Eeftinck Schattenkerk JK, Van Gool T, Bartelsman JF, Lange JM, Reiss P; International Conference on AIDS.
Int Conf AIDS. 1991 Jun 16-21; 7: 248 (abstract no. W.B.2267).
Department of Medicine, AIDS-unit, Academic Medical Centre, University of Amsterdam, the Netherlands
OBJECTIVE: Preliminary assessment of the efficacy of metronidazole for the treatment of microsporidium-associated diarrhoea in HIV-1 infected individuals. METHODS: Between January 1986 and December 1990 microsporidiosis was diagnosed consecutively by duodenal biopsy in 22 patients with CDC stage IV (IVC1 in 20, KS in 1, and IVA or IVC2 in 1 patients) disease and diarrhoea, characterized by the occasional to 2-6 times daily loss of liquid stool during 3 or more weeks. Culture and microscopy of stool and duodenal biopsies in all, as well as of sigmoid biopsies in 20 patients, had not revealed any other bacterial, parasitic, or viral causes of diarrhoea. Of the 22 patients with microsporidiosis, 17 received metronidazole 500 mg t.i.d. for a median of 12.3 days (range 2-24 days), and two 250 mg b.i.d. continuously. Of the 3 remaining patients, one received primaquine for 14 days, and 2 no treatment. RESULTS: In the 19 metronidazole-treated patients, diarrhoea disappeared (passage of only normally formed stool) in 5 and improved (frequency of passage of unchanged liquid stool reduced by greater than or equal to 50%) in 10 patients, always within 2 days of starting treatment. In the 4 remaining patients, symptoms persisted, like in the 2 untreated patients. In the primaquine-treated patient, diarrhoea disappeared 4 weeks after therapy. Of the 15 patients with a response to metronidazole, 3 patients, including the two continuously treated, had a persistent response during a median follow-up of 12 months (range 2-24 months) and 12 relapsed within 4 weeks. Upon relapse, 10 patients received a second course of metronidazole 500 mg t.i.d. for 10-14 days. In 9 of these patients diarrhoea improved, again within 2 days of starting therapy, and this response was maintained with metronidazole 500 mg q.d. in 6 patients for a median follow-up of 7.6 months (range 3-18 months). Duodenal biopsies which were repeated in 6 of the metronidazole-treated patients and in the primaquine-treated patient after 1-12 months, again showed microsporidia, regardless of the response to treatment. CONCLUSION: Metronidazole appears to induce symptomatic benefit in microsporidium-associated diarrhoea in HIV-1 infection. Controlled studies are needed to confirm our findings and elucidate the mechanism in view of the persistence of the parasite following treatment.
Publication Types:
Keywords:
- Diarrhea
- Feces
- HIV Infections
- HIV-1
- Humans
- Metronidazole
- Microsporidia
- Microsporidia, Unclassified
- Microsporidiosis
Other ID:
UI: 102192871
From Meeting Abstracts