Intestinal Microsporidiosis in Human Immunodeficiency Virus-Infected Patients with Chronic Unexplained Diarrhea: Prevalence and Clinical and Biologic Features

Abstract

Eighteen patients infected with human immunodeficiency virus and with chronic unexplained diarrhea were prospectively studied to investigate the prevalence and clinical and biologic features of intestinal microsporidiosis. All patients underwent extensive evaluation for bacterial, viral, and parasitic pathogens. Enterocytozoon bieneusi was found in 9 patients (50%; 95% confidence interval, 27-73) in stools and duodenal and jejunal biopsies. In 8 patients, it was the sole pathogen found. Other pathogens were also isolated from the intestinal tracts of 4 patients, but diarrhea remained unexplained in 6. Patients with intestinal microsporidiosis had significantly lower mean Karnofsky scores (69.4 vs. 85.5, P = .009), CD4 cell counts (18.6 vs. 209.8/microL, P = .02), and D-xylose absorption tests (0.13 vs. 0.36 g/L, P < .001) than did patients without intestinal microsporidiosis. Intestinal microsporidiosis appears to be a frequent cause of unexplained chronic diarrhea in patients with AIDS and is associated with diminished D-xylose absorption.

Modification of the clinical course of intestinal microsporidiosis in acquired immunodeficiency syndrome patients by immune status and anti-human immunodeficiency virus therapy.

“…[1][2][3][4]15 The CD4 cell counts among patients in this study who resolved their infection were generally higher than those described in the literature (161.1 Ϯ 133.9/mm 3 ). [1][2][3][4][5]11 Even studies somewhat skeptical of the role of E. bieneusi in the production of diarrhea in HIV-positive patients demonstrated a similarly elevated CD4 count (average ϭ 168/mm 3 ) in groups of infected patients, many of which were considered asymptomatic. 16 Kotler and Orenstein posited the possibility of a relationship between parasite burden and immune status that may, in part, be responsible for the patient's overall minimally symptomatic clinical status.…”

“…[1][2][3] Parasite eradication using metronidazole, albendazole, and thalidomide was considered problematic. [4][5][6] Recent observations suggest that the clinical course of E. bieneusi-associated gastrointestinal infection has changed from its original description. A four-year evaluation of the yearly and seasonal prevalence of microsporidiosis in southern California by our group revealed a large, and statistically significant, decrease in yearly prevalence in 1995 and 1996 as compared to 1993 and 1994 (Conteas CN, OGW Berlin, unpublished data).…”

Direct amplification and species determination of microsporidian DNA from stool specimens

“…Since different microsporidian species vary in their response to chemotherapeutical agents (Dieterich et al 1994; De Groote e t a / . 1995; Molina et al 1995; Sun et al 1994;Weber et al 1994; Weiss et al 1991)~ both the detection of microsporidian infections and identification of the species are of clinical importance.…”

Microsporidiosis and Malnutrition in Children with Persistent Diarrhea, Uganda

“…E nterocytozoon bieneusi is an important cause of persistent diarrhea, intestinal malabsorption, and wasting in HIV-positive adults. Mucosal damage associated with microsporidiosis is more extensive than that related to other opportunistic intestinal infections (1,2) and leads to substantial malabsorption of carbohydrates, fat, and essential nutrients (2)(3)(4)(5). Although microsporidiosis is common in children <5 years of age, particularly those who live in developing countries (6,7) or who are HIV positive (6,8,9), the effects of infection on nutritional health of these vulnerable populations are not well documented.…”