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E. bieneusi No Albendazole — SCE Infectious Diseases MCQ

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HardHIV MedicineE. bieneusi No AlbendazoleSCE Infectious Diseases

A 40-year-old man with HIV (CD4 50, not on ART) develops chronic diarrhoea. Stool is positive for Microsporidium (modified trichrome stain shows tiny spores 1–2 µm). The species is identified as Enterocytozoon bieneusi. What is the treatment?

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Correct answer: C — ART initiation is the primary treatment — there is no reliably effective antimicrobial for E. bieneusi; immune reconstitution clears the infection; Albendazole has no activity against E. bieneusi (unlike Encephalitozoon species)

Microsporidium species cause chronic diarrhoea in advanced HIV. Crucially, E. bieneusi (the most common species in HIV) does NOT respond to Albendazole (which is effective against Encephalitozoon species). For E. bieneusi, immune reconstitution with ART is the primary treatment. Fumagillin has activity against E. bieneusi but is not widely available and has significant toxicity (thrombocytopenia). Nitazoxanide has been used with variable success. The key teaching: species identification matters for Microsporidium — E. bieneusi vs Encephalitozoon determines treatment.

Reference: BHIVA 2022 – OI guidelines; WHO 2021 – Microsporidiosis