Pathogen:
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Treatment Results:
A larger placebo-controlled study of albendazole is currently underway. All patients with microsporidiosis who may also receive albendazole on a case-by-case compassionate basis from the manufacturer.
Eeftinck-Schattenkerk et al. treated 19 patients with microsporidium-associated diarrhea with metronidazole (Flagyl®) 500 mg tid PO. Diarrhea improved in 10 and resolved completely in five. 12/15 responders relapsed within 4 weeks of stopping drug. The effect of metronidazole was symptomatic only; duodenal biopsies showed Microsporidia regardless of response to treatment.
Sharpstone et al. recently treated 12 HIV-positive patients with thalidomide (100 mg PO qd) for microsporidial diarrhea. All had diarrhea for a minimum of 12 months and had failed prior treatment with albendazole. After three weeks, bowel frequency fell from a mean of six per day to 2.8 per day. In all cases stools, which had previously been liquid, became semi-solid. Mean weight loss prior to therapy was 8.4 kg and after three weeks of treatment patients had gained 1.2 kg. 1/12 patients reported a relapse of chronic diarrhea at one week of therapy. The primary dose-limiting toxicity in three patients was daytime drowsiness.
REFERENCES:
Dieterich D et al. Treatment with albendazole for intestinal disease due to Enterocytozoon bieneusi in patients with AIDS. JID 169:178-83,1994.
Dore GJ et al. Septata intestinalis microsporidiosis in 8 HIV-infected patients. Abstract #PBO653, X Intl Conf AIDS, Yokohama, 1994.
Eeftinck-Schattenkerk JM et al. Metronidazole for microsporidium-associated diarrhea in symptomatic HIV-1 infection. VII Intl Conf AIDS, Florence. Vol 2: 248 (W.B.2267), 1991.
Kotler DP et al. Prevalence of microsporidiosis in AIDS patients with chronic diarrhea. Abstract PoB 3340, VIII Intl Conf AIDS, Amsterdam, 1992.
Orenstein JM et al. A microsporidian previously indescribed in humans, infecting enterocytes and macrophages, and asoc>ciated with diarrhea in acquired immunodeficiency syndrome patient. Hum Pathol 23: 722-8, 1992.
Orenstein JM et al. Systemic dissemination by a newly recognized intestinal microsporidia species in AIDS. AIDS 6:1143-50, 1992.
Pol S et al. Microsporidia infection in patients with the human immunodeficiency virus and unexplained cholangitis. NEJM 328:95-9, 1993.
Rabeneck L et al. The role of Microsporidia in the pathogenesis of HIV-related chronic diarrhea. Ann Int Med 119:9: 895-99, 1993.
Sandfort J et al. Albendazole treatment in patients with intestinal microsporidiosis. Abstract PO-B10-1491, IX Intl Conf AIDS, Berlin. 1993.
Sharpstone D et al. The treatment microsporidial diarrhea with thalidomide. AIDS 9:658-9, 1995.
Schwartz DA et al. Pulmonary microsporidiosisÑan emerging opportunistic lung infection in AIDS. Abstract WS-B14-6, IX Intl AIDS Conf, Berlin, 1993.
OTHER REPORTS:
Eeftinck-Schattenkerk JKM et al. Clinical significance of small-intestinal microsporidiosis in HIV- I infected individuals. Lancet 337: 895-8, 1991.
Shadduck JA et al. Microsporidia and human infections. Clin Microbiol Rev 2(2): 158-65, 1989.
Simon D et a. Light microscopic diagnosis of human microsporidiosis and variable response to octreotide. Gastroenterology 100: 271-3, 1991.
Blanshard C et al. Treatment of intestinal microsporidiosis with albendazole. AIDS 6:311-3,1992.
Beaugerie L et al. Cholangiopathy associated with Microsporidia infection of the common bile duct mucosa in a patient with HIV infection. Ann Int Med 117:401-2, 1992.
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