Supplementary Material for: Infection of Enterocytozoon bieneusi in a patient with long-term immunosuppression after liver transplantation: a case report and literature review

Enterocytozoon bieneusi (E.b) can cause opportunistic infections in immunocompromised patients especially HIV/AIDS recipients, but currently there are still few case reports of E.b infections in solid organ transplant recipients. As E.b cannot be diagnosed by routine examination and culture, it is often overlooked as a possible cause of chronic diarrhea in transplant recipients. With no known established guidelines for E.b, the effective and available treatment options are limited. In this article, we reported a case of persistent chronic diarrhea and renal failure due to E.b infection after liver transplantation, which was definitively diagnosed using metagenomic Next Generation Sequencing (mNGS). Short course of Albendazole was applied to the patient, resulting in rapid resolution of clinical symptoms and recovery of renal function. The case demonstrates the advantages of mNGS for the diagnosis of rare pathogenic bacterial infections, and together with the previous case reports further suggests Albendazole may serve as a effective therapy for the treatment of E.b for some patient.This article reviews relevant literature and provides an updated and more comprehensive reference for the selection of E.b treatment drugs. To be note, the overview showed there may be individualized differences in the efficacy of Albendazole, which needs more study.毕氏肠微孢子虫（Enterocytozoon bieneusi，以下简称E.b）可在免疫功能低下人群中引发机会性感染，尤以艾滋病病毒/艾滋病（HIV/AIDS）感染者为甚，但目前实体器官移植受者感染E.b的病例报告仍较为少见。由于E.b无法通过常规检查与培养进行诊断，其常被忽视为移植受者慢性腹泻的潜在病因。目前尚无针对E.b感染的既定诊疗指南，可供选择的有效治疗方案十分有限。 本文报告1例肝移植术后因E.b感染引发持续性慢性腹泻与肾功能衰竭的病例，该病例通过宏基因组二代测序（metagenomic Next Generation Sequencing，mNGS）得以明确诊断。患者接受短疗程阿苯达唑（Albendazole）治疗后，临床症状迅速缓解，肾功能得以恢复。本病例彰显了mNGS在罕见病原菌感染诊断中的优势，结合既往病例报告进一步提示，阿苯达唑或可作为部分E.b感染患者的有效治疗药物。 本文复习了相关文献，为E.b感染的治疗药物选择提供了更新且更全面的参考依据。 需注意的是，本次综述显示阿苯达唑的疗效可能存在个体差异，有待进一步研究。