eMedicine Specialties > Infectious Diseases > Parasitic Infections

Microsporidiosis: Follow-up

Author: Valda M Chijide, MD, Clinical Professor, Department of Medicine, University of Saskatchewan; Consultant in Infectious Diseases, Regina, Saskatchewan, Canada
Contributor Information and Disclosures

Updated: Sep 18, 2009

Follow-up

Further Inpatient Care

  • Patients with severe fluid loss due to diarrhea should undergo volume replacement with intravenous fluids.
  • Monitor electrolytes frequently and replace as necessary.

Further Outpatient Care

  • Follow-up visit: In patients with microsporidiosis who have persistent diarrhea, obtain stool samples to assess response to therapy and evaluate for other etiologies. In addition, consider repeating small-bowel endoscopy.
  • Nutritional assessment: Question patients regarding dietary habits at each routine clinic visit. Dietary referral may be needed to assist in obtaining a dietary history and calorie count. Immediately address complaints regarding loss of appetite and weight loss to determine if an opportunistic infection is the underlying cause. Bioimpedance analysis (BIA) is a rapid noninvasive technique that uses a portable analyzer to help assess lean body mass.8 When BIA is performed on subsequent visits, the information obtained can be used to determine the need for intervention, such as anabolic steroids.

Inpatient & Outpatient Medications

  • Postantibiotic treatment: After patients with microsporidiosis undergo an adequate course of antibiotic treatment, those with significant weight loss or appetite loss require further assessment to determine whether to institute nutritional supplements, drugs, or both to reverse these effects (eg, anabolic steroids such as testosterone or oxandrolone, appetite stimulant such as megestrol acetate).

Deterrence/Prevention

  • Counsel immunosuppressed patients on the importance of frequent handwashing, thorough cooking of meat, and limiting exposure to animals suspected of being infected with microsporidia.
  • Inform patients with microsporidiosis that this disease may be transmitted sexually and to consider screening of sexual partners.

Prognosis

  • Most patients who develop intestinal microsporidiosis are severely immunosuppressed; therefore, the prognosis is usually poor in these patients.
  • Diarrhea generally resolves spontaneously in immunocompetent patients who develop microsporidiosis.

Patient Education

  • Counsel patients regarding meticulous handwashing to help decrease the risk of opportunistic infections.

Miscellaneous

Medicolegal Pitfalls

  • Ocular microsporidiosis occurs in 1-2% of persons with HIV infection who have advanced illness; therefore, an ophthalmologic examination is indicated in this group of patients.
  • Microsporidiosis in persons with AIDS may relapse if the antiretroviral regimen fails.
  • Suspect ocular microsporidiosis in HIV-negative individuals with unilateral eye symptoms, especially in those who have used topical steroids.
 
Acknowledgments

The author would like to thank Deidrea Parker, BS, and the Medical College of Georgia Department of Pharmacy for assistance in the literature review of the drug therapy for microsporidiosis.



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References
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Further Reading

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Keywords

microsporidiosis, microsporidiasis, microsporidia, Enterocytozoon bieneusi, E bieneusi, Encephalitozoon hellem, E hellem, Encephalitozoon intestinalis, E intestinalis, Septata intestinalis, S intestinalis, Encephalitozoon cuniculi, E cuniculi, Pleistophora, Trachipleistophora hominis, T hominis, Trachipleistophora anthropophthera, T anthropophthera, Nosema connori, N connori, Nosema ocularum, N ocularum, Brachiola vesicularum, B vesicularum, Vittaforma corneae, V corneae, Nosema corneum, N corneum, Microsporidium ceylonensis, M ceylonensis, Microsporidium africanum, M africanum, microsporidial keratoconjunctivitis, ocular microsporidiosis, intestinal microsporidiosis, disseminated microsporidiosis, biliary microsporidiosis

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Contributor Information and Disclosures

Author

Valda M Chijide, MD, Clinical Professor, Department of Medicine, University of Saskatchewan; Consultant in Infectious Diseases, Regina, Saskatchewan, Canada
Valda M Chijide, MD is a member of the following medical societies: American College of Physicians, HIV Medicine Association of America, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Joseph Richard Masci, MD, Chief of Infectious Diseases, Associate Director, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Elmhurst Hospital Center, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

John W King, MD, Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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