Intestinal coccidian: an overview epidemiologic worldwide and Colombia / Coccidias Intestinales: Panorama epidemiológico mundial y en Colombia

Intestinal coccidia have been classified as protozoa of the Apicomplex phylum, with the presence of an intracellular behavior and adaptation to the habit of the intestinal mucosa, related to several parasites that can cause enteric infections in humans, generating especially complications in immunocompetent patients and opportunistic infections in immunosuppressed patients. Alterations such as HIV/AIDS, cancer and immunosuppression. Cryptosporidium spp., Cyclospora cayetanensis and Cystoisospora belli are frequently found in the species. Multiple cases have been reported in which their parasitic organisms are associated with varying degrees of infections in the host, generally characterized by gastrointestinal clinical manifestations that can be observed with diarrhea, vomiting, abdominal cramps, malaise and severe dehydration. Therefore, in this review a specific study of epidemiology has been conducted in relation to its distribution throughout the world and in Colombia, especially, global and national reports about the association of coccidia informed with HIV/AIDS. Proposed revision considering the needs of a consolidated study in parasitology, establishing clarifications from the transmission mechanisms, global and national epidemiological situation, impact at a clinical level related to immunocompetent and immunocompromised individuals, as well as a focus on public health in institutional government policies and scientific information based on the characterization of coccidia in the tropical region and Colombia.

Los coccidios intestinales se han clasificado como protozoos del Apicomplexa phylum, con presencia de un comportamiento intracelular y adaptación al hábito de la mucosa intestinal, relacionado con varios parásitos que pueden causar infecciones entéricas en los humanos, generando especialmente complicaciones en pacientes inmunocompetentes e infecciones oportunistas en pacientes inmunodeprimidos. Alteraciones como el VIH/SIDA, cáncer e inmunosupresión con tratamientos farmacológicos. En las especies que se encuentran frecuentemente se encuentran Cryptosporidium spp., Cyclospora cayetanensis y Cystoisospora belli. Se han reportado múltiples casos en los que sus organismos parásitos se asocian a diversos grados de infecciones en el huésped, generalmente caracterizadas por manifestaciones clínicas gastrointestinales que pueden observarse con diarrea, vómitos, calambres abdominales, malestar general y deshidratación severa. Por lo tanto, en esta revisión se ha realizado un estudio específico de epidemiología con relación a su distribución en todo el mundo y en Colombia, especialmente, reportes a nivel global y nacional a cerca de la asociación de coccidios informados con el VIH/SIDA. Revisión propuesta con el objetivo de considerar las necesidades de un estudio consolidado a nivel del campo de la parasitología, evidenciando literatura actualizada, estableciendo información de los mecanismos de transmisión, situación epidemiológica global y nacional, impacto a nivel clínico relacionadas con individuos inmunocompetentes e inmunocomprometidos, así como un enfoque en salud pública en políticas gubernamentales institucionales y la información científica basada en la caracterización de coccidias en la región tropical y principalmente en Colombia.

Diversity of enteric coccidia in pigs from the Paraíba Semiarid Region of Northeastern Brazil / Diversidade de coccídios entéricos em suínos no Semiárido Paraibano, Nordeste do Brasil

Abstract There is great diversity in swine coccidia, which are responsible for causing intestinal disorders ranging from sporadic diarrhea to severe cases of hemorrhagic enteritis. Thus, determining the species of coccidia that affect the animals of a region and associating them with the characteristics of the farms become extremely important. The objective of this study was to determine the prevalence of coccidia parasites in pigs reared in a family farming production system in the Semiarid Region of the State of Paraíba, Northeast Brazil. Fecal samples for analysis were collected from 187 pigs on 51 farms. For morphological analysis, 1,590 sporulated oocysts were used. The prevalence of oocysts in fecal samples was 56.6% (106/187). The most prevalent species were Eimeria suis (21.9%), followed by Eimeria neodebliecki (16.6%), Eimeria perminuta (14.9%), Eimeria polita (12.8%), Eimeria debliecki (10.6%), Eimeria porci (10.1%), Cystoisospora suis (3.7%), Eimeria scabra (1.6%) and Eimeria cerdonis (0.5%). It can be concluded that pigs from the Semiarid Region of the State of Paraíba were parasitized by a diversity of coccidia species, mainly of the genus Eimeria, and predominantly presented with mixed infections occurring in the subclinical form.

