Intestinal microsporidiosis in HIV-positive patients with chronic unexplained diarrhea in Rio de Janeiro, Brazil: diagnosis, clinical presentation and follow-up

Rev Inst Med Trop Sao Paulo. 1996 Mar-Apr;38(2):97-102. doi: 10.1590/s0036-46651996000200003.

Abstract

After the diagnosis of two cases of microsporidial intestinal infection in 1992, in Rio de Janeiro, we have started looking for this parasite in HIV-infected patients with chronic unexplained diarrhea. We have studied 13 patients from Hospital Evandro Chagas, IOC-FIOCRUZ. Fecal specimens from these patients were examined for the presence of Cryptosporidia and Microsporidia, in addition to routine examination. Spores of Microsporidia were found in the stools of 6 (46.1%) of the 13 patients studied, with 2 histological jejunal confirmations. The Microsporidia-infected patients presented chronic diarrhea with about 6 loose to watery bowel movements a day. Five infected patients were treated with Metronidazole (1.5 g/day). They initially showed a good clinical response, but they never stopped eliminating spores. After about the 4th week of therapy, their diarrhea returned. Two patients utilized Albendazole (400 mg/day-4 weeks) with a similar initial improvement and recurrence of the diarrhea. Intestinal Microsporidiosis seems to be a marker of advanced stages of AIDS, since 5 of our 6 infected patients were dead after a 6 month period of follow-up. The present study indicates that intestinal microsporidiosis may be a burgeoning problem in HIV-infected patients with chronic diarrhea in Brazil, which deserves further investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Albendazole / therapeutic use
  • Animals
  • Antiprotozoal Agents / therapeutic use
  • Brasilien
  • Chronic Disease
  • Diarrhea / etiology*
  • Feces / parasitology
  • Female
  • Follow-Up Studies
  • HIV Enteropathy / complications*
  • HIV Enteropathy / diagnosis
  • HIV Enteropathy / drug therapy
  • Humans
  • Jejunum / parasitology
  • Male
  • Metronidazole / therapeutic use
  • Microsporidiosis / complications*
  • Microsporidiosis / diagnosis
  • Microsporidiosis / drug therapy
  • Middle Aged
  • Prospective Studies
  • Recurrence

Substances

  • Antiprotozoal Agents
  • Metronidazole
  • Albendazole