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Query: UMLS:C0001175 (AIDS)
 120,706 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the efficacy and safety of albendazole for treatment of intestinal microsporidosis due to Enterocytozoon bieneusi, 29 patients with AIDS were studied. All had chronic diarrhea, weight loss, and evidence of malabsorption. After 1 month of treatment with albendazole (400 mg orally twice a day), the mean number of bowel movements decreased from 7.0 to 3.8 stools/day (P < .0001) and the mean weight gain was 0.56 kg (P = .259). Albendazole at this dose did not clear E. bieneusi on follow-up small-bowel biopsies, but ultrastructural studies revealed an apparent decrease in parasite burden in 2 patients and an increased proportion of dividing plasmodia in 5 patients. There were no significant adverse events associated with this dose of albendazole. A formal double-blind placebo-controlled study using higher doses has recently been approved and will soon be underway (AIDS Clinical Trial Group protocol 207).
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PMID:Treatment with albendazole for intestinal disease due to Enterocytozoon bieneusi in patients with AIDS. 827 79

The importance of microsporidium as an opportunistic agent in immunocompromised and AIDS patients is reviewed. Five strains of the agent have been described: Encephalitozoon, Enterocytozoon, Nosema, Pleistophora and Septata. The clinical presentation may be as 1) Generalized infections with multisystemic involvement, specially of the central nervous system; 2) Intestinal, that is the most important and frequent localization in man, and that may cause death in AIDS patients; 3) Ocular, that affects cornea, conjunctiva and may extend to paranasal sinuses; 4) Liver and biliary tract infection with granulomatous lesions, hepatic necrosis or sclerosing colangitis and 5) Muscular, affecting skeletal muscle. The diagnosis is difficult and is established finding spores in the affected tissues with light or electron microscopy. Lately, the diagnosis of intestinal microsporidiosis is made looking for faecal spores. The resistant wall of spores hampers treatment. However, good results are obtained with Albendazole in intestinal microsporidiosis.
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PMID:[Update on microsporidiosis in humans]. 852 32

Many different infections with protozoan and helminthic parasites are common global health problems. Several protozoa are responsible for opportunistic infections in patients with AIDS. The newly developed drug, albendazole, has a strong activity against many nematode and cestode parasites. In the case of echinococcosis, it reduces the viability of protoscolices and cysts. Its hepatic metabolite, albendazole sulfoxide, is active against the larval cestodes. In the case of neurocysticercosis, administration of either the standard treatment, praziquantel, or the newly developed drug, albendazole, reduces or eliminates tapeworm cysts in 80-90% of patients. Patients with numerous cysts and those in whom neurologic symptoms or intracranial hypertension develops after therapy against cysticerci should receive adjunctive therapy with dexamethasone. Mass chemotherapy with single doses of albendazole or the older drug, mebendazole, is feasible for school-age children to treat the soil-transmitted helminthiases (ascariasis, hook-worm infection, and trichuriasis). The newly developed drug, ivermectin, is more effective against chronic strongyloidiasis than albendazole. It has been used most extensively against river blindness. It greatly reduces the number of microfilariae in the skin and eyes but has no effect on sclerosing keratitis or chorioretinitis. Both drugs are available in the US on a compassionate-use basis from their manufacturers. Field trials show that ivermectin is also effective against lymphatic filariasis and Mansonella ozzardi. Praziquantel is effective against many trematode and cestode infections. It is the drug of choice for schistosomiasis. Albendazole was effective against giardiasis in children in Bangladesh but ineffective in adult travelers returning from tropical areas. It appears to effect symptomatic improvement of intestinal microsporidial infections in patients with AIDS. The newly developed drug, fumagillin, can ameliorate ocular microsporidiosis. The newly developed drug, paromycin, treats cryptosporidiosis. Trimethoprim-sulfamethoxazole treats cyclosporiasis and isosporiasis.
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PMID:Antiparasitic drugs. 860 86

