AUTOPSY VERIFICATION OF ENCEPHALITOZOON INTESTINALIS (MICROSPORIDIOSIS) ERADICATION FOLLOWING ALBENDAZOLE THERAPY

Microsporidian infections are increasingly recognized as an important cause of morbidity for persons infected with the human immunodeficienc y virus. Encephalitozoon (formerly Septata) intestinalis is a recently described microsporidian that causes intestinal and disseminated infe ctions in severely immunocompromised patients with acquired immunodefi ciency syndrome. Several studies suggest that albendazole is an effect ive therapy for E intestinalis infection. However, relapses of symptom s and reappearance of microsporidian spores in diagnostic specimens ha ve been reported following treatment in some cases. Because these resu lts are based on examination of feces or cytologic specimens with an i nherent sampling bias, it would be ideal to have autopsy data on the c omplete tissue evaluation of major organ systems of patients who had a ntemortem E intestinalis infection treated with albendazole. This repo rt describes an acquired immunodeficiency syndrome patient with diarrh ea and wasting syndrome associated with E intestinalis infection. Trea tment with albendazole produced relief of his clinical symptoms and el iminated microsporidian spores in his feces. Following his death from other causes, an autopsy was performed. Comprehensive microscopic exam ination of all major organs revealed no evidence of residual microspor idian infection, suggesting parasitologic cure of E intestinalis with albendazole. The postmortem finding of complete clearance of microspor idia from body tissues is significant for future albendazole treatment of patients infected with E intestinalis and provides strong support for the value of the autopsy in evaluating the therapeutic efficacy of antimicrobials in emerging infections.