Patient selection: HIV-positive
Microsporidia: Enterocytozoon bieneusi (10 different genotypes involved)
Risk factors for microsporidiosis included:
(1) low CD4 lymphocyte count (< 100 per µL)
(2) recent contact with duck or chicken droppings
(3) recent (in the preceding month) presence of domestic animals in the household
(4) no municipal garbage collection
(5) no flush toilet in home
(6) no running water in the home
(7) recent (in the preceding month) consumption of watermelon
The association with watermelon was difficult to explain. The watermelon has a seasonal availability. It is sold by street vendors already cut and kept moist with potentially contaminated water. However, other fruits and vegetables have similar characteristics but are not associated with microsporidiosis.
These risk factors can also help design preventive measures to help reduce the risk of microsporidiosis.