The only way to be sure is to examine bees by microscope. A sample of bees is macerated in a small amount of water, and then a drop of the liquid is examined on a microscope slide at 400 power. Spores appear as ovals, about 3 by 5 microns. One outward indication of Nosema is brown spots (faecal material) on the outside or inside of a hive. The inner cover or top bars can be soiled with faeces in a hive that carries Nosema ceranae. However, a hive heavily infested with Nosema ceranae may appear normal otherwise. – Tom Webster, Kentucky State University