Microsporidiosis Follow-up

Updated: Oct 05, 2015
  • Author: Valda M Chijide, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Follow-up

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. [14] When BIA is performed on subsequent visits, the information obtained can be used to determine the need for intervention, such as anabolic steroids.

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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.

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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).

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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.

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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.

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Patient Education

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

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