A review was conducted to examine published works that focus on the complex epidemiology of Enterocytozoon bieneusi infection in humans. Studies on the prevalence of these emerging microsporidian pathogens in humans, in developed and developing countries, the different clinical spectra of E. bieneusi intestinal infection in children, in different settings, and the risk factors associated with E. bieneusi infection have been reviewed. This paper also analyses the impact of the recent application of PCR-based molecular methods for species-specific identification and genotype differentiation has had in increasing the knowledge of the molecular epidemiology of E. bieneusi in humans. The advances in the epidemiology of E. bieneusi, in the last two decades, emphasize the importance of epidemiological control and prevention of E. bieneusi infections, from both the veterinary and human medical perspectives. 1. Introduction Microsporidia are a group of obligate intracellular eukaryotic parasites first identified as the cause of pébrine disease of silkworms in 1857 [1]. Over the past two decades, microsporidia have risen from obscure organisms to well-recognized human pathogens. Several genera and species of microsporidia were found in humans, and diagnosis and clinical management of microsporidiosis cases have improved significantly. Despite these scientific advances, the epidemiology of human microsporidiosis is still unclear. Most of what is now known about human microsporidiosis can be attributed to experience with patients infected with human immunodeficiency virus (HIV). Since 1985 and the first recognition of Enterocytozoon bieneusi as an acquired immunodeficiency syndrome (AIDS)-associated opportunistic pathogen [2], several hundred patients with chronic diarrhea attributed to this organism have been reported. Cases of intestinal microsporidiosis due to E. bieneusi have been increasingly reported in other immunocompromised individuals such as organ transplant recipients, as well as in travelers, children, and elderly [3–12]. Hepatobiliary and pulmonary involvement has also been observed in immunocompromised persons [13–15]. Some reports in humans suggested that this species can produce asymptomatic infections in immunocompromised and immunocompetent individuals [16–20]. In addition, E. bieneusi has been commonly identified in animals, especially mammals [21–32], and water, raising public health concerns about zoonotic and waterborne transmission of microsporidia [33–35]. 2. Prevalence of Enterocytozoon bieneusi in Humans Enterocytozoon bieneusi infections
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