Resumo Há uma grande diversidade de coccídios que parasitam os suínos, sendo responsáveis por causarem desordens intestinais que variam de diarreias esporádicas a casos severos de enterites hemorrágicas. Assim, determinar as espécies de coccídios que afetam os animais de uma região e associá-los com as características das fazendas torna-se extremamente importante. Objetivou-se determinar a prevalência de coccídios em suínos criados em sistema de produção de agricultura familiar no Semiárido da Paraíba, Nordeste do Brasil. Foram analisados oocistos íntegros e esporulados no período de março a setembro de 2018, oriundos de 187 suínos, em 51 propriedades. Para a análise morfológica foram utilizados 1.590 oocistos esporulados. A prevalência de oocistos de coccídios foi detectada em 56,6% (106/187) das amostras analisadas. A espécie mais prevalente foi Eimeria suis (21,9%), seguida por Eimeria neodebliecki (16,6%), Eimeria perminuta (14,9%), Eimeria polita (12,8%), Eimeria debliecki (10,6%), Eimeria porci (10,1%), Cystoisospora suis (3,7%), Eimeria scabra (1,6%) e Eimeria cerdonis (0,5%). Concluiu-se que os suínos do Semiárido da Paraíba estavam parasitados por uma alta diversidade de espécies de coccídios, principalmente do gênero Eimeria, apresentando predominantemente infeções mistas, que ocorrem sob a forma subclínica.

Frecuencia y etiología de la enteroparasitosis en pacientes con virus inmunodeficiencia humana en un hospital de Lambayeque, Perú / Frequency and etiology of enteroparasitosis in patients with human immunodeficiency virus at a hospital of Lambayeque, Peru

RESUMEN Introducción: A pesar de terapia antiretroviral aún es común encontrar la presencia de infecciones oportunistas, tales como enteroparásitos que causan un gran impacto en salud y economía de los pacientes. Objetivos: Determinar la frecuencia, etiología y factores asociados a las enteroparasitosis en pacientes con VIH, en un hospital referencial de Lambayeque, Perú. Material y Métodos: Se realizó un estudio prospectivo tipo observacional en pacientes diarreicos con infección por VIH de un hospital de Lambayeque desde enero a junio del 2016. Tanto la recolección y transporte, como el análisis de las muestras siguieron las recomendaciones del Manual de procedimientos para el diagnóstico de las parasitosis humanas del Instituto Nacional de Salud. Resultados: La mediana de edad fue 28 años, predominó el sexo masculino y el porcentaje de parasitismo fue de 73,08%. Pacientes con carga viral > 1000 fueron 69,2% y pacientes en TARGA fueron 55,8%. Blastocystis hominis fue el parásito más frecuente (30,77%), seguida de Cryptosporidium spp. y Cystoisospora belli con el 21,2% y 11,5% respectivamente. El análisis bivariado entre carga viral y TARGA con parasitismo, demostró asociación con el parasitismo. Conclusiones: La enteroparasitosis es frecuente en pacientes con VIH y diarrea, predominando las infecciones oportunistas por encima de las no oportunistas.

ABSTRACT Introduction: Despite antiretroviral therapy, it is still common to find the presence of opportunistic infections such as enteroparasites, which cause a big impact on the health and economy of patients. Objetive: To determine the frequency, etiology and factors associated with enteroparasitosis in patients with HIV at a reference hospital in Lambayeque, Peru. Material and Methods: A prospective observational study was conducted in diarrheic patients with HIV infection in a hospital in Lambayeque from January to June, 2016. The study was a census. Both the collection and transport as well as the analysis of the samples followed the recommendations of the Manual of procedures for the diagnosis of human parasitosis of the National Institute of Health. Results: The meadian age was 28 years, the male sex predominated, and the percentage of parasitism was 73.08%. Patients with viral load >1000 were 69.2% and patients with HAART were 55.8%. Blastocystis hominis was the most frequent parasite (30.77%), followed by Cryptosporidium spp. and Cystoisospora belli with 21.2% and 11.5%, respectively. The bivariate analysis between viral load and HAART with parasitism, demonstrated an association with parasitism. Conclusions: Enteroparasitosis is frequent in patients with HIV and diarrhea, predominating opportunistic infections over non opportunistic ones.

