Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.

Opportunistic Parasites among Immunosuppressed Children in Minia District, Egypt

A total of 450 stool samples were collected from inpatient and outpatient clinics of Pediatric Department, Minia University Hospital, Minia District, Egypt. Two groups of patients were studied, including 200 immunosuppressed and 250 immunocompetent children. Stool samples were subjected to wet saline and iodine mounts. A concentration technique (formol-ether sedimentation method) was carried out for stool samples diagnosed negative by wet saline and iodine mounts. Samples were stained by 2 different methods; acid fast stain (modified Ziehl-Neelsen stain) and Giemsa stain. Total 188 cases (94%) were diagnosed positive for parasitic infections among immunosuppressed children, whereas 150 cases (60%) were positive in immunocompetent children (P<0.0001). The most common protozoan infection in immunosuppressed group was Cryptosporidium parvum (60.2%), followed by Blastocystis hominis (12.1%), Isospora belli (9.7%), and Cyclospora caytenensis (7.8%). On the other hand, Entamoeba histolytica (24.6%) and Giardia lamblia (17.6%) were more common than other protozoans in immunocompetent children.

Infección por Isospora belli en pacientes con infección por VIH: presentación de dos casos y revisión de la literatura / Isospora belli infection in HIV positive patients: report of two cases and literature review

Isosporosis is an infection caused by parasitic protozoa of the genus Isospora, coccidia affecting various different vertebrate species, including humans. It is an uncommon infection in our country and it is not a zoonosis. We present two cases oí Isospora belli infection in HIV positive patients from the Valparaiso region. We discuss the clinical events caused by this agent, its epidemiology, cases published in the local and foreign literature, as well as its treatment and prevention measures.

La isosporosis es una infección parasitaria provocada por protozoos del género Isospora, coccidio que afecta con diversas especies a diferentes vertebrados, entre los que se encuentra el ser humano. Es una infección poco frecuente en nuestro país y no constituye una zoonosis. Se presentan dos casos con infección por Isospora belli en pacientes infectados con el virus de inmunodeficiencia humana procedentes de la Región de Valparaíso. Se analizan las manifestaciones producidas por este agente, la epidemiología de la infección, los casos publicados en la literatura nacional e internacional, así como su tratamiento y las medidas de prevención.

AIDS - associated parasitic diarrhoea.

Since the advent of human immunodeficiency virus infection, with its profound and progressive effect on the cellular immune system, a group of human opportunistic pathogens has come into prominence. Opportunistic parasitic infection can cause severe morbidity and mortality. Because many of these infections are treatable, an early and accurate diagnosis is important. This can be accomplished by a variety of methods such as direct demonstration of parasites and by serological tests to detect antigen and/or specific antibodies. However, antibody response may be poor in these patients and therefore immunodiagnostic tests have to be interpreted with caution. Cryptosporidium parvum , Isospora belli , Cyclospora cayetanensis , Microsporidia, Entamoeba histolytica and Strongyloides stercoralis are the commonly detected parasites. Detection of these parasites will help in proper management of these patients because drugs are available for most of these parasitic infections.

Isosporiasis in HIV/AIDS Patients in Edo State, Nigeria

Background: The role of opportunistic infections in accelerating disease progression in HIV-positive individuals, leading to quick death, is still receiving serious attention. The objective of this study was to determine the prevalence of Isospora belli infections in HIV-positive patients in Edo State, Nigeria between August 2007 and March 2008. Methods: A total of 268 samples from HIV-positive patients and 20 samples from HIV-negative patients were processed using the modified Ziehl-Neelsen staining technique to microscopically identify the presence of I. belli oocysts. Results: The overall prevalence of the coccidian was 3.1%. Gender and age had no correlation with the prevalence of the parasite (P > 0.05). There was a significant relationship between isosporiasis and CD4+ T cell counts in HIV-positive patients (OR=11.388, 95% CI= 2.797–46.371, P=0.0004). Conclusions: Routine investigation of I. belli in HIV-positive subjects is advocated in tertiary health institutions.

