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Thalidomide: a novel therapy for microsporidiosis.

AbstractBACKGROUND & AIMS:
Microsporidiosis is a common cause of chronic diarrhea in human immunodeficiency virus (HIV)-seropositive individuals and often does not respond to treatment. Fecal tumor necrosis factor alpha (TNF-alpha) is elevated in microsporidiosis; therefore, thalidomide, an anti-TNF-alpha agent, was used as therapy.
METHODS:
Eighteen subjects with chronic diarrhea caused by Enterocytozoon bieneusi that had not responded symptomatically to albendazole and 1 untreated subject with Encephalitozoon intestinalis received 1 month of thalidomide, 100 mg nocte. Clinical response was assessed by stool frequency and body weight, histological response by light microscopy with villus height/crypt depth ratios and electron microscopy, and immunologic response by fecal TNF-alpha level.
RESULTS:
Seven subjects with chronic diarrhea due to E. bieneusi had a complete clinical response, and 3 had a partial response to thalidomide. There was a significant decrease in stool frequency from 5.3 to 3.1 per day (P = 0.001), and weight increased significantly by 1.2 kg (P < 0.02). Thalidomide significantly increased the villus height/crypt depth ratio (1.95 to 2.07; P = 0.045) and number of abnormal forms of microsporidia (P < 0.01). Fecal TNF-alpha level nonsignificantly decreased from 17.9 to 8.9 U/mL. There was apparent disruption of all stages of the life cycle of E. intestinalis.
CONCLUSIONS:
Thalidomide may be an effective therapy for diarrhea and weight loss from E. bieneusi.
AuthorsD Sharpstone, A Rowbottom, N Francis, G Tovey, D Ellis, M Barrett, B Gazzard
JournalGastroenterology (Gastroenterology) Vol. 112 Issue 6 Pg. 1823-9 (Jun 1997) ISSN: 0016-5085 [Print] United States
PMID9178672 (Publication Type: Clinical Trial, Journal Article)
Chemical References
  • Thalidomide
Topics
  • Acquired Immunodeficiency Syndrome (drug therapy)
  • Adult
  • Animals
  • Diarrhea (drug therapy)
  • Female
  • Humans
  • Male
  • Microsporidiosis (drug therapy)
  • Middle Aged
  • Thalidomide (therapeutic use)

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