Abstract
AIM: To investigate morphological changes in Enterocytozoon bieneusi and the duration of symptomatic relief after combination treatment with furazolidone and albendazole in AIDS patients. METHODS: Four severely immunocompromised AIDS patients with symptomatic E bieneusi infection of the gut received an 18 day course of combined furazolidone and albendazole (500 + 800 mg daily). All patients were monitored for parasite shedding in stool by light microscopy at the end of treatment and monthly during follow up. At the end of treatment, duodenal biopsy specimens obtained from three patients were studied by transmission electron microscopy by two pathologists blind to the patients' treatment or clinical outcome. Duodenal biopsy specimens obtained from one of the patients two months after completion of treatment were also studied electronmicroscopically. RESULTS: All patients had long lasting symptomatic relief, with a major decrease--or transient absence--of spore shedding in stools from completion of treatment. After treatment, changes in faecal spores were persistently found by light microscopy in all cases, and there was evidence of both a substantial decrease in the parasite load and ultrastructural damage in the parasite in all biopsy specimens. The treatment was well tolerated, and no patient had clinical or parasitological relapse during follow up (up to 15 months). CONCLUSIONS: The long lasting symptomatic relief observed in all four treated patients correlated with the persistent decrease in parasite load both in tissue and in stool, and with the morphological changes observed in the life cycle of the protozoan. These data suggest that combined treatment with furazolidone and albendazole is active against E bieneusi and may result in lasting remission even in severely immunocompromised patients.
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- Albrecht H., Stellbrink H. J., Sobottka I. Failure of itraconazole to prevent Enterocytozoon bieneusi infection. Genitourin Med. 1995 Oct;71(5):325–326. doi: 10.1136/sti.71.5.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Altamirano A., Bondani A. Adverse reactions to furazolidone and other drugs. A comparative review. Scand J Gastroenterol Suppl. 1989;169:70–80. doi: 10.3109/00365528909091336. [DOI] [PubMed] [Google Scholar]
- Anwar-Bruni D. M., Hogan S. E., Schwartz D. A., Wilcox C. M., Bryan R. T., Lennox J. L. Atovaquone is effective treatment for the symptoms of gastrointestinal microsporidiosis in HIV-1-infected patients. AIDS. 1996 Jun;10(6):619–623. doi: 10.1097/00002030-199606000-00007. [DOI] [PubMed] [Google Scholar]
- Blanshard C., Ellis D. S., Dowell S. P., Tovey G., Gazzard B. G. Electron microscopic changes in Enterocytozoon bieneusi following treatment with albendazole. J Clin Pathol. 1993 Oct;46(10):898–902. doi: 10.1136/jcp.46.10.898. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cali A., Owen R. L. Intracellular development of Enterocytozoon, a unique microsporidian found in the intestine of AIDS patients. J Protozool. 1990 Mar-Apr;37(2):145–155. doi: 10.1111/j.1550-7408.1990.tb05885.x. [DOI] [PubMed] [Google Scholar]
- Clarridge J. E., 3rd, Karkhanis S., Rabeneck L., Marino B., Foote L. W. Quantitative light microscopic detection of Enterocytozoon bieneusi in stool specimens: a longitudinal study of human immunodeficiency virus-infected microsporidiosis patients. J Clin Microbiol. 1996 Mar;34(3):520–523. doi: 10.1128/jcm.34.3.520-523.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Curry A., Canning E. U. Human microsporidiosis. J Infect. 1993 Nov;27(3):229–236. doi: 10.1016/0163-4453(93)91923-d. [DOI] [PubMed] [Google Scholar]
- Didier E. S. Effects of albendazole, fumagillin, and TNP-470 on microsporidial replication in vitro. Antimicrob Agents Chemother. 1997 Jul;41(7):1541–1546. doi: 10.1128/aac.41.7.1541. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dieterich D. T., Lew E. A., Kotler D. P., Poles M. A., Orenstein J. M. Treatment with albendazole for intestinal disease due to Enterocytozoon bieneusi in patients with AIDS. J Infect Dis. 1994 Jan;169(1):178–183. doi: 10.1093/infdis/169.1.178. [DOI] [PubMed] [Google Scholar]
