HIV opportunistic infection cryptosporidiosis: prevention and treatment guidelines: Difference between revisions

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ART with immune restoration (an increase of CD4+ T lymphocyte count to >100 cells/µL) is associated with resolution of symptoms of enteric microsporidiosis, including that caused by E. bieneusi.<ref name="pmid10795595">{{cite journal |author=Maggi P, Larocca AM, Quarto M, Serio G, Brandonisio O, Angarano G, Pastore G |title=Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1 |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=19 |issue=3 |pages=213–7 |year=2000 |month=March |pmid=10795595 |doi= |url=http://link.springer.de/link/service/journals/10096/bibs/0019003/00190213.htm |accessdate=2012-04-19}}</ref><ref name="pmid9365777">{{cite journal |author=Goguel J, Katlama C, Sarfati C, Maslo C, Leport C, Molina JM |title=Remission of AIDS-associated intestinal microsporidiosis with highly active antiretroviral therapy |journal=AIDS |volume=11 |issue=13 |pages=1658–9 |year=1997 |month=November |pmid=9365777 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=11&issue=13&spage=1658 |accessdate=2012-04-19}}</ref><ref name="pmid9598440">{{cite journal |author=Conteas CN, Berlin OG, Speck CE, Pandhumas SS, Lariviere MJ, Fu C |title=Modification of the clinical course of intestinal microsporidiosis in acquired immunodeficiency syndrome patients by immune status and anti-human immunodeficiency virus therapy |journal=Am. J. Trop. Med. Hyg. |volume=58 |issue=5 |pages=555–8 |year=1998 |month=May |pmid=9598440 |doi= |url=http://www.ajtmh.org/cgi/pmidlookup?view=long&pmid=9598440 |accessdate=2012-04-19}}</ref> All patients should be offered ART as part of the initial management of their infection ('''AII'''). Nevertheless, data indicate that microsporidia are suppressed but not eliminated.<ref name="pmid9365777">{{cite journal |author=Goguel J, Katlama C, Sarfati C, Maslo C, Leport C, Molina JM |title=Remission of AIDS-associated intestinal microsporidiosis with highly active antiretroviral therapy |journal=AIDS |volume=11 |issue=13 |pages=1658–9 |year=1997 |month=November |pmid=9365777 |doi=|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=11&issue=13&spage=1658 |accessdate=2012-04-19}}</ref>
ART with immune restoration (an increase of CD4+ T lymphocyte count to >100 cells/µL) is associated with resolution of symptoms of enteric microsporidiosis, including that caused by E. bieneusi.<ref name="pmid10795595">{{cite journal |author=Maggi P, Larocca AM, Quarto M, Serio G, Brandonisio O, Angarano G, Pastore G |title=Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1 |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=19 |issue=3 |pages=213–7 |year=2000 |month=March |pmid=10795595 |doi= |url=http://link.springer.de/link/service/journals/10096/bibs/0019003/00190213.htm |accessdate=2012-04-19}}</ref><ref name="pmid9365777">{{cite journal |author=Goguel J, Katlama C, Sarfati C, Maslo C, Leport C, Molina JM |title=Remission of AIDS-associated intestinal microsporidiosis with highly active antiretroviral therapy |journal=AIDS |volume=11 |issue=13 |pages=1658–9 |year=1997 |month=November |pmid=9365777 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=11&issue=13&spage=1658 |accessdate=2012-04-19}}</ref><ref name="pmid9598440">{{cite journal |author=Conteas CN, Berlin OG, Speck CE, Pandhumas SS, Lariviere MJ, Fu C |title=Modification of the clinical course of intestinal microsporidiosis in acquired immunodeficiency syndrome patients by immune status and anti-human immunodeficiency virus therapy |journal=Am. J. Trop. Med. Hyg. |volume=58 |issue=5 |pages=555–8 |year=1998 |month=May |pmid=9598440 |doi= |url=http://www.ajtmh.org/cgi/pmidlookup?view=long&pmid=9598440 |accessdate=2012-04-19}}</ref> All patients should be offered ART as part of the initial management of their infection ('''AII'''). Nevertheless, data indicate that microsporidia are suppressed but not eliminated.<ref name="pmid9365777">{{cite journal |author=Goguel J, Katlama C, Sarfati C, Maslo C, Leport C, Molina JM |title=Remission of AIDS-associated intestinal microsporidiosis with highly active antiretroviral therapy |journal=AIDS |volume=11 |issue=13 |pages=1658–9 |year=1997 |month=November |pmid=9365777 |doi=|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0269-9370&volume=11&issue=13&spage=1658 |accessdate=2012-04-19}}</ref>


