Human infection with the Microsporidium species Enterocytozoon bieneusi was first reported in 1985 by Modigliani et al., who found the parasite in electron micrographs of small-intestinal biopsies in patients with AIDS. Microsporidia (including E. bieneusi) are obligate intracellular spore-forming organisms. Infection is confined to the small bowel, principally from the distal duodenum to the ileum. E. bieneusi infection rarely occurs outside the context of AIDS diarrhea.
Albendazole. Noncontrolled studies suggest that albendazole 400 mg twice daily for 4 weeks is the treatment of choice. Although symptoms can improve and parasite burden in feces decreases, however, eradication usually does not occur. In those patients who achieve a clinical response, relapse about 1 month after discontinuation of treatment is not unusual. A 7 day course of albendazole (15 mg/kg twice daily) in hospitalized children resulted in a reduction in stool frequency, duration of diarrhea and the number of fecal microsporidia, although the species of microsporidia were not categorized.
Fumagillin. Fumagillin and its analog TNP-470 inhibit angiogenesis, but have also been shown to inhibit growth of microsporidia in vitro. A randomized, placebo-controlled trial of fumagillin 60 mg daily for 14 days in AIDS patients with E. bieneusi infection showed that treated patients had symptomatic improvement and parasite clearance.
Nat Clin Pract Gastroenterol Hepatol. 2006;3(8) © 2006 Nature Publishing Group
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