- Dionisio D., Manneschi L. I., Di Lollo S., Orsi A., Sterrantino G., Meli M., Gabbrielli M., Tani A., Papucci A., Leoncini F. Enterocytozoon bieneusi in AIDS: symptomatic relief and parasite changes after furazolidone. J Clin Pathol. 1997 Jun;50(6):472–476. doi: 10.1136/jcp.50.6.472. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dore G. J., Marriott D. J., Hing M. C., Harkness J. L., Field A. S. Disseminated microsporidiosis due to Septata intestinalis in nine patients infected with the human immunodeficiency virus: response to therapy with albendazole. Clin Infect Dis. 1995 Jul;21(1):70–76. doi: 10.1093/clinids/21.1.70. [DOI] [PubMed] [Google Scholar]
- Haque A., Hollister W. S., Willcox A., Canning E. U. The antimicrosporidial activity of albendazole. J Invertebr Pathol. 1993 Sep;62(2):171–177. doi: 10.1006/jipa.1993.1092. [DOI] [PubMed] [Google Scholar]
- Ignatius R., Henschel S., Liesenfeld O., Mansmann U., Schmidt W., Köppe S., Schneider T., Heise W., Futh U., Riecken E. O. Comparative evaluation of modified trichrome and Uvitex 2B stains for detection of low numbers of microsporidial spores in stool specimens. J Clin Microbiol. 1997 Sep;35(9):2266–2269. doi: 10.1128/jcm.35.9.2266-2269.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Joste N. E., Rich J. D., Busam K. J., Schwartz D. A. Autopsy verification of Encephalitozoon intestinalis (microsporidiosis) eradication following albendazole therapy. Arch Pathol Lab Med. 1996 Feb;120(2):199–203. [PubMed] [Google Scholar]
- Li J., Katiyar S. K., Hamelin A., Visvesvara G. S., Edlind T. D. Tubulin genes from AIDS-associated microsporidia and implications for phylogeny and benzimidazole sensitivity. Mol Biochem Parasitol. 1996 Jun;78(1-2):289–295. doi: 10.1016/s0166-6851(96)02628-x. [DOI] [PubMed] [Google Scholar]
- Molina J. M., Goguel J., Sarfati C., Chastang C., Desportes-Livage I., Michiels J. F., Maslo C., Katlama C., Cotte L., Leport C. Potential efficacy of fumagillin in intestinal microsporidiosis due to Enterocytozoon bieneusi in patients with HIV infection: results of a drug screening study. The French Microsporidiosis Study Group. AIDS. 1997 Nov;11(13):1603–1610. doi: 10.1097/00002030-199713000-00009. [DOI] [PubMed] [Google Scholar]
- Sharpstone D., Rowbottom A., Francis N., Tovey G., Ellis D., Barrett M., Gazzard B. Thalidomide: a novel therapy for microsporidiosis. Gastroenterology. 1997 Jun;112(6):1823–1829. doi: 10.1053/gast.1997.v112.pm9178672. [DOI] [PubMed] [Google Scholar]
- Soule J. B., Halverson A. L., Becker R. B., Pistole M. C., Orenstein J. M. A patient with acquired immunodeficiency syndrome and untreated Encephalitozoon (Septata) intestinalis microsporidiosis leading to small bowel perforation. Response to albendazole. Arch Pathol Lab Med. 1997 Aug;121(8):880–887. [PubMed] [Google Scholar]
- Voglino M. C., Donelli G., Rossi P., Ludovisi A., Rinaldi V., Goffredo F., Paloscia R., Pozio E. Intestinal microsporidiosis in Italian individuals with AIDS. Ital J Gastroenterol. 1996 Sep;28(7):381–386. [PubMed] [Google Scholar]
- Weber R., Bryan R. T., Owen R. L., Wilcox C. M., Gorelkin L., Visvesvara G. S. Improved light-microscopical detection of microsporidia spores in stool and duodenal aspirates. The Enteric Opportunistic Infections Working Group. N Engl J Med. 1992 Jan 16;326(3):161–166. doi: 10.1056/NEJM199201163260304. [DOI] [PubMed] [Google Scholar]
- White A. H. Absorption, distribution, metabolism, and excretion of furazolidone. A review of the literature. Scand J Gastroenterol Suppl. 1989;169:4–10. doi: 10.3109/00365528909091325. [DOI] [PubMed] [Google Scholar]
- van Gool T., Snijders F., Reiss P., Eeftinck Schattenkerk J. K., van den Bergh Weerman M. A., Bartelsman J. F., Bruins J. J., Canning E. U., Dankert J. Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique. J Clin Pathol. 1993 Aug;46(8):694–699. doi: 10.1136/jcp.46.8.694. [DOI] [PMC free article] [PubMed] [Google Scholar]