Treatment Options for the Eradication of Intestinal Protozoa

Michael JG Farthing

Disclosures

Nat Clin Pract Gastroenterol Hepatol. 2006;3(8) 

In This Article

Enterocytozoon Bieneusi

Human infection with the Microsporidium species Enterocytozoon bieneusi was first reported in 1985 by Modigliani et al.,[57] 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.[58] 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.[59] Although symptoms can improve and parasite burden in feces decreases, however, eradication usually does not occur.[60] 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.[61]

Fumagillin. Fumagillin and its analog TNP-470 inhibit angiogenesis, but have also been shown to inhibit growth of microsporidia in vitro.[62] 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.[62]

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