Fumagillin Effective for Microsporidiosis Treatment

The fungal antibiotic fumagillin can resolve intractable intestinal infections in HIV patients and others, according to researchers in France. "Intestinal microsporidiosis due to Enterocytozoon bieneusi is a cause of chronic diarrhea, malabsorption, and wasting in immunocompromised patients," explained Jean-Michel Molina and colleagues at Saint-Louis Hospital, Public Assistance Hospitals of Paris, and the Pitie-Salpetriere Hospital Group in Paris. "Currently, there is no effective treatment."

Fumagillin is the first effective therapy for patients suffering from chronic intestinal E. bieneusi infection, Molina and coauthors found. The researchers assessed the performance of the fungal antibiotic in a group of 10 AIDS patients and two organ transplant recipients. All six patients treated with fumagillin achieved E. bieneusi clearance, which was not seen in any of the six placebo-treated patients, they said.

Patients who received fumagillin therapy enjoyed significant improvements in Karnofsky performance status and intestinal nutrient absorption, and were able to reduce their intake of the antidiarrehea drug loperamide, study data showed. None of these benefits was seen in control patients until they were switched to open-label fumagillin treatment.

However, three of the six patients originally treated with fumagillin developed severe neutropenia and/or thrombocytopenia, while two patients relapsed within 1 year ("Fumagillin Treatment of Intestinal Microsporidiosis," New England Journal of Medicine 2002;346(25):1963-1969).

"Fumagillin is an effective treatment for chronic E. bieneusi infection in immunocompromised patients," Molina and colleagues concluded.

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