Thalidomide: a novel therapy for microsporidiosis.
OBJECTIVE
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.
Sharpstone
D
D
Department of HIV/GUM, Chelsea and Westminster Hospital, London, England.
Rowbottom
A
A
Francis
N
N
Tovey
G
G
Ellis
D
D
Barrett
M
M
Gazzard
B
B
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D000818:Animals; D003967:Diarrhea / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D016881:Microsporidiosis / Q000188:drug therapy*; D008875:Middle Aged; D013792:Thalidomide / Q000627:therapeutic use*
D013792:Thalidomide