Chronic Cystoisospora belli infection in an HIV/AIDS patient treated at the specialized assistance service in Porto Velho County - Rondônia

Abstract Cystoisospora belli infection manifests as diarrhea, and can potentially progress to malabsorption in HIV patients. Here, we report a case of C. belli infection in an HIV/AIDS patient with chronic diarrhea symptoms for at least 2 years. Coproscopic analyses based on direct technique and modified Ziehl-Neelsen technique without a commercial kit were performed. The current case report highlights the protocol to be adopted in coproscopic analyses applied to HIV patients. The importance of including the appropriate parasitological testing of patients with chronic intestinal isosporiasis in parasitological test routines must be considered.

A road less travelled: Clinical comparison of HIV seropositive and seronegative patients with cystoisosporiasis � An 11-year experience from a tertiary care centre in Northern India

Background: Cystoisospora is a well-known opportunistic enteric parasite among human immunodeficiency virus (HIV) seropositive patients but there is a paucity of data among HIV negative patients. This study investigated Cystosporiasis on both HIV positive and negative patients, with or without diarrhea, presenting to a tertiary care and super specialty center of northern India. Methodology: Oocysts of Cystoisospora were detected on light microscopy, by modified Kinyoun staining of stool specimens, over an 11-year study period. Results: Of the 10,233 stool specimens evaluated, Cystoisospora was detected in 64 patients, 37 (57.81%) of whom were HIV positive. Year-wise analysis showed an overall declining trend of cystoisosporiasis. Maximum cases were detected in May and June in HIV positive patients and February and September among HIV negative patients. Among HIV positive patients, the mean CD4 count was 152.04 � 81.12cells/?L, mean absolute eosinophil count (AEC) was 229.16 � 175.62 cells/?L and 12.5% patients had mild eosinophilia. Tuberculosis was the most common co-morbidity. Dual infections of Cystoisospora with Cryptosporidium and Giardia were also seen. Among HIV negative patients, eight had primary autoimmune disorders, seven were solid organ transplant recipients and the rest had chronic bowel diseases. The mean AEC was 485.47 � 414.88 cells/?L, with 14.81% patients showing mild and 11.11% showing marked eosinophilia. Dual infection with Giardia was seen. Recurrent cystoisosporiasis was noted, despite cotrimoxazole treatment in a single case. Conclusion: The epidemiology of cystoisosporiasis differs between HIV seropositive and seronegative patients in terms of year-wise and month-wise trends, co-infections and most importantly, AECs.

Presentación inusual de infección por HTLV-1: una caja de pandora de infecciones oportunistas / An unusual presentation of HTLV-1 infection: a pandora box of opportunist infections

HTLV-1 es un retrovirus endémico en Perú, relacionado ocasionalmente con algunas infecciones oportunistas aisladas. Presentamos el caso de un varón de 41 años, avicultor, con antecedente de TBC pulmonar tratado hace 6 meses. Ingresó a emergencia por presentar alteración de conciencia, disartria y diarrea acuosa. Al examen físico se evidenciaron placas confluentes en cavidad oral, lesiones máculo-papulares violáceas y placas costrosas; por biopsia de piel se confirmó sarcoma de Kaposi y sarna costrosa, además adenopatías cervicales que al estudio microscópico con test de Auramina mostró BAAR (++) y en el examen de heces con tinción Zielh Nielsen modificado, se evidenció ooquiste de Cystoisospora belli. Recibió trimetropin / sulfametozaxol, tratamiento antituberculoso. Se confirmó HTLV-1 por inmunofluorescencia. En el fondo de ojo se observó retinitis por citomegalovirus, recibió ganciclovir. A las tres semanas del ingreso hospitalario, falleció por insuficiencia respiratoria severa. Se discute la presencia de múltiples co-infecciones oportunistas en un paciente con inmunosupresión por HTLV-1.

HTLV-1 is an endemic retrovirus in Peru , occasionally associated with some isolated opportunistic infections. We present the case of a 41-year-old male poultry farmer with a history of pulmonary tuberculosis treated 6 months ago. He was admitted to emergency due to alteration of conscience, dysarthria and watery diarrhea; the examination revealed confluent plaques in the oral cavity, violaceous maculopapular lesions and crusted plaques. Skin biopsy confirmed Kaposi's sarcoma and crusted scabies; in addition, cervical lymphadenopathies showed evidence of BAAR (++) in the microscopic study with Auramine test, and in the examination of feces with modified Zielh Nielsen's stain, Cystoisospora belli oocyst was observed, and trimetropin / sulfametozaxol received antituberculous treatment. HTLV-1 was confirmed by immunofluorescence. In the fundus of the eye cytomegalovirus retinitis was evidenced, he received ganciclovir. At three weeks of hospital admission he died due to severe respiratory failure. We discuss the presence of multiple opportunistic co-infections in a patient with immunosuppression by HTLV-1.

