PERSISTENT DAMAGE TO ENTEROCYTOZOON-BIENEUSI WITH PERSISTENT SYMPTOMATIC RELIEF, AFTER COMBINED FURAZOLIDONE AND ALBENDAZOLE IN AIDS PATIENTS

Aim-To investigate morphological changes in Enterocytozoon bieneusi an d the duration of symptomatic relief after combination treatment with furazolidone and albendazole in AIDS patients. Methods-Four severely i mmunocompromised AIDS patients with symptomatic E bieneusi infection o f the gut received an 18 day course of combined furazolidone and alben dazole (500 + 800 mg daily). All patients were monitored for parasite shedding in stool by light microscopy at the end of treatment and mont hly during follow up. At the end of treatment, duodenal biopsy specime ns obtained from three patients were studied by transmission electron microscopy by two pathologists blind to the patients' treatment or cli nical outcome. Duodenal biopsy specimens obtained from one of the pati ents two months after completion of treatment were also studied electr onmicroscopically. Results-All patients had long lasting symptomatic r elief, with a major decrease-or transient absence-of spore shedding in stools from completion of treatment. After treatment, changes in faec al spores were persistently found by light microscopy in all cases, an d there was evidence of both a substantial decrease in parasite load a nd ultrastructural damage in the parasite in all biopsy specimens. The treatment was well tolerated, and no patient had clinical or parasito logical relapse during follow up (up to 15 months). Conclusions-The lo ng lasting symptomatic relief observed in all four treated patients co rrelated with the persistent decrease in parasite load both in tissue and in stool, and with the morphological changes observed in the life cycle of the protozoan. These data suggest that combined treatment wit h furazolidone and albendazole is active against E bieneusi and may re sult in lasting remission even in severely immunocompromised patients.