A randomized double blind placebo controlled trial was conducted in Zambia at the home care service of the University Teaching Hospital in Lusaka, the Ndola Central Hospital in the north, and the Kara HIV Counselling and Testing Project in central Lusaka to determine the extent albendazole can treat or suppress diarrhea in AIDS patients. The trial also aimed to identify a chemotherapeutic agent that could achieve diarrhea treatment or suppression and be administered in the community without prior investigation. Clinical researchers randomly allocated 174 HIV-positive patients with persistent diarrhea (i.e., loose but not bloody stools at least 3 times/day) to the group that received 800 mg albendazole twice daily for 2 weeks or the placebo group. They followed the patients for 6 months. The albendazole group had diarrhea less often than the placebo group for the entire 6 month period. The difference was significant at all time points (p 0.025) except at 5-8 weeks. At 3-4 weeks post-treatment, the reduction in diarrhea was significant among patients at the Kara Trust (31% reduction; p = 0.004) and in Ndola (41% reduction; p 0.0001) but not at the University Teaching Hospital (10% reduction). Two weeks after treatment, the albendazole group had diarrhea on 29% fewer days than the placebo group (p 0.0001). During the post-treatment weeks of 9-16, the albendazole group experienced diarrhea on 42% fewer days than the placebo group (p = 0.002). Throughout the entire 6-month period, patients in the albendazole group were more likely to achieve remission of diarrhea than the placebo group (e.g., 26% vs. 9%, p = 0.003). The proportion of patients who were in remission increased to 35% when the researchers excluded deaths and withdrawals from treatment. Patients who had a Karnofsky score (a measure of overall severity of illness at the time of entry into the study) of 50-70 benefitted the most from albendazole treatment for diarrhea. Albendazole had no significant effect on mortality. The researchers surmised that much of albendazole's effectiveness was due to its effect on microsporidia infections.
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PMID:Albendazole chemotherapy for treatment of diarrhoea in patients with AIDS in Zambia: a randomised double blind controlled trial. 863 60

We report a patient with AIDS and intestinal microsporidiosis. While undergoing treatment with albendazole, he developed worsening diarrhea with abdominal pain and fever. The diagnosis of pseudomembranous colitis was made by flexible sigmoidoscopy and a positive stool specimen for Clostridium difficile toxin. The patient's symptoms resolved with oral vancomycin and his stool C. difficile toxin became negative. Albendazole is an antibiotic that is chemically related to metronidazole. Although a few case reports link metronidazole with the development of pseudomembranous colitis, albendazole has not been associated with the development of this condition. The spectrum of antimicrobial activity of albendazole and its efficacy in the treatment of intestinal microsporidiosis are reviewed. Pathogenic mechanisms for the development of pseudomembranous colitis and the epidemiology of this condition in patients with AIDS are discussed.
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PMID:Albendazole-induced pseudomembranous colitis. 867 15

After the diagnosis of two cases of microsporidial intestinal infection in 1992, in Rio de Janeiro, we have started looking for this parasite in HIV-infected patients with chronic unexplained diarrhea. We have studied 13 patients from Hospital Evandro Chagas, IOC-FIOCRUZ. Fecal specimens from these patients were examined for the presence of Cryptosporidia and Microsporidia, in addition to routine examination. Spores of Microsporidia were found in the stools of 6 (46.1%) of the 13 patients studied, with 2 histological jejunal confirmations. The Microsporidia-infected patients presented chronic diarrhea with about 6 loose to watery bowel movements a day. Five infected patients were treated with Metronidazole (1.5 g/day). They initially showed a good clinical response, but they never stopped eliminating spores. After about the 4th week of therapy, their diarrhea returned. Two patients utilized Albendazole (400 mg/day-4 weeks) with a similar initial improvement and recurrence of the diarrhea. Intestinal Microsporidiosis seems to be a marker of advanced stages of AIDS, since 5 of our 6 infected patients were dead after a 6 month period of follow-up. The present study indicates that intestinal microsporidiosis may be a burgeoning problem in HIV-infected patients with chronic diarrhea in Brazil, which deserves further investigation.
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PMID:Intestinal microsporidiosis in HIV-positive patients with chronic unexplained diarrhea in Rio de Janeiro, Brazil: diagnosis, clinical presentation and follow-up. 907 Oct 28