Aspectos epidemiológicos de coccidiosis intestinales en comunidad rural de la Península de Paraguaná, estado Falcón, Venezuela / Epidemiological aspects of intestinal coccidiosis in a rural community of Paraguaná peninsula, Falcon state, Venezuela

Resumen Introducción: Las coccidiosis intestinales ocasionadas por Cryptosporidium, Cystoisospora belli y entre abril- junio de 2015, se realizó un estudio prospectivo, descriptivo y transversal para Cyclospora cayetanensis constituyen patologías parasitarias de alta relevancia en la Salud Pública. Objetivo: Determinar la prevalencia y parámetros epidemiológicos de coccidiosis intestinales en 188 habitantes de "El Hato", Estado Falcón, Venezuela. Metodología: Para la identificación de los probables factores de riesgos asociados a las coccidiosis intestinales se usó una ficha encuesta-epidemiológica. El diagnóstico parasitológico se realizó con el método directo y la coloración de Kinyoun. Resultados: La prevalencia global de parasitosis intestinales fue 64,36%, siendo Blastocystis spp. el taxón más frecuentemente observado (39,89%). La prevalencia de coccidios intestinales fue 37,23%, observándose prevalencias de 32,98% para Cyclospora cayetanensis, 26,60% para Cryptosporidium spp. y 3,19% para Cystoisospora belli. Con la aplicación del análisis de regresión logística múltiple se determinó como potenciales factores de riesgo independientes significativamente involucrados en la transmisión de las entero-coccidiosis: lavado inadecuado de manos [Odds Ratio (OR) = 1,89], el consumo de "comidas rápidas" (OR=1,26), empleo del agua más frecuentemente para aseo personal y lavado de vestimentas (OR=2,88), tener un nivel socio-económico bajo (nivel IV/V-Graffar) (OR=1,41), nivel de instrucción de la madre (primaria/secundaria) (OR=0,53), que se realice limpieza del hogar interdiario (OR=2,95), y que se posea animales (OR=2,06). Conclusiones: Los hallazgos de esta investigación muestran que las infecciones ocasionadas por los coccidios intestinales aun representan un problema de salud pública en las áreas rurales de Venezuela.

Abstract Introduction: Intestinal coccidioses caused by Cryptosporidium sp., Cystoisospora belli and Cyclospora cayetanensis are parasitic diseases of major clinical importance in Public Health. Objective: Between April to June 2015, a prospective, descriptive and cross-sectional survey was designed to determine the prevalence and epidemiological profiles of intestinal coccidioses in 188 inhabitants of "El Hato", Falcon State, Venezuela. Methods: Probable risk factors for intestinal coccidioses were identified by using epidemiological questionnaires. The diagnosis of coccidian infection was made by direct wet-mounting and Kinyoun staining. Results: The overall prevalence of intestinal parasitosis was 64.36%, and Blastocystis spp. was the most prevalent taxa (39.89%). Enterococcidioses prevalence was 37.23%, detecting prevalence values of 32.98% for Cyclospora cayetanensis, 26.60% for Cryptosporidium spp. and 3.19% for Cystoisospora belli. Multiple logistic regression analysis allowed us to determine as independent potential risk factors for transmission of these enterococciodioses: inappropriate hand washing [Odds Ratio (OR) = 1.89], fast food consumption (OR=1.26), major use of water for personal and clothes washing (OR=2.88), low socio-economic status (level IV/V-Graffar) (OR=1.41), mother's educational status (primary/secondary school) (OR=0.53), non-daily home cleaning (OR=2.95), and keeping domestic animals (OR=2.06). Conclusions: Findings of this study showed that infections caused by intestinal coccidian infections are still remains as a serious health problem in rural areas of Venezuela.