Seasonal profile and level of CD4+ lymphocytes in the occurrence of cryptosporidiosis and cystoisosporidiosis in HIV/AIDS patients in the Triângulo Mineiro region, Brazil

Patients with AIDS are particularly susceptible to infection with intestinal coccidia. In this study the prevalence of infections with Cryptosporidium sp and Cystoisospora belli were evaluated among HIV/AIDS patients in the Triângulo Mineiro region, Brazil. Between July 1993 and June 2003 faecal samples from 359 patients were collected and stained by a modified Ziehl-Neelsen method, resulting in 19.7 percent of positivity for coccidian (8.6 percent with Cryptosporidium sp, 10.3 percent with Cystoisospora belli and 0.8 percent with both coccidian). Patients with diarrhoea and T CD4+ lymphocyte levels < 200 cells/mm3 presented higher frequency of these protozoans, demonstrating the opportunistic profile of these infections and its relationship with the immunological status of the individual. It was not possible to determine the influence of HAART, since only 8.5 percent of the patients positive for coccidian received this therapy regularly. Parasitism by Cryptosporidium sp was more frequent between December and February and thus was characterised by a seasonal pattern of infection, which was not observed with Cystoisospora belli.

Pacientes com AIDS são particularmente susceptíveis a infecção por coccídios intestinais e nesse estudo foi avaliada a freqüência de Cryptosporidium sp. e Cystoisospora belli entre pacientes HIV/AIDS na região do Triângulo Mineiro, Brasil. No período de julho de 1993 a junho de 2003, amostras de fezes de 359 pacientes foram submetidas à coloração pelo método de Ziehl-Neelsen modificado, sendo detectada a presença de coccídios em 19,7 por cento destas (8,6 por cento de Cryptosporidium sp, 10,3 por cento de Cystoisospora belli e 0,8 por cento de ambos coccídios). Pacientes com diarréia e níveis de linfócitos T CD4+ < 200 células/mm3 apresentaram maior frequência destes protozoários, demonstrando o perfil oportunista destas infecções e a relação com o status imunológico do indivíduo. Não foi possível determinar a influência da HARRT, pois apenas 8,5 por cento dos pacientes positivos para coccídios fazriam uso regular desta terapia. Parasitismo por Cryptosporidium sp foi mais freqüente no período compreendido de dezembro a fevereiro caracterizando padrão sazonal desta infecção, fato não observado com Cystoisospora belli.

Parasitic infections in HIV-infected patients who visited Seoul National University Hospital during the period 1995-2003

The prevalence of parasitic infections was investigated in human immunodeficiency virus (HIV)-infected patients (n = 105) who visited Seoul National University Hospital, Seoul, Korea, during the period from 1995 to 2003. Fecal samples were collected from 67 patients for intestinal parasite examinations, and sputum or bronchoalveolar lavage samples from 60 patients for examination of Pneumocystis carinii. Both samples were obtained from 22 patients. Thirty-three (31.4%) of the 105 were found to have parasitic infections; Cryptosporidium parvum (10.5%; 7/67), Isospora belli (7.5%; 5/67), Clonorchis sinensis (3.0%; 2/67), Giardia lamblia (1.5%; 1/67), Gymnophalloides seoi (1.5%; 1/67), and Pneumocystis carinii (28.3%; 17/60). The hospital records of the 11 intestinal parasite-infected patients showed that all suffered from diarrhea. This study shows that parasitic infections are important clinical complications in HIV-infected patients in the Republic of Korea.

Isospora belli infection associated with chronic cholecystitis and sclerosing cholangitis in immuncompetent host : A case report.

Isospora belli (I. belli) is a spore-forming protozoa that primarily infects enterocyte. The clinical manifestation may very from asmptomatic to self-limited diarrhea in healthy persons. Rarely, in the normal hosts,5 chronic persistent or intermittent symptom may continue for many years.1,2 Treatment with cotrimoxazole is usually effective in both normal patients19 and patients with AIDS20,21 Nevertheless, relapse is common and is believed to be associated with the presence of extraintestinal infection.3,4,17 Few cases of extraintestinal I. belli infection have been documented in patients with AIDS,3-5 and one case in an immuncompetent patient.24 This report presents a unique case of isosporiasis in a 58-year-old anti-HIV negative Thai female suffering from chronic recurrent diarrhea due to I. belli, despite two episodes of complete 4-week cotrimoxazole and another course of nitazoxanide. Abdominal computer tomographic examination and ultrasonography identified sclerosing cholangitis and chronic cholecstitis. Histologic examination of the cholecystectomy specimen recovered schizonts and merozoites in the parasitophorous vacuoles located in gallbladder epithelium.