Presently, the two most commonly used drugs for treating microsporidiosis in persons with AIDS are albendazole and fumagillin. Albendazole is effective for treating disseminated infections due to Encephalitozoon spp. but is variably effective against Enterocytozoon bieneusi infections. Fumagillin is highly effective when used topically to treat ocular infections with Encephalitozoon hellem or Encephalitozoon intestinalis but is too toxic for systemic use. In this study, the fumagillin analog TNP-470 was assayed for antimicrosporidial activity in vitro. The MICs of TNP-470 at which 50% of isolates were killed (MIC50s) were 0.35 +/- 0.21 and 0.38 +/- 0.11 ng/ml for E. intestinalis and Vittaforma corneae, respectively, and were similar to the MIC50s of fumagillin for these organisms, which were 0.515 +/- 0.002 and 0.81 +/- 0.014 ng/ml, respectively. The MIC50 of albendazole for E. intestinalis was 8.0 +/- 4.23 ng/ml, significantly less (P < 0.01) than its MIC50 for V. corneae, which was 55.0 +/- 7.07 ng/ml. TNP-470 inhibited replication of E. intestinalis in RK-13 cells if it was given at the same time as infection or if treatment was initiated 7 days later. In addition, treatment of the infected cultures with TNP-470 at a dose of 10 ng/ml for 2 weeks, followed by discontinuation of the drug treatment, resulted in no significant increase in E. intestinalis shedding during the following 3 weeks in culture. Because TNP-470 acts against both E. intestinalis and V. corneae, and because TNP-470 was found by others to be less toxic in vivo, TNP-470 may be a promising new drug for the treatment of microsporidiosis.
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PMID:Effects of albendazole, fumagillin, and TNP-470 on microsporidial replication in vitro. 921 Jun 81

Recent reports have described the successful treatment of Encephalitozoon intestinalis infection in AIDS patients with albendazole. However, this compound is rapidly metabolized in vivo to albendazole sulfoxide, and furthermore it is only 1 of about 15 commercially developed benzimidazole derivatives. To compare the activities of albendazole, albendazole sulfoxide, and other benzimidazoles, an in vitro system involving infection of green monkey kidney cell (E6) monolayers with E. intestinalis spores was developed. After 14 days, the effects of benzimidazoles on spore production were determined. Ten of fourteen derivatives tested, including albendazole, were inhibitory at concentrations of 1 to 10 ng/ml. Derivatives modified at the 1 or 2 position were less active. Albendazole sulfoxide was 1.7-fold more inhibitory than albendazole but significantly less toxic to E6 cells, a finding that explains the clinical efficacy of this compound. Potential alternatives to albendazole are discussed. No albendazole-resistant E. intestinalis mutants were obtained following in vitro selection.
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PMID:In vitro susceptibilities of the AIDS-associated microsporidian Encephalitozoon intestinalis to albendazole, its sulfoxide metabolite, and 12 additional benzimidazole derivatives. 942 47

Microsporidia are protozoan parasites responsible for significant gastrointestinal disease in patients infected with the human immunodeficiency virus. We report the clinical features of three patients with chronic diarrhea and intestinal microsporidiosis caused by Enterocytozoon bieneusi. The average value for CD4 in these patients was < or = 50 cells/mm3. The spores were detected in smears from stool samples and duodenal aspirates stained with trichrome blue in all patients. Light microscopy of semi-thin plastic sections revealed parasites and spores in the enterocytes and were associated with villous atrophy (2 out of 3). Thin section-electron microscopy showed a variety of developmental stages of the microsporidio. Patients treated with Albendazole had an unsatisfactory clinical response to therapy. Enterocytozoon bieneusi infection may be an important cause of diarrhea in patients with AIDS in our country.
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PMID:[Morphological study of Enterocytozoon bineousi in patients with AIDS and chronic diarrhea]. 952 21

A double-blind placebo-controlled trial was conducted to assess the efficacy and safety of albendazole (400 mg twice daily for 3 weeks) for the treatment of Encephalitozoon intestinalis infection in patients with AIDS. Clearance of microsporidia from the intestinal tract was obtained in 4 of 4 patients in the albendazole group versus 0 of 4 in the control group (P = .01, one-sided Fisher's exact test) and was associated with significant clinical benefit. All 4 controls subsequently cleared microsporidia following open-labeled albendazole treatment. To investigate the effect of albendazole in preventing relapse, these 8 patients were then randomly assigned to receive either albendazole (400 mg twice daily) or no treatment for the next 12 months. Albendazole significantly delayed the occurrence of relapse (P = .04, one-sided log-rank test). In human immunodeficiency virus-infected patients with E. intestinalis infection, albendazole has parasitologic and clinical efficacy and reduces the risk of relapse.
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PMID:Albendazole for treatment and prophylaxis of microsporidiosis due to Encephalitozoon intestinalis in patients with AIDS: a randomized double-blind controlled trial. 959 27


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