Microspridiosis

Microspridiosis is an infection of the intestines that causes diarrhea and wasting in people with HIV. It can also cause infections of the brain, sinus, eyes, lungs, bile ducts, kidneys, muscles and other organs. It is caused by several kinds of microspridia, or one-celled parasites.

The infection usually happens when a person's CD4 cell count drops below 100. It can be life threatening. Before the AIDS epidemic began, only 11 cases of microspridiosis had been reported in medical literature.

Symptoms

The main sign of microspridiosis is watery diarrhea. There may also be stomach pain, nausea, a loss of appetite, weight loss, dehydration and passing gas (flatulence). The symptoms may come and go for months. Not all people exposed to microsporidia even those with weakened immune systems show symptoms of infection.

Causes

The parasites that cause microspridiosis can be found in the feces of people and animals. It can be spread to people through contaminated food or water or swimming in contaminated water. Oral-anal sex may also spread the infection.

Prevention

Washing the hands, especially after going to the bathroom or before handling food, helps prevent infection. Keeping food clean can also help. Meats and fish should washed thoroughly. Fruits and vegetables should be cleaned and peeled.

Oral-anal sex should be done only with a latex barrier such as a dental dam or Saran wrap. This is especially important for HIV-positive people with weakened immune systems.

Diagnosis

It is hard to diagnosis microspridiosis. The parasites are so small that even with an electron microscope it is hard to see them.

It used to be necessary to get a sample of the tissue of the small intestine (a biopsy) to look at under a microscope. A stool test is now used to easily diagnose infection by the parasite E. bieneusi. If the parasites have spread, tests can be done on samples of urine or water used to flush the sinuses. Many doctors treat the condition as if it were microspridiosis even without a solid diagnosis. If the diarrhea goes away, the condition probably was microspridiosis.

Treatment

To date, there is no one treatment that effectively gets rid of microspridiosis. Several drugs are being studied to fight microspridiosis. Some help stop the diarrhea but donÕt get rid of the parasites from the gut. Some are effective against microspridiosis of the eye.

The drug albendazole (Albenza) is often used to treat microspridiosis. Sometimes it is effective; sometimes it is not. It can take up to two months or more to become effective. Different parasites can cause microspridiosis. Albendazole works against some of them like Septata intestinalis. It doesnÕt work as well against the more common parasite, E. bieneusi. The drug is hard to absorb. It may cause birth defects and should not be taken by anyone who is pregnant.

One of the best ways to treat microspridiosis is anti-HIV drugs. These drugs can raise CD4 cell counts above 100. This strengthens the immune system and helps it fight the parasites. Having the parasites makes it hard for the body to absorb the drugs.

Sometimes diarrhea makes it hard to digest pills or tablets given as part of antiretroviral therapy. In this case, grinding up the tables or capsules can help the body absorb the medicines.

It is important to treat the diarrhea and prevent dehydration (not having enough water in the body). Medicines like loperamide (Imodium), diphenoxylate (Lomotil) and Pepto-Bismol¨ can help. While this helps control the diarrhea, it doesnÕt fight the parasite. As soon as the anti-diarrhea medicine is stopped, the diarrhea will come back.

Non-steroidal anti-inflammatory drugs (NSAIDS) can be helpful in fighting the inflammation that goes with the parasite infection. An example of an NSAID is ibuprofen (Advil).

Cutting down on the amount of fat in the diet and eating more fruits and vegetables can help. As ongoing diarrhea can cause wasting, it is important to help build back any weight loss. These means eating healthy amounts of the right food. If loss of appetite is a problem, appetite-boosting drugs may be helpful. These include Marinol (gel-caps containing THC, the active ingredient in marijuana) and megestrol acetate (Megace).

Wasting causes a loss of muscle. Doing weightlifting or other exercises to build up muscles is helps the wasting.