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Previous Volume 346:1963-1969 June 20, 2002 Number 25 Next

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ABSTRACT

Background Intestinal microsporidiosis due to Enterocytozoon bieneusi is a cause of chronic diarrhea, malabsorption, and wasting in immunocompromised patients. Currently, there is no effective treatment.

Methods We conducted a randomized, double-blind, placebo-controlled trial of fumagillin (60 mg per day orally for two weeks) in patients with chronic E. bieneusi infection. Efficacy was assessed primarily by the clearance of microsporidia, as evidenced by analysis of stool specimens. Patients in whom microsporidia were not cleared received treatment for two weeks with open-label fumagillin. After clearance of the parasite, follow-up stool examinations were performed monthly to detect relapses.

Results Twelve patients were enrolled in this study, 10 with the acquired immunodeficiency syndrome and 2 who had received organ transplants. Clearance of microsporidia occurred in all six of the patients in the fumagillin group, as compared with none of the six in the placebo group (P=0.002). Treatment with fumagillin was also associated with increases in absorption of D-xylose (P=0.003) and in Karnofsky performance scores (P<0.001) and with decreases in loperamide use (P=0.01) and total stool weight (P=0.04). There were serious adverse events (neutropenia and thrombocytopenia) in three patients in the fumagillin group; one patient in the placebo group had severe diarrhea. All six controls subsequently had clearance of microsporidia after open-label treatment with fumagillin. Relapses of the infection were identified in two patients during follow-up (median follow-up, 10 months).

Conclusions Fumagillin is an effective treatment for chronic E. bieneusi infection in immunocompromised patients.

Source Information

From the Department of Infectious Diseases (J.-M.M., M.T., A.G., S.B.), the Laboratory of Parasitology (C.S., F.D.), and the Department of Biostatistics (S.C.), Hôpital Saint-Louis and University of Paris VII; and the Laboratory of Parasitology, Groupe Hospitalier Pitié–Salpétrière, Assistance Publique–Hôpitaux de Paris (J.-G.G.) — all in Paris.

Address reprint requests to Dr. Molina at the Department of Infectious Diseases, Hôpital Saint-Louis, 1 Ave. Claude Vellefaux, 75475 Paris CEDEX 10, France, or at jean-michel.molina{at}sls.ap-hop-paris.fr.

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Fumagillin for Intestinal Microsporidiosis
Carr A., Cooper D. A., Molina J.-M., Tourneur M.
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N Engl J Med 2002; 347:1381, Oct 24, 2002. Correspondence

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