CLINICAL-FEATURES OF MICROSPORIDIOSIS IN PATIENTS WITH AIDS

Microsporidia are protozoan parasites responsible for significant gast rointestinal disease in patients infected with human immunodeficiency virus. We report the clinical features of 20 patients with chronic dia rrhea for whom microsporidian spores were identified by modified trich rome staining of stool smears and confirmed by biopsy and/or electron microscopy of stool. Of the 18 microsporidian protozoa identified to t he species level, 14 (78%) were Enterocytozoon bieneusi and four (22%) were Septata intestinalis. The mean CD4 count in these patients was 3 5 +/- 29 cells/mm(3). Parameters of absorption, specifically absorptio n of fat and D-xylose, and levels of zinc were strikingly abnormal in patients who were tested. Treatment with albendazole led to clinical r esponses in six of 10 patients, and dietary manipulation resulted in c linical improvement in eight of nine patients. We recommend that patie nts with chronic, intermittent diarrhea and CD4 counts of < 100 cells/ mm(3) be further evaluated for microsporidia by modified trichrome sta ining of stool and light and electron microscopy of small bowel biopsy specimens. Antiprotozoal therapies are currently experimental, but so me patients who have been treated with these therapies have dramatic r esponses. We also recommend that special attention be paid to the meas urement of parameters of absorption with appropriate modification of d iet.