Fumagillin Treatment of Intestinal Microsporidiosis

• Published in: The New England journal of medicine Vol. 346; no. 25; pp. 1963 - 1969
• Main Authors: Molina, Jean-Michel, Tourneur, Muriel, Sarfati, Claudine, Chevret, Sylvie, de Gouvello, Amaury, Gobert, Jean-Gérard, Balkan, Suna, Derouin, Francis
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 20-06-2002
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiparasitic agents; Antiprotozoal Agents - adverse effects; Antiprotozoal Agents - therapeutic use; Biological and medical sciences; Chronic Disease; Cyclohexanes; Double-Blind Method; Enterocytozoon - isolation & purification; Fatty Acids, Unsaturated - adverse effects; Fatty Acids, Unsaturated - therapeutic use; Feces - parasitology; HIV; Human immunodeficiency virus; Humans; Immunocompromised Host; Infections; Intestinal Diseases, Parasitic - diagnosis; Intestinal Diseases, Parasitic - drug therapy; Male; Medical research; Medical sciences; Microsporidiosis - diagnosis; Microsporidiosis - drug therapy; Opportunistic Infections - drug therapy; Pharmacology. Drug treatments; Sesquiterpenes; Human; Immunopathology; Protozoa; Opportunistic infection; Protozoal disease; Treatment efficiency; Gut; Oral administration; Parasitosis; Cnidosporidia; Infection; Chemotherapy; Chronic; Immunosuppression; Treatment; Parasiticid; Enterocytozoon bieneusi; Digestive diseases; Intestinal disease; Microsporidiosis; Fumagillin
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa012924

This double-blind trial involved 12 immunocompromised patients with chronic diarrhea and
Enterocytozoon bieneusi
infection. Treatment with fumagillin (60 mg per day orally for two weeks) led to some symptomatic improvement and to clearance of the parasite in six of six patients, as compared with none of six in the placebo group (P=0.002). All patients were eventually treated with fumagillin, but severe thrombocytopenia or neutropenia developed in three patients.
Enterocytozoon bieneusi,
a spore-forming, eukaryotic, unicellular parasite, has been recognized as an opportunistic enteric pathogen in patients with the acquired immunodeficiency syndrome (AIDS).
1
–
5
Intestinal microsporidiosis can cause chronic diarrhea, malabsorption, and weight loss in immunocompromised patients.
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–
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The diagnosis of intestinal microsporidiosis can now be made reliably on the basis of the detection of spores in stool samples with the use of appropriate staining.
9
,
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Definitive identification of the species, however, requires amplification of DNA by the polymerase chain reaction (PCR).
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Several agents have been tested as treatments for this infection, but they do not lead to clearance of . . .