Freguência de cryptosporidium sp e Isospora belli em pacientes soropositivos para o HIV na regiäo de Ribeiräo Preto, SP - Brasil / Freguency of cryptosporidium sp and Isospora belli in HIV - seropositive patients in the region of Ribeiräo Preto, SP, Brazil

Entre os patógenos entéricos que acometem os pacientes portadores vírus da imunodeficiência humana (HIV) estäo os protozoários oportunistas Cryptosporidium sp e Isospora belli. O objetivo de estudo é avaliar a frequência de criptosporodiose e isosporíase em pacientes soropositivos para o HIV na região de Ribeirão Preto. Entre julho de 1990 a junho de 1997, foram examinados no Instituto Adolfo Lutz de Ribeirão Preto 3.340 amostras de fezes de 1.833 pacientes sintomáticos ou não, com idade entre 10 meses e 55 anos, atendidos nos Ambulatórios de DST/AIDS do município. A frequência destes protozoários nas amostras de fezes foi 9,3(por cento). Foi observado que 207, 11,3(por cento) dos pacientes estavam parasitados, sendo que cryptosporidium sp foi encontrado em 117, 6,4(por cento) pacientes e Isospora belli em 81, 4,4(por cento). Infecção concomitante por ambos parasitas ocorreu em 09, 05(por cento) dos pacientes. (AU)

Among the enteric pathogens that attack patients with the human immunodeficiency vírus (HIV) are opportunistic protozoans Cryptosporidium spp and Isospora belli . The purpose of this investigation was to establish the frequency of cryptosporidiosis and isosporidiosis in HIV seropositives patients in Ribeir"o Preto region. From July 1990 to June 1997 in Adolfo Lutz Institute ñ Ribeir"o Preto,3340 stool samples were examined from 1833 symptomatic and asymptomatic patients, with ages ranging between 10 months and 55 years, attended in Ribeir"o Preto AIDS Outpatient Departaments. The frequency of these protozoans among all the examined stool samples was 9,3%. We observed 207 (11,3%) patients with these parasites. Cryptosporidium spp was identified in 117 (6,4%) patients, Isospora belli in 81(4,4%) and 09 (0,5%) patients were infected by both parasites. (AU)

Identificação de Cryptosporidium e Isospora belli em pacientes HIV positivo com diarréia / Identification of Creyptosporidium and Isospora belli in patients HIV positive with diarrhoea

Foram analisadas 1.500 amostras de fezes de pacientes HIV positivo adultos de ambos os sexos, internados no hospital São José, no período de agosto de 1997 a fevereiro de 1998. As amostras foram encaminhadas ao laboratório central (LACEN) de saúde pública para realização dos exames. Oocistos de Cryptosporidium sp e Isospora belli fora encontrados em 180 (12%) e 300 (20%) amostras de fezes, respectivamente após prévia concentração do material pela técnica de sedimentação em formol-éter e posterior coloração dos esfregaços pelo carbol-fucsina. Em nenhuma amostra foi observada a presença de Cryptosporidium parvum e Isospora belli em concomitância. Entretanto foram identificados Strongyloides stercoralis, Giardia lamblia, Entamoeba coli e Entaboema histolytica em concomitância com o Cryptosporidium ou Isospora belli. Nesse estudo observamos a presença dos coccidios em apenas 32% dos pacientes HIV positivo com diarréia, sugerindo que esses coccidios não são os únicos agentes patogênicos responsáveis pela diarréia.

Isospora belli infection in children, a third occurrence in Thailand.

Two cases of Isospora belli infection were found in stool examinations of 222 children of the gpvernment orphanage in Pagkred District, Nonthaburi Province. The authors collected 222 faecal specimens in September 1985 to study about the intestional parasitic infection in these children. The stool specimens were examined by fresh simple saline smear technique and were confirmed by iodine preparation. The rate of overall intestinal parasitic infection (both helminthes and protozoa) was 53.15% and the rate of Isospora belli infection was 0.9%. This is the third occurrence of human isosporiasis belli in Thailand.