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Fumagillin Treatment of Intestinal Microsporidiosis
- Source :
- New England Journal of Medicine. 346:1963-1969
- Publication Year :
- 2002
- Publisher :
- Massachusetts Medical Society, 2002.
-
Abstract
- Intestinal microsporidiosis due to Enterocytozoon bieneusi is a cause of chronic diarrhea, malabsorption, and wasting in immunocompromised patients. Currently, there is no effective treatment.We conducted a randomized, double-blind, placebo-controlled trial of fumagillin (60 mg per day orally for two weeks) in patients with chronic E. bieneusi infection. Efficacy was assessed primarily by the clearance of microsporidia, as evidenced by analysis of stool specimens. Patients in whom microsporidia were not cleared received treatment for two weeks with open-label fumagillin. After clearance of the parasite, follow-up stool examinations were performed monthly to detect relapses.Twelve patients were enrolled in this study, 10 with the acquired immunodeficiency syndrome and 2 who had received organ transplants. Clearance of microsporidia occurred in all six of the patients in the fumagillin group, as compared with none of the six in the placebo group (P=0.002). Treatment with fumagillin was also associated with increases in absorption of D-xylose (P=0.003) and in Karnofsky performance scores (P0.001) and with decreases in loperamide use (P=0.01) and total stool weight (P=0.04). There were serious adverse events (neutropenia and thrombocytopenia) in three patients in the fumagillin group; one patient in the placebo group had severe diarrhea. All six controls subsequently had clearance of microsporidia after open-label treatment with fumagillin. Relapses of the infection were identified in two patients during follow-up (median follow-up, 10 months).Fumagillin is an effective treatment for chronic E. bieneusi infection in immunocompromised patients.
- Subjects :
- Adult
Male
medicine.medical_specialty
Malabsorption
Opportunistic infection
medicine.medical_treatment
Antiprotozoal Agents
Opportunistic Infections
Microsporidiosis
Gastroenterology
Feces
Immunocompromised Host
fluids and secretions
Double-Blind Method
Cyclohexanes
Internal medicine
parasitic diseases
medicine
Humans
Fumagillin
Enterocytozoon bieneusi
Intestinal Diseases, Parasitic
Wasting
biology
business.industry
fungi
Immunosuppression
General Medicine
Enterocytozoon
medicine.disease
biology.organism_classification
Surgery
Chronic Disease
Microsporidia
Fatty Acids, Unsaturated
medicine.symptom
business
Sesquiterpenes
medicine.drug
Subjects
Details
- ISSN :
- 15334406 and 00284793
- Volume :
- 346
- Database :
- OpenAIRE
- Journal :
- New England Journal of Medicine
- Accession number :
- edsair.doi.dedup.....4cb9e6c52ea10481cc4be135077d24aa