Coccidiosis y amibiasis intestinal en niños de edad escolar de un distrito de Lambayeque, Perú / Intestinal coccidiosis and amebiasis in school age children of a district in Lambayeque, Peru

Objetivos: Determinar la prevalencia y los factores asociados a coccidiosis y amibiasis intestinal en niños de edad escolar del distrito de Chongoyape, Chiclayo, Perú. Material y métodos: Estudio transversal de tipo relacional entre noviembre del 2014 y enero del 2015 en 133 escolares. Para recolectar la información sociodemográfica y de saneamiento se usó un cuestionario estructurado. La detección de los parásitos se realizó en muestras seriadas de heces. Para los coccidios intestinales se realizó examen microscópico directo (EMD), técnica ácido resistente modificada (TARM) y ELISA coproantígenos para Cryptosporidium spp., mientras que para la amibiasis se usó EMD y ELISA coproantígenos para Entamoeba hystolitica. Resultados: El 6,8% (9/133) de la muestra presentó coccidiosis intestinal, 3,8% (5/133) con Cryptosporidium spp., y 3,0% (4/133) con Cyclospora cayetanensis. No se detectó Cystoisospora belli. El 4,5% (6/133) de la muestra presentó E. histolytica. El factor asociado en ambas parasitosis fue el consumo de agua insalubre (p=0,001 y p=0,026 respectivamente), mientras que el contacto con animales se asoció a la coccidiosis intestinal (p=0,013). Conclusiones: La coccidiosis y la amibiasis intestinal son frecuentes en niños de la población estudiada, evidenciando su importancia como problema de salud pública y la necesidad de un diagnóstico específico y rutinario en las instituciones de salud de la región. (AU)

Objectives: To determine the prevalence of and risk factors for intestinal coccidiosis and amebiasis in school-age children in the district of Chongoyape, Chiclayo, Peru. Methods: Cross-sectional study carried-out between November 2014 and January 2015 among 133 school-aged children. A structures questionnaire collected socio-demographic and sanitation information. Serial stool samples were required, which were processed under direct microscopy, modified acid-fast staining and ELISA to detect antigens of Cryptosporidium spp, while direct microscopy and ELISA were used to detect Entamoeba hystolitica. Results: 6.8% (9/133) of the samples were positive for coccidian parasites, 3.8% (5/133) were positive for Cryptosporidium and 3% (4/133) for Cyclospora cayetanensis, no Cystoisospora belli was identified. E. hystolitica was found in 4.5% (6/133) samples. Drinking non-potable water was a risk factor for getting both infections, while animal contact was associated with getting a coccidian parasite (p=0.013). Conclusions: Both coccidian and intestinal amebas are frequent protozoan infections in this population. These parasites are public health problem that require routine and specific diagnostic methods in the region. (AU)

Acid fast cysts in diarrheal stool samples of HIV positive patients.

Background: Gastrointestinal infections are very common in patients with HIV infection or AIDS, and diarrhea is a common clinical presentation of these infections. Acid fast protozoans are very commonly responsible for diarrhea in HIV positive patients leading to death in many cases. Methods: The study group included 50 HIV seropositive patients suffering from diarrhea and the control group included 50 HIV seronegative patients suffering from diarrhea. The stool samples collected were concentrated using formol-ether concentration technique and stained using modified Ziehl-Neelsen’s staining procedure. Results: Among the diarrheal stool samples of HIV positive patients (n=50), 17 (34%) were positive for acid fast cysts, and among the HIV negative stool samples (n=50), 2 (4%) were positive for acid fast cysts. Cryptosporidium oocysts were detected in 15 (30%) and Isospora oocysts in 2 (4%) of the samples in the study group. Cryptosporidium oocysts were detected in 2 (4%) of the samples in the control group. There existed a significant difference between the positivity of HIV-positive and HIV-negative diarrheal stool samples. Conclusion: Timely and effective diagnosis could help in delivering appropriate treatment in an already immunocompromised patient.

