbiology Laboratory, Izmir Katip Celebi University, Izmir, Turkey, and Institute of Health Sciences, Department of Basic Oncology, Ege University, Izmir, Turkey, E-mail: email@example.com. Can Muftuoglu, Institute of Health Sciences, Department of Basic Oncology, Ege University, Izmir, Turkey, and Translational Pulmonary Research Center, Ege University (EgeSAM), Izmir, Turkey, E-mail: firstname.lastname@example.org. Filiz Guldaval and Gulru Polat, Chest Disease Department, Izmir Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey, E-mails: email@example.com and firstname.lastname@example.org. Damla Serce Unat, Institute of Health Sciences, Department of Basic Oncology, Ege University, Izmir, Turkey, and Chest Disease Department, Izmir Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey, E-mail: email@example.com. Ufuk Mert, Institute of Health Sciences, Department of Basic Oncology, Ege University, Izmir, Turkey, Translational Pulmonary Research Center, Ege University (EgeSAM), Izmir, Turkey, and Ataturk Health Care Vocational School, Ege University, Izmir, Turkey, E-mail: firstname.lastname@example.org. Seray Ozensoy Toz, Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey, E-mail: email@example.com. Myeong Hee Moon, Department of Chemistry, Yonsei University, Seoul, South Korea, E-mail: firstname.lastname@example.org. Ayse Caner, Institute of Health Sciences, Department of Basic Oncology, Ege University, Izmir, Turkey, Translational Pulmonary Research Center, Ege University (EgeSAM), Izmir, Turkey, and Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey, Email: email@example.com.