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Enteric microsporidiosis: incidence and response to albendazole or metronidazole therapy.




 

Int Conf AIDS. 1992 Jul 19-24;8(2):B144 (abstract no. PoB 3344). Unique

OBJECTIVES: To assess the frequency of chronic diarrhoea due to Enterocytozoon bieneusi in Australian HIV-infected patients and the response to treatment with albendazole or metronidazole. METHODS: Enterocytozoon bieneusi has been described as a cause of chronic HIV-related diarrhoea in the United States, Europe and Africa. The incidence in Australia is unknown. To investigate the prevalence in HIV-infected patients with chronic diarrhoea, 112 consecutive patients with chronic diarrhoea of undetermined cause underwent duodenoscopy and small bowel biopsy. Specimens were examined by light microscopy using the Warthin-Starry and haematoxylin and eosin stains and by electron microscopy. Patients with microsporidiosis as the only identifiable cause of diarrhoea were treated with albendazole 400 mgs b.d. or metronidazole 400 mgs t.d.s. for 4 to 6 weeks. RESULTS: Light microscopy revealed duodenal microsporidiosis in 22/112 patients (20%). These were confirmed by electron microscopy and no further cases were identified by this technique. Nine of the patients who were positive for microsporidia on duodenal biopsy also had ileal biopsies and the organism was demonstrated in all cases. No other pathogens were demonstrated in 17/22 patients. In 5 patients, concomitant duodenal pathogens included cytomegalovirus (2), cryptosporidium (1), giardia (1), cytomegalovirus and giardia (1). Diagnostic findings were the presence of intracellular plasmodia and spores of E. bieneusi in the enterocytes of the villous tips. Electron microscopy confirmed the findings and allowed speciation. Nine patients were treated with albendazole, with 5 having no response and 2 patients having a moderate (50%) reduction in diarrhoea. Eight patients received metronidazole, with 1 having a sustained and complete response, 2 patients achieving a partial response but relapsing within 3 months, and 5 patients failing to respond. Seven patients undergoing biopsy after treatment (4 albendazole, 3 metronidazole) showed more florid duodenitis with increased numbers of microsporidia and prominent villous degeneration. CONCLUSION: Intestinal microsporidiosis was the commonest significant finding in duodenal biopsies in this series of Australian HIV-infected patients with otherwise unexplained diarrhoea. Light microscopy using the Warthin-Starry stain is a simple and sensitive method for diagnosis. Less than one-quarter of patients responded to treatment with albendazole or metronidazole.

Albendazole/*THERAPEUTIC USE Animal Australia/EPIDEMIOLOGY Biopsy Comparative Study Cross-Sectional Studies Diarrhea/COMPLICATIONS/DRUG THERAPY/*PARASITOLOGY Human HIV Infections/COMPLICATIONS/DRUG THERAPY/*PARASITOLOGY Incidence Intestinal Mucosa/PATHOLOGY Metronidazole/*THERAPEUTIC USE Microspora Infections/COMPLICATIONS/DRUG THERAPY/*PARASITOLOGY Microsporida/*DRUG EFFECTS Opportunistic Infections/COMPLICATIONS/DRUG THERAPY/*PARASITOLOGY ABSTRACT



 




Information in this article was accurate in December 30, 1992. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.