No specific therapeutic agent is active against E. bieneusi infection. A controlled clinical trial suggests that E. bieneusi might respond to oral fumagillin (60 mg/day), a water insoluble antibiotic made by Aspergillus fumigatus (BII).
No specific therapeutic agent is active against E. bieneusi infection. A controlled clinical trial suggests that E. bieneusi might respond to oral fumagillin (60 mg/day), a water insoluble antibiotic made by Aspergillus fumigatus ('''BII''').


==Reference==
==Reference==

Revision as of 17:50, 19 April 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:, Ujjwal Rastogi, MBBS [2]

Overview

Cryptosporidiosis is caused by Cryptosporidium species, a group of protozoan parasites that infect the small bowel mucosa, and in immunosuppressed persons, the large bowel and extraintestinal sites. Those at greatest risk for disease are patients with advanced immunosuppression (i.e., CD4+ T lymphocyte counts generally <100 cells/µL)[1] The three most common species infecting humans are C. hominis (formerly C. parvum genotype 1 or human genotype), C. parvum (formerly C. parvum genotype 2 or bovine genotype), and C. meleagridis. In addition, infections with C. canis, C. felis, C. muris, and Cryptosporidium pig genotype have been reported in immunocompromised patients. Preliminary analyses indicate that some zoonotic species might have a stronger association with chronic diarrhea than C. hominis. However, whether the different Cryptosporidium species are associated with differences in severity of disease or response to therapy is unknown.

Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

Outline of the Guideline:

Treatment Recommendations

ART with immune restoration (an increase of CD4+ T lymphocyte count to >100 cells/µL) is associated with resolution of symptoms of enteric microsporidiosis, including that caused by E. bieneusi.[2][3][4] All patients should be offered ART as part of the initial management of their infection (AII). Nevertheless, data indicate that microsporidia are suppressed but not eliminated.[3]

No specific therapeutic agent is active against E. bieneusi infection. A controlled clinical trial suggests that E. bieneusi might respond to oral fumagillin (60 mg/day), a water insoluble antibiotic made by Aspergillus fumigatus (BII).

Reference

  1. ↑ Flanigan T, Whalen C, Turner J, Soave R, Toerner J, Havlir D, Kotler D (1992). "Cryptosporidium infection and CD4 counts". Ann. Intern. Med. 116 (10): 840–2. PMID 1348918. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. ↑ Maggi P, Larocca AM, Quarto M, Serio G, Brandonisio O, Angarano G, Pastore G (2000). "Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1". Eur. J. Clin. Microbiol. Infect. Dis. 19 (3): 213–7. PMID 10795595. Retrieved 2012-04-19. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Goguel J, Katlama C, Sarfati C, Maslo C, Leport C, Molina JM (1997). "Remission of AIDS-associated intestinal microsporidiosis with highly active antiretroviral therapy". AIDS. 11 (13): 1658–9. PMID 9365777. Retrieved 2012-04-19. Unknown parameter |month= ignored (help)
  4. ↑ Conteas CN, Berlin OG, Speck CE, Pandhumas SS, Lariviere MJ, Fu C (1998). "Modification of the clinical course of intestinal microsporidiosis in acquired immunodeficiency syndrome patients by immune status and anti-human immunodeficiency virus therapy". Am. J. Trop. Med. Hyg. 58 (5): 555–8. PMID 9598440. Retrieved 2012-04-19. Unknown parameter |month= ignored (help)


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