Microsporidiosis Treatment & Management

Updated: Jul 17, 2019
  • Author: Shirin A Mazumder, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Treatment

Medical Care

Pay attention to volume replacement and electrolyte repletion in patients with microsporidiosis who develop severe diarrhea.

Evaluate the patient by assessing dentition and addressing difficulty of chewing or swallowing. Then, focus on providing adequate nutritional support with the aid of a dietitian.

Consider enteral feeding in patients who are too ill to obtain adequate nutrition by mouth. Substitution of medium-chain for long-chain triglycerides can decrease fat malabsorption. [11] Parenteral nutrition is reserved for situations in which the small intestine is nonfunctional.

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Consultations

Gastroenterologist for colonoscopy and small-bowel endoscopy

Ophthalmologist for a slit-lamp examination in patients with symptomatic microsporidiosis

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Diet

One study has found that individuals infected with HIV and who have microsporidiosis-related diarrhea had less diarrhea and malabsorption on a medium-chain triglyceride diet as opposed to a long-chain triglyceride diet. [12]

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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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Long-Term Monitoring

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. [13]  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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