Panel’s Recommendations

Avoiding untreated water sources, washing fresh fruit and vegetables, and washing the hands after possible exposure to an infected person or animal (AIII) are recommended. Effective combination antiretroviral therapy is the primary initial treatment for microsporidiosis in HIV-infected children (AII*). Supportive care with hydration, correction of electrolyte abnormalities, and nutritional supplementation should be provided (AIII). Albendazole is recommended for initial therapy of microsporidiosis caused by microsporidia other than Enterocytozoon bieneusi and Vittaforma corneae (AII*). Topical therapy with fumagillin eye drops can be considered in HIV-infected children with keratoconjunctivitis caused by microsporidia (BII*). Oral albendazole is recommended in addition to topical therapy for keratoconjunctivitis (BIII). Treatment for microsporidiosis should be continued until improvement in severe immunosuppression is sustained (more than 6 months at CDC immunologic category 1 or 2) and clinical signs and symptoms of infection are resolved (BIII).

Rating of Recommendations: A = Strong; B = Moderate; C = Optional

Rating of Evidence: I = One or more randomized trials in children^† with clinical outcomes and/or validated endpoints; I* = One or more randomized trials in adults with clinical outcomes and/or validated laboratory endpoints with accompanying data in children^† from one or more well-designed, nonrandomized trials or observational cohort studies with long-term clinical outcomes; II = One or more well-designed, nonrandomized trials or observational cohort studies in children^† with long-term outcomes; II* = One or more well-designed, nonrandomized trials or observational studies in adults with long-term clinical outcomes with accompanying data in children^† from one or more similar nonrandomized trials or cohort studies with clinical outcome data; III = Expert opinion

^†Studies that include children or children/adolescents, but not studies limited to post-pubertal adolescents