OBSERVATIONS ON THE PATHOLOGICAL SPECTRUM AND CLINICAL COURSE OF MICROSPORIDIOSIS IN MEN INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS - FOLLOW-UP-STUDY

The purposes of this research were to determine whether microsporidian infection is accompanied by structural alterations of the duodenal mu cosa and to characterize the clinical and morphological evolution of i ntestinal microsporidiosis, In a previous systematic electron microsco pic evaluation of mucosal biopsy specimens from patients with human im munodeficiency virus infection, we detected Enterocytozoon bieneusi in the duodenal tissue of 31 men. This report concerns a follow-up study of these 31 men, who underwent repeated clinical and laboratory evalu ations, including repeated duodenal biopsies, Eighteen men had chronic diarrhea at enrollment and 13 had no diarrhea, The CD4+ cell counts ( per mm(3)) ranged from to to 660 and were normal for three men, E. bie neusi infection was accompanied by a wide spectrum of histopathology o f duodenal tissue; over a mean follow-up of 15 months, no consistent c hange in duodenal mucosal morphology was observed, and diarrhea did no t invariably develop, These observations indicate that diarrhea and se vere villus injury do not invariably accompany infection, Further stud ies are needed to determine the relationship between E. bieneusi infec tion and clinical illness.