1. Fumagillin Shortage: How to Treat Enterocytozoon bieneusi Microsporidiosis in Solid Organ Transplant Recipients in 2024?
- Author
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Cyril Garrouste, Philippe Poirier, Charlotte Uro-Coste, Xavier Iriart, Nassim Kamar, Julie Bonhomme, Eve Calvar, Solène Le Gal, Luca Lanfranco, Brice Autier, Lucien Rakoff, Marie-Fleur Durieux, Clément Danthu, Florent Morio, Clément Deltombe, Alicia Moreno-Sabater, Nacera Ouali, Damien Costa, Dominique Bertrand, Adélaïde Chesnay, Philippe Gatault, Meja Rabodonirina, Emmanuel Morelon, Jérôme Dumortier, Emilie Sitterlé, Anne Scemla, Samia Hamane, Laurène Cachera, Céline Damiani, Coralie Poulain, Coralie L’Ollivier, Valérie Moal, Laurence Delhaes, Hannah Kaminski, Estelle Cateau, Laure Ecotière, Julie Brunet, Sophie Caillard, Stéphane Valot, Claire Tinel, Nicolas Argy, Quentin Raimbourg, Marie Gladys Robert, Johan Noble, Aude Boignard, Françoise Botterel, Marie Matignon, Anne-Pauline Bellanger, Thomas Crépin, Jordan Leroy, Arnaud Lionet, Anne Debourgogne, Muriel Nicolas, Joëlle Claudéon, Maxime Moniot, Céline Lambert, and Céline Nourrisson
- Subjects
solid organ transplant ,nitazoxanide ,microsporidiosis ,Enterocytozoon bieneusi ,infectious diarrhea ,Specialties of internal medicine ,RC581-951 - Abstract
Intestinal microsporidiosis caused by Enterocytozoon bieneusi is an opportunistic infection that especially affects solid organ transplant (SOT) recipients. Management revolves around tapering the immunosuppressive regimen and/or using a specific anti-microsporidia treatment, but only fumagillin has demonstrated efficacy for treatment of this infection. Since fumagillin has been commercially discontinued, nitazoxanide is increasingly being used in this indication. We aimed to describe therapeutic management of E. bieneusi infections in this context. We conducted a French nationwide observational retrospective study on reported cases of E. bieneusi infections in SOT recipients. We identified 154 cases: 64 (41.6%) were managed by simply modifying the immunosuppressive regimen, 54 (35.1%) were given fumagillin, and 36 (23.4%) were given nitazoxanide. Clinical remission rate ranged from 77.8% to 90.7% and was not significantly different between therapeutic strategies but tended to be lower with nitazoxanide. Stool negativization rate was highest with fumagillin (91.7%) and lowest with nitazoxanide (28.6%). Relapses occurred in 6.9% of cases and were more frequent with nitazoxanide (14.3%). This study shows that tapering immunosuppression can result in a satisfactory remission rate but is sometimes accompanied by relapses. Nitazoxanide had limited effectiveness, whereas fumagillin had good results that provide a solid rationale for bringing fumagillin back to market.Trial Registration NumberClinicalTrials.gov ID: NCT05417815.
- Published
- 2024
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