Microsporidiosis Follow-up

  • Author: Valda M Chijide, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

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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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.[11] 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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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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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.

Specialty Editor Board

Joseph Richard Masci, MD  Professor of Medicine, Professor of Preventive Medicine, Mount Sinai School of Medicine; Director of Medicine, Elmhurst Hospital Center

Joseph Richard Masci, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Association of Professors of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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; MERCK None Other

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.

Additional Contributors

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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Electron micrograph (X30,000) of Nosema connori in diaphragm showing a coiled polar filament (arrow). Courtesy of the Armed Forces Institute of Pathology (AFIP 71-11521-4).
 
 
 
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