Parasitos oportunistas intestinais em pacientes submetidos à hemodiálise - revisão sistemática da literatura / Opportunistic intestinal parasites in hemodialysis patients - a systematic literature review / Parásitos intestinales oportunistas en pacientes sometidos a hemodiálisis - revisión sistemática de la literatura

Realizou-se uma revisão sistemática da literatura com o objetivo de identificar a ocorrência de parasitos entéricos oportunistas em pacientes nefropatas crônicos submetidos à hemodiálise. A revisão consistiu de busca de artigos publicados nas bases de dados MEDLINE, LILACS, SciELO, PubMed entre 1991 e 2013. Foram identificados 178 artigos, dos quais dez foram considerados relevantes para o presente trabalho. Nos trabalhos os pesquisadores demonstraram que os pacientes imunossuprimidos submetidos à hemodiálise são potencialmente infectados por agentes entéricos oportunistas. Há necessidade de maior quantidade de estudos sobre o tema uma vez que existe uma ocorrência mundial crescente das doenças renais crônicas e o potencial acometimento de doenças oportunistas nesta população podendo, inclusive, ocasionar a contaminação de ambientes hospitalares por protozoários entéricos oportunistas.

The objective of this systematic literature review was to identify the occurrence of opportunistic enteric parasites in chronic kidney patient undergoing hemodialysis. The review consisted on searching articles published on MEDLINE, LILACS, SciELO, and PubMed databases between 1991 and 2013. A total 178 articles were identified, ten of which were considered relevant for the present study. In the referred studies, the researchers demonstrated that immunosuppressed patients undergoing hemodialysis are potentially infected by opportunistic enteric agents. Further studies are needed on this topic, as there is a growing global concern with chronic kidney diseases and the potential for these patients contracting opportunistic diseases, which, inclusively, could contaminate hospital environments with opportunistic enteric protozoa.

Se realizó revisión sistemática de la literatura con el objetivo de identificar la ocurrencia de parásitos entéricos oportunistas en pacientes de nefropatía crónica sometidos a hemodiálisis. La revisión consistió en la búsqueda de artículos publicados en las bases de datos MEDLINE, LILACS, SciELO y PubMed, entre 1991 y 2013. Fueron identificados 178 artículos, de los cuales diez fueron considerados relevantes para el presente estudio. En los trabajos, los investigadores demostraron que los pacientes inmunosuprimidos sometidos a hemodiálisis son potencialmente infectados por agentes entéricos oportunistas. Hay necesidad de mayor cantidad de estudios sobre el tema, toda vez que existe presencia creciente a nivel mundial de enfermedades renales crónicas y el potencial agravamiento por enfermedades oportunistas en ésta población, pudiendo, inclusive, dar lugar a la contaminación de ambientes hospitalarios por protozoarios entéricos oportunistas.

Isospora bocamontensis (Protozoa: Apicomplexa) in captive yellow cardinal Gubernatrix cristata (Passeriformes: Emberezidae) / Isospora bocamontensis (Protozoa: Apicomplexa) em cardeais-amarelo Gubernatrix cristata (Passeriformes: Emberezidae) mantidos em cativeiro

The yellow cardinal (Gubernatrix cristata) is a passerine found in southern Brazil, especially along the border with Uruguay and Argentina. It is an endangered species and its population is decreasing. Among the parasites that affect passerines, the genus Isospora is the most easily found in both captive and free-living birds. This parasite commonly causes injury to the intestinal tissue and could occasionally affect other organs. In this work we examined the occurrence of coccidiosis in captive yellow cardinals and its association with factors such as sex, use of parasiticides, type of enclosure, contact with feces, type of food and cleaning frequency. We collected fecal samples of 45 yellow cardinals, healthy and kept in captivity, in late afternoon at the end of the reproductive period. The examination showed parasitic infection by Isospora bocamontensis in 44.5% of the birds. This infection is not influenced by the sex of birds, but is significantly affected by the type of enclosure, contact with the feces, use of parasiticides, type of food and cleaning frequency. The results indicate that to keep yellow cardinals captive, these factors must be observed.

