Therapy for human gastrointestinal microsporidiosis
Therapy for human gastrointestinal microsporidiosis
复制标题
DOI：
10.4269/ajtmh.2000.63.121
复制
发表时间：
2000-09-01
影响因子：
3.3
通讯作者：
Pruthi, JS
中科院分区：
文献类型：
--
作者：
Conteas, CN;Berlin, OGW;Pruthi, JS
胃肠道微孢子虫病是获得性免疫缺陷综合症（艾滋病）患者腹泻和消瘦的主要原因。微孢子虫表现出真正的真核生物和原核生物的特性。微孢子虫的生物学特性使其从胃肠道中消除在治疗上具有挑战性。这种生物体的能量需求和繁殖很大程度上依赖于宿主。小孢子孢子不受这些元素的影响。艾滋病患者的胃肠道微孢子虫感染，主要是比氏肠细胞虫和肠脑炎原虫感染，已采用不同的医疗方案进行治疗，取得了不同程度的成功。不太常见的病原体肠道肠球菌对阿苯达唑反应良好，使其成为极好的一线治疗药物，但比氏肠球菌却并非如此。没有一种苯并咪唑被证明对 E. bieneusi 有效。另一方面，E. bieneusi 对夫马洁林或其类似物 TNP-470 的直接作用，或通过采用更具侵略性、高效的抗逆转录病毒疗法抑制 HIV 病毒而间接增强免疫而表现出优异的临床治疗反应。需要进一步的工作来充分建立适当的治疗方案并管理治疗的副作用。其他有前途的治疗形式，如多胺抑制剂和沙利度胺，在体外（多胺抑制剂）和选定的体内病例（沙利度胺）治疗微孢子虫方面表现出一定的有效性。由于缺乏足够的提示性或明确的人体研究，目前无法认可这些治疗胃肠道微孢子虫病的疗法。
Gastrointestinal microsporidiosis is a major cause of diarrhea and wasting in persons with acquired immune deficiency syndrome (AIDS). Microsporidia demonstrate properties of both true eukaryotes and prokaryotes. The biology of microsporidia makes its elimination from the gastrointestinal tract therapeutically challenging. This organism depends greatly on the host for its energy needs and reproduction; microsporidial spores are impervious to the elements. Microsporidial infection of the gastrointestinal tract, principally with Enterocytozoon bieneusi and Encephalitozoon intestinalis in patients with AIDS has been treated with different medical regimens with variable success. The less common pathogen, E. intestinalis, responds well to albendazole, making it excellent first-line therapy, but such is not the case for E. bieneusi. None of the benzimidazoles has been demonstrated to be efficacious for E. bieneusi. On the other hand, E. bieneusi has shown excellent clinical therapeutic response to either direct action with fumagillin or its analogue, TNP-470, or indirectly by immune enhancement by suppression of the HIV virus with more aggressive, highly effective antiretroviral therapy. Further work is necessary to fully establish proper therapeutic protocols and manage side effects of the treatments. Other promising forms of therapy such as polyamine inhibitors and thalidomide demonstrate certain effectiveness in treatment of microsporidian in vitro (polyamine inhibitors) and in selected cases in vivo (thalidomide). Lack of either sufficiently suggestive or definitive human studies prevents the endorsement of these modes of therapy for treatment of gastrointestinal microsporidiosis at this time.