Identification of Cystoisospora ohioensis in a Diarrheal Dog in Korea

A 3-month-old female Maltese puppy was hospitalized with persistent diarrhea in a local veterinary clinic. Blood chemistry and hematology profile were analyzed and fecal smear was examined. Diarrheal stools were examined in a diagnostic laboratory, using multiplex real-time polymerase chain reaction (PCR) against 23 diarrheal pathogens. Sequence analysis was performed using nested PCR amplicon of 18S ribosomal RNA. Coccidian oocysts were identified in the fecal smear. Although multiplex real-time PCR was positive for Cyclospora cayetanensis, the final diagnosis was Cystoisospora ohioensis infection, confirmed by phylogenetic analysis of 18S rRNA. To our knowledge, this the first case report of C. ohioensis in Korea, using microscopic examination and phylogenetic analysis.

FACTORES DE RIESGO ASOCIADOS A LA INFECCIÓN POR Cystoisospora suis EN GRANJAS PORCINAS DE LA REGIÓN CENTRAL DE VENEZUELA / RISK FACTORS ASSOCIATED WITH Cystoisospora suis INFECTION IN SWINE HERDS OF THE CENTRAL REGION OF VENEZUELA

Se condujo una investigación en Venezuela con la finalidad de conocer algunos aspectos epidemiológicos sobre la presencia de Cystoisospora suis en 67 granjas porcinas intensivas. Para la determinación de la carga parasitaria se seleccionaron 572 camadas con signos de diarrea, así como 1.712 muestras fecales de cerdos adultos. Las muestras se cultivaron en dicromato de potasio al 2,5% y posteriormente se procesaron mediante una técnica copro-parasitológica. Además, en cada granja se aplicó una encuesta epidemiológica. El protozoario se encontró en 55 granjas (82,1%) y 210 camadas (36,7%). Al referirlo a camadas, se observaron ooquistes en lechones menores de tres días de edad, lo que podría indicar la existencia de rutas alternativas de la infección. En cerdos adultos se encontró correlación significativa (rho = 0,35; P < 0,05) entre la excreción de ooquistes en lechones y en madres, lo que sugiere que estas podrían actuar como fuentes de infección. Se constató correlación entre el número de partos de la cerda y la prevalencia en camadas y cerdas lactantes (P < 0,05), pues, a mayor número de partos, disminuye la prevalencia. Probablemente estos hallazgos están asociados con mecanismos inmunológicos desconocidos. El tamaño de la granja no afectó la presencia del parásito; sin embargo, las granjas con pisos plásticos mostraron mayor control de la infección. Se concluye que algunos mecanismos inmunológicos, aún sin dilucidar, podrían estar involucrados en la cadena de transmisión del protozoario, los cuales podrían jugar un papel importante en el desarrollo de la cystoisosporosis porcina.

It was carried out an investigation in Venezuela with the aim of studying the epidemiological aspects of Cystoisospora suis in intensive swine herds. Sixty-seven intensive swine herds were included. For parasite determination 572 litters with signs of diarrhea, as well as 1,712 faecal samples from mature pigs were selected. Stool samples were cultured in a 2.5% potassium dichromate solution and later processed by copro-parasitological technique. Epidemiological surveys were applied on each farm. The results indicated that C. suis was observed in 55 herds (82.1%) and 210 litters (36.7%). Regarding to litters, oocysts were observed in piglets less than three days of life, which could indicate the existence of alternative infection way. Regarding to mature pigs, there was a significant correlation (rho = 0.35; P < 0.05) among oocysts excretion in piglets and sows, suggesting that sows may act as infection sources. Sows parity was statistically correlated with the prevalence values in litters as in lactating sows (P < 0.05). This might indicate that as parity increase, prevalence decreases in these groups. Probably, these findings are associated with unknown immunologic mechanisms. The herd size did not affect the presence of the parasite, however, farms with plastic floors showed greater control of the infection. It is concluded that non elucidated immunologic mechanisms might be involved in the protozoa transmission cycle and play an important role in the development of porcine cystoisosporosis.

PREVALENCIA DE Cystoisospora suis EN GRANJAS PORCINAS INTENSIVAS DE LA REGIÓN CENTRAL DE VENEZUELA / PREVALENCE OF Cystoisospora suis IN SWINE INTENSIVE HERDS AT THE CENTRAL REGION OF VENEZUELA

Entre enero y junio de 2014 se condujo una investigación en la región central de Venezuela con la finalidad de determinar la prevalencia del enterococcidio Cystoisospora suis en granjas porcinas intensivas. Para la determinación parasitaria se seleccionaron 572 camadas con signos de diarrea, así como 1.712 muestras fecales de cerdos adultos. Todas las muestras se cultivaron en dicromato de potasio al 2,5% y posteriormente se procesaron mediante una técnica coproparasitológica. Los resultados señalan que C. suis se encontró en 55 granjas (82,1%) y 210 camadas (36,7%), con los mayores valores de prevalencia en las dos primeras semanas de vida (P < 0,05). Al referir los resultados en cerdos adultos se encontró correlación significativa (rho = 0,35; P < 0,05) entre excreción de ooquistes en lechones y madres, lo que sugiere que cerdas madres podrían actuar como fuentes de infección. Se encontró correlación entre el número de partos de la cerda y los valores de prevalencia en camadas y cerdas lactantes (P < 0,05) lo que indica que, a mayor número de partos, disminuye la prevalencia. Probablemente estos hallazgos se asocian con mecanismos inmunológicos desconocidos. Se concluye que C. suis se encuentra ampliamente distribuido en Venezuela y que el enterococcidio puede ser controlado mejorando las condiciones higiénicas de las granjas; sin embargo, hay mecanismos inmunológicos aún sin dilucidar que podrían incidir en la cadena de transmisión del protozoario.

It was carried out an investigation at the central region of Venezuela from January to June 2014 with the aim to determine the prevalence of coccidian Cystoisospora suis in intensive swine herds. For parasitic determination 572 litters were selected with signs of diarrhea. Likewise, 1.712 fecal samples were also collected in mature pigs. Stool samples were cultured in a 2.5% potassium dichromate solution and later processed by coprological technique. The results of this investigation indicated that C. suis was observed in 55 herds (82.1%) and 210 litters (36.7%) with the highest prevalence values in first two weeks of age (P < 0.05). Regarding to mature pigs, there was a significant correlation (rho = 0.35; P < 0.05) among oocysts excretion in piglets and sows, suggesting that sows may act as infection sources. Sows parity was statistically correlated with the prevalence values in litters as in lactating sows (P < 0.05). This might indicate that as parity increase, prevalence decreases in these groups. Probably these findings are associated with unknown immunologic mechanisms. It is concluding that C. suis is broadly distributed in Venezuela and it could be controlled by improving conditions sanitary herd, however, non elucidated immunologic mechanisms might be involved in the protozoa transmission cycle.

Genotypic Identification of Cystoisospora in Immunocompromised Patients Using T(m)-Variation Analysis

Cystoisospora is responsible for morbidity in immunocompromised patients. PCR is sensitive for diagnosing Cystoisospora; however, it needs reevaluation for differential molecular diagnosis of cystoisosporiasis. We aimed at evaluating melting curve analysis (MCA) after real-time PCR (qPCR) in diagnosis and genotyping of Cystoisospora as an alternative to conventional PCR. We included 293 diarrheic stool samples of patients attending the Department of Clinical Oncology and Nuclear Medicine of Cairo University Hospitals, Egypt. Samples were subjected to microscopy, nested PCR (nPCR), and qPCR targeting the internal transcribed spacer 2 region (ITS2) of the ribosomal RNA (r RNA) gene followed by melting temperatures (T(m)s) analysis and comparing the results to PCR-RFLP banding patterns. Using microscopy and ITS2-nPCR, 3.1% and 5.8% of cases were Cystoisospora positive, respectively, while 10.9% were positive using qPCR. Genotyping of Cystoisospora by qPCR-MCA revealed 2 genotypes. These genotypes matched with 2 distinct melting peaks with specified T(m)s at 85.8°C and 88.6°C, which indicated genetic variation among Cystoisospora isolates in Egypt. Genotype II proved to be more prevalent (65.6%). HIV-related Kaposi sarcoma and leukemic patients harbored both genotypes with a tendency to genotype II. Genotype I was more prevalent in lymphomas and mammary gland tumors while colorectal and hepatocellular tumors harbored genotype II suggesting that this genotype might be responsible for the development of cystoisosporiasis in immunocompromised patients. Direct reliable identification and differentiation of Cystoisospora species could be established using qPCR-T(m)s analysis which is useful for rapid detection and screening of Cystoisospora genotypes principally in high risk groups.

Isosporiasis in a tertiary care center of North India.

Background: Cystoisospora (Isospora) belli is a coccidian, protozoan parasite that resides in the gastrointestinal tract of humans. It is mainly reported from HIV-positive individuals. However, a few cases have been reported in other immunosuppressed individuals including renal transplant patients, and those with lymphoma and leukemia. Materials and Methods: During a period of 5 years (2008-2012), approximately 1700 stool samples of immunosuppressed patients were screened for the presence of opportunistic parasitic infections by a modifi ed acid fast staining technique. Results: A total of 41 C. belli were reported, out of which 30 were HIV-positive individuals while 11 were HIV negative. The latter individuals were also immunosuppressed due to prolonged use of steroids or other immunosuppressive drugs. Twenty-six out of 30 HIVpositive patients and all the HIV-negative individuals with C. belli infection had diarrhea. Conclusion: All immunosuppressed individuals should be examined for the presence of opportunistic coccidian parasitic infections and treated accordingly and alternatively, isolation of opportunistic parasites should trigger a hunt for immunocompromised state to reduce the morbidity and mortality in such patients.

Prevalence and genetic characterization of Cryptosporidium spp. and Cystoisospora belli in HIV-infected patients / Prevalência e caracterização genética de Cryptosporidium spp. e Cystoisospora belli em pacientes infectados pelo HIV

Cryptosporidium spp. and Cystoisospora belli are monoxenic protozoa that have been recognized as the causative agents of chronic diarrhea in immunocompromised individuals, especially HIV-infected subjects. The objective of this study was to evaluate the frequency of these intestinal protozoa in HIV-positive patients in the Triângulo Mineiro region of Brazil and to correlate the presence of these infections with clinical, epidemiological and laboratory data of the patients. Oocysts were detected in stool samples of 10 (16.9%) of the 59 patients studied, while Cryptosporidium spp. were present in 10.1% (6/59) and C. belli in 6.7% (4/59). The frequency of these parasites was higher among patients with diarrheic syndrome and CD4+ T lymphocyte counts < 200 cells/mm 3 , demonstrating the opportunistic characteristic of these infections. A significant association was observed between the lack of adherence to antiretroviral therapy and the presence of Cryptosporidium spp. and/or C. belli. Parasitism with Cryptosporidium spp. was more frequent in February and April, the months following the period of high rainfall. The same was not observed for C. belli. Genetic characterization of two isolates led to the identification of Cryptosporidium parvum, one of the main species associated with the zoonotic transmission of cryptosporidiosis.

Cryptosporidium spp. e Cystoisospora belli são protozoários monoxenos reconhecidos como agentes causadores de diarréia crônica em indivíduos imunocomprometidos, especialmente aqueles infectados pelo HIV. Os objetivos deste estudo foram o de avaliar a frequência destes protozoários em pacientes HIV - positivos na região do Triângulo Mineiro, Brasil, e correlacionar a presença destas infecções com dados clínicos, epidemiológicos e laboratoriais dos pacientes. Oocistos foram detectados em amostras fecais de 10 (16,9%) dos 59 pacientes estudados, sendo 10.1% (6/59) das amostras positivas para Cryptosporidium spp. e 6,7% (4/59) das amostras positivas para C. belli. A frequência destes parasitos foi maior entre pacientes com síndrome diarreica e contagem de linfócitos T CD4+ < 200 cells/mm 3 , o que demonstra o caráter oportunista destas infecções. Foi observada uma associação significativa entre a falta de aderência à terapia antiretroviral e a presença de Cryptosporidium spp. e/ou C. belli. Parasitismo por Cryptosporidium spp. foi mais frequente em fevereiro e abril, meses subsequentes ao período chuvoso. O mesmo não foi observado para C. belli. A caracterização genética de dois isolados levou à identificação de Cryptosporidium parvum, uma das principais espécies associadas com a transmissão zoonótica da criptosporidiose.

Severe diarrhoea due to Cystoisospora belli in renal transplant patient on Immunosuppressive drugs.

Cystoisospora belli , formerly known as Isospora belli, protozoal parasite endemic to many regions of the world including the Caribbean, Central and South America, Africa, and South-East Asia. It is frequently encountered in patients with acquired immunodeficiency syndrome (AIDS) and is considered to be an AIDS-defining illness. Chronic severe watery diarrhoea due to C. belli has also been reported in other immunodeficiency states. C. belli infection in immunosuppressed patients has rarely been described. We describe severe diarrhoea due to C. belli in a human immunodeficiency virus-negative renal transplant recipient on immunosuppressive drugs. Oocysts of C. belli were detected in direct smear preparation of the diarrheic stool sample of the patient. The patient responded to combination treatment with Bactrim-double-strength (trimethoprim-sulfamethoxazole) and Nitazoxanide.

