clinical features and therapies for cryptosporidiosis and microsporidiosis
GI microsporidial infection is generally attributed to two species: E. bieneusi and E. intestinalis . In general, intestinal disease is relatively mild in contrast to the severe diarrhea typical for cryptosporidiosis. Loose stools and mild weight loss are common, with colonic symptoms typically absent. GI bleeding suggests another diagnosis as this infection does not cause mucosal ulceration. Although stool studies can establish the diagnosis, small bowel biopsies, of either the duodenum or ileum, with special stains are more sensitive. Although there is no effective antimicrobial therapy for E. bieneusi, albendazole is highly effective for E. intestinalis. As with all opportunistic infections in AIDS, HAART may result in clinical remission.
Cryptosporidia are a common cause of chronic diarrhea in HIV-infected patients with severe immunodeficiency. There are at least 40 species of Cryptosporidia, but the most common cause of human disease is Cryptosporidium muri . The diarrhea is generally voluminous and watery. Dehydration and weight loss are common in patients with advanced immunodeficiency. Disease severity correlates with immune function. The disease may wax and wane, but persistent or progressive disease may be manifested by dehydration and electrolyte imbalances. Constitutional symptoms are prominent, including low-grade fever, malaise, anorexia, nausea, and vomiting. Both of these infections improve with reconstitution of the immune system following successful HAART.