Résumé
We report a severe case of diarrhea in a 62-year-old female HIV-negative patient from whom Giardia lamblia and Isospora belli were isolated. Because unusual and opportunistic infections should be considered as criteria for further analysis of immunological status, laboratory investigations led to a diagnosis of common variable immunodeficiency (CVID). This is the first reported case of isosporiasis in a patient with CVID and illustrates the importance of being aware of a possible link, particularly in relation to primary immunodeficiency.
Trata-se de relato de caso de uma paciente de 62 anos, sexo feminino, HIV negativo apresentando um quadro grave de diarréia, sendo isolados Giardia lamblia e Isospora belli. Infecções incomuns e oportunistas devem ser consideradas como um sinal para alerta para que se analise o sistema imunológico. O diagnóstico de imunodeficiência de comum variável foi realizado após investigação. Este é o primeiro caso relatado de isosporíase em pacientes com imunodeficiência comum variável e mostra a importância de estar alerta tambem em relação a imunodeficiências primárias.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Déficit immunitaire commun variable/complications , Giardiase/complications , Isosporidiose/complications , Infections opportunistes/complications , Déficit immunitaire commun variable/diagnostic , Diarrhée/parasitologie , Fèces/parasitologie , Giardiase/diagnostic , Isosporidiose/diagnostic , Infections opportunistes/diagnostic , Indice de gravité de la maladieRésumé
The authors describe a case of severe debilitating diarrhea due to isosporiasis in a two year old child, a known case of systemic vasculitis receiving prolonged corticosteroids therapy, an association rarely reported previously. It was refractory to treatment with dihydrofolate reductase inhibitor combined with sulfonamide such as cotrimoxazole to which isosporiasis usually responds well and is being described here for clinical interest and uniqueness of its presentation and laboratory findings.
Sujets)
Animaux , Anti-infectieux/usage thérapeutique , Enfant d'âge préscolaire , Diarrhée/étiologie , Issue fatale , Fèces/parasitologie , Humains , Isospora/isolement et purification , Isosporidiose/complications , Mâle , Récidive , Association triméthoprime-sulfaméthoxazole/usage thérapeutiqueRésumé
The clinical, laboratory and therapeutic data of patients with diarrhea in Human immunodeficiency virus (HIV) antibody positive, immunocompromised and immunocompetent individuals were studied especially to look for prevalence of intestinal coccidiosis. During a study period of one decade, Isospora belli were identified in the stool samples of seven children with diarrhea. Diarrhea persisted for a little longer period in HIV-seropositive children compared to sero-negatives but the clinical picture did not differ significantly in either HIV infected or HIV uninfected individuals.