Compromised nutrition in gerbils infected by Cystoisospora felis detected through an animal performance analysis tool / Comprometimento nutricional em gerbis infectados por Cystoisospora felis detectado através de uma ferramenta de análise de desempenho animal

The impact of Cystoisospora felis infection on the nutritional efficiency of gerbils was studied. The variables weight gain and feed intake were measured during four weeks in 28 laboratory gerbils, of which 14 were inoculated with 3.5 × 10(5) sporulated oocysts of C. felis and the remaining 14 were controls. The animals from both groups were weighted, killed, eviscerated and had their carcasses and tissues weighted and compared. A modern tool designed for measuring nutritional performance of farm animals was applied. The results showed compromised nutritional efficiency of the infected animals within the first week after infection. The consequences of these results are discussed here, including the potential impact of infection on farm animals performance.

O impacto da infecção por Cystoisospora felis na eficiência nutricional de gerbis foi estudado. As variáveis ganho de peso e consumo de ração foram mensuradas durante quatro semanas em 28 gerbis de laboratório, dos quais 14 foram inoculados com 3,5 × 10(5) oocistos esporulados de C. felis e os 14 restantes serviram como controle. Os animais de ambos os grupos foram pesados, mortos, eviscerados e tiveram suas carcaças e tecidos pesados e comparados. Uma ferramenta moderna desenvolvida para mensurar o desempenho nutricional de animais de produção foi aplicada. Os resultados mostraram eficiência nutricional comprometida dos animais infectados na primeira semana após a infecção. As consequências destes resultados são discutidas aqui, incluindo o possível impacto de infecção no desempenho de animais de produção.

Pleomorfismo de oocistos de Cystoisospora felis (Wenyon, 1923) Frenkel, 1977 (Apicomplexa: Cystoisosporinae) induzido por differentes fontes de infecção / Pleomorfism of Cystoisospora felis (Wenyon, 1923) Frenkel, 1977 (Apicomplexa: Cystoisosporinae) oocysts induced by different sources of infection

Com o objetivo de avaliar as diferenças morfométricas dos oocistos esporulados de Cystoisospora felis oriundos de diferentesfontes de infecção: natural em gatos peri-domiciliados, experimental induzida por oocistos esporulados e experimental induzidapor hipnozoítas em vísceras de camundongos pré-inoculados por via oral com 106 oocistos esporulados de C. felis, foramutilizados 40 gatos, sendo 28 oriundos de áreas peridomiciliares do município de Seropédica, estado do Rio de Janeiro, dosquais foram obtidos oocistos de C. felis por infecção natural e 12 livres de coccídios, nascidos em laboratório. Estes últimosforam divididos em dois grupos com seis animais cada, que receberam por via oral inóculo contendo 106 oocistos esporuladose vísceras de camundongos inoculados previamente com C. felis, respectivamente. Os oocistos provenientes das três fontesde infecção foram diferentes entre si quando se consideraram os diâmetros polar e equatorial. No entanto, em relação aoíndice morfométrico, não houve variação. Os oocistos provenientes de infecção por vísceras foram pouco homogêneos emrelação aos oocistos oriundos de infecção experimental com oocistos esporulados e de infecção natural.

The present work aimed at to evaluate morphological differences that can be observed on Cystoisospora felis oocysts fromnatural, oocyst-borne experimental infection and mice viscera-borne experimental infection. For this reason, forty cats wereused in this experiment. Twenty-eight cats were taken in the municipality of Seropédica, State of Rio de Janeiro, which werecorresponded to natural infection and twelve coccidia-free kittens which were borne inside laboratory facilities. These coccidia-free cats were divided into two groups with six animals each: the first group was inoculated with 106 sporulated oocysts and thesecond one with mice visceras previously inoculated with 106 sporulated oocysts. Oocysts shed by these kittens submitted tothree sources of infection were different from each other, when were considered the length and width, although there was notvariation on the shape index of them. Oocysts proceeding from kittens fed on mice visceras showed lower homogeneity incomparison to oocysts that came from oocyst-to-oocyst experimental and natural infections.

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.