O cardeal-amarelo (Gubernatrix cristata) é um pássaro que ocorre no sul do Brasil, principalmente na fronteira com Uruguai e Argentina. É uma ave ameaçada de extinção e sua população está decrescendo. Dentre, os parasitas que afetam a ordem Passeriformes, o gênero Isospora está entre o mais encontrado, tanto em aves de cativeiro quanto em aves de vida-livre. Comumente causam injúrias no tecido intestinal, podendo ocasionalmente afetar outros órgãos. Neste trabalho examinamos a ocorrência de coccidiose em cardeais mantidos em cativeiro e verificamos sua associação com fatores como sexo, uso de produtos parasiticidas, tipo de recinto, contato com fezes, tipo de alimentação e frequência de limpeza. Foram coletadas amostras de fezes, ao entardecer, de 45 cardeais-amarelos, hígidos, mantidos em cativeiro, no final do período reprodutivo. O exame coproparasitológico revelou infecção parasitária por Isospora bocamontensis, em 44,5% das aves. Esta infecção não é influenciada pelo sexo das aves, mas é significativamente afetada pelo tipo de recinto, contato com as fezes, uso de parasiticidas, tipo de alimentação e frequência de limpeza. Indicando que para a manutenção em cativeiro estes fatores devem ser observados.

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.

Principales aspectos de los coccidos asociados a diarrea en pacientes VIH positivos / Key aspects of coccidia associated with diarrhea in HIV patients

Las parasitosis intestinal afectan sobre todo a los países en vías de desarrollo y constituyen un problema de salud pública, relacionado muchas veces con la falta de sistemas de salud eficientes, o fuentes de agua potable, que también se acentúan con enfermedades de fondo como Sida, que se presentan también en los países desarrollados. La bibliografía describe que Cryptosporidium spp, Isospora belli y Cyclospora cayetanensis son los parásitos con más frecuencia asociados con diarrea persistente en casos avanzados de pacientes con VIH/Sida. Este grupo de protozoarios requiere exámenes específicos para su diagnóstico, siendo la coloración de Ziehl-Neelsen, uno de los exámenes no rutinarios que permiten su identificación y que, en la mayoría de las ocaciones, no se realiza en el laboratorio si no es solicitado por el médico de manera explícita...

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.

Infestación por Cryptosporidium Spp e Isospora Belli en preescolar inmunocompetente: a propósito de un caso / Infestation by Crytosporidium Spp and Isospora belli in immunocompetent preschool: a report of a case

El Cryptosporidium spp e Isospora belli son parásitos emergentes, que representan la cuarta causa de diarrea a nivel mundial, principalmente en niños y en pacientes inmunocomprometidos. Producen diarrea aguda o crónica dependiendo de la edad del paciente, estado nutricional e inmunológico asociado a factores sanitarios desfavorables. El diagnostico se realiza por visualización directa en heces con tinción de Zelh Neelsen modificado o Kinyou y biopsia intestinal con presencia de protozoos en las criptas y atrofia vellositaria de acuerdo al grado de infestación. Se reporta el caso de preescolar de 2 años de edad, eutrófico e inmunocompetente, perteneciente a estrato social bajo; con episodios de diarreas acuosas autolimitadas, dolor y distensión abdominal frecuentes. La biopsia intestinal revelo atrofia vellositaria e infestación simultanea por Cryptosporidium spp e Isospora belli corroborado por Tinción de Kinyou en heces; se descarto además Alergia Alimentaria, Enfermedad Celiaca e Inmunodeficiencias. El propósito de este caso clínico es alertar sobre la necesidad de incluir dentro del protocolo de estudio de diarrea crónica, la búsqueda de protozoarios formadores de esporas, mediante tinción especial en heces; un método no invasivo y sencillo, no solicitado en forma rutinaria.

Cryptosporidium spp and Isospora belli parasites are emerging that represent the fourth leading cause of diarrhea worldwide, mainly in children and in immunocompromised patients. Acute or chronic diarrhea occur depending on the patient's age, nutritional status and immunological factors associated with adverse health. The diagnosis is made by direct visualization in feces Neelsen stain Zelh Kinyou modified or intestinal biopsy and the presence of protozoa in the crypts and villous atrophy according to the degree of infestation. We report the case of preschool age 2, eutrophic immunocompetent, belonging to low socioeconomic levels, with self-limiting episodes of acute watery diarrhea, frequent abdominal pain and bloating. The intestinal biopsy revealed villous atrophy and simultaneous infestation by Cryptosporidium spp and Isospora belli Kinyou confirmed by staining in feces, while discarding also Food Allergy, Celiac disease and immunodeficiencies. The purpose of this case to alert about the need to include in the study protocol of chronic diarrhea, the search for spore-forming protozoa by special staining in feces, a noninvasive and simple method, not routinely requested.

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.

Ocurrencia de Isospora belli, Cryptosporidium spp y Cyclospora cayetanenesis en pacientes urbanos evaluados por síntomas gastrointestinales con o sin imnunosupresión / Occurrence of Isospora belli, Cryptosporidium and Cyclospora cayetanenesis spp in urban patients evaluated for gastrointestinal symptoms with or without immunosuppresion

Este estudio de corte transversal, estimó la ocurrencia de infecciones por coccidias intestinales (CI) en pacientes urbanos procedentes de Caracas-Venezuela. Se analizaron, 1 831 referencias de pacientes externos de ambos sexos y con edad promedio ± desviación estándar de 28,8 ± 22,93 años. En la Sección de Geohelmintiasis del Instituto de Medicina Tropical (SGH-IMT), se evaluaron 4 650 muestras de heces seriadas, por examen directo, formol tritón éter y Baermann, pertenecientes a 1 550 pacientes. Adicionalmente, la prueba de Ziehl-Neelsen modificada, se aplicó a las muestras fecales de 150 pacientes, por solicitud del médico tratante o sugerencia de SGH-IMT. La eosinofilia (40,54 por ciento; 225/555) constituyó el principal motivo de referencia y consulta. El promedio ± DS de contaje absoluto de eosinófilo (3 151 ± 5 161) demostró eosinofilias leves (63/204) y moderadas (25/204). Otros motivos de consulta fueron: dolor abdominal (27,72 por ciento; 122/440), náuseas/vómitos (19,03 por ciento; 83/436), pujo/tenesmo (16,05 por ciento; 70/436) y por último, la consistencia líquida de las heces (4,87 por ciento; 74/1 477). Los parasitados (43,7 por ciento; 677/1 550) presentaron evacuaciones pastosa (81,25 por ciento; 494/608) y blandas (37 por ciento; 57/608). Sólo, 5,92. por ciento (36/608) presentaron consistencia líquida. La prueba de Ziehl-Neelsen modificada demostró 12 casos positivos (8 por ciento) para CI: Isospora belli (5,33 por ciento; 8/150), Cryptosporidium spp (2 por ciento; 3/150) y Cyclospora cayetanensis (0,66 por ciento; 1/150). El único caso de ciclosporiosis estaba co-infectado con Blastocystis hominis y no presentó cambios en la consistencia de las heces. Estos resultados apoya la idea de que los médicos interconsultantes soliciten la aplicación de exámenes coproparasitológicos adicionales, en forma seriada, de bajo costo, para evaluar pacientes inmunocompetentes urbanos, con síntomas gastrointestinales/ eosinofilia, ...

These two years follow up; cross-sectional study estimates the occurrence of intestinal coccidias in urban patients from the metropolitan area of Caracas-Venezuela. One thousand eight hundred thirty one outpatient case reports were analyzed, both sex and 28.8 ± 22.93 years. Soil-transmitted helminthes laboratory of the Tropical Medicine Institute (SGH-IMT) evaluated 4 650 feces samples from 1 550 outpatients by direct, formol triton ether and Baermann techniques, Additionally, modified Ziehl-Neelsen, were done because of clinicians or SGH-IMT suggestion for 150 outpatients. Eosinophilia (40.54 percent; 225/555) was the major cause of referral and consultation. The mean of the absolute count of eosinophils (3 151+ 5 161) showed low (63/204) and moderate (25/204) eosinophila. Other causes of consultation were: abdominal pain (27.72 percent; 122/440), nausea/ vomiting (19.03 percent; 83/436), tenesmus/constipation (16.05 percent; 70/436) and finally, liquid fecal consistency (4.87 percent; 74/1477). Parasite infected patients (43.7 percent; 677/1550) had normal (81.25 percent; 494/608) and semi liquid feces (37 percent; 57/608). Only, 5.92