Sharpstone D, Rowbottom A, Francis N, Tovey G, Ellis D, Barrett M, Gazzard B
Department of HIV/GUM, Chelsea and Westminster Hospital, London, England.
Gastroenterology. 1997 Jun;112(6):1823-9. doi: 10.1053/gast.1997.v112.pm9178672.
BACKGROUND & AIMS: Microsporidiosis is a common cause of chronic diarrhea in human immunodeficiency virus (HIV)-seropositive individuals and often does not respond to treatment. Fecal tumor necrosis factor alpha (TNF-alpha) is elevated in microsporidiosis; therefore, thalidomide, an anti-TNF-alpha agent, was used as therapy.
Eighteen subjects with chronic diarrhea caused by Enterocytozoon bieneusi that had not responded symptomatically to albendazole and 1 untreated subject with Encephalitozoon intestinalis received 1 month of thalidomide, 100 mg nocte. Clinical response was assessed by stool frequency and body weight, histological response by light microscopy with villus height/crypt depth ratios and electron microscopy, and immunologic response by fecal TNF-alpha level.
Seven subjects with chronic diarrhea due to E. bieneusi had a complete clinical response, and 3 had a partial response to thalidomide. There was a significant decrease in stool frequency from 5.3 to 3.1 per day (P = 0.001), and weight increased significantly by 1.2 kg (P < 0.02). Thalidomide significantly increased the villus height/crypt depth ratio (1.95 to 2.07; P = 0.045) and number of abnormal forms of microsporidia (P < 0.01). Fecal TNF-alpha level nonsignificantly decreased from 17.9 to 8.9 U/mL. There was apparent disruption of all stages of the life cycle of E. intestinalis.
Thalidomide may be an effective therapy for diarrhea and weight loss from E. bieneusi.
微孢子虫病是人类免疫缺陷病毒（HIV）血清阳性个体慢性腹泻的常见病因，且通常对治疗无反应。微孢子虫病患者粪便中的肿瘤坏死因子α（TNF-α）水平升高；因此，沙利度胺这种抗TNF-α药物被用作治疗药物。
18例由比氏肠微孢子虫引起的慢性腹泻患者，对阿苯达唑无明显症状反应，以及1例未经治疗的肠道脑炎微孢子虫患者，接受了为期1个月的沙利度胺治疗，每晚100mg。通过大便频率和体重评估临床反应，通过光镜观察绒毛高度/隐窝深度比值和电镜观察评估组织学反应，通过粪便TNF-α水平评估免疫反应。
7例由比氏肠微孢子虫引起慢性腹泻的患者有完全临床反应，3例对沙利度胺有部分反应。大便频率从每天5.3次显著降至3.1次（P = 0.001），体重显著增加1.2kg（P < 0.02）。沙利度胺显著提高了绒毛高度/隐窝深度比值（从1.95升至2.07；P = 0.045），并显著增加了微孢子虫异常形态的数量（P < 0.01）。粪便TNF-α水平从17.9U/mL降至8.9U/mL，但差异无统计学意义。肠道脑炎微孢子虫的整个生命周期各阶段均出现明显破坏。
沙利度胺可能是治疗比氏肠微孢子虫引起的腹泻和体重减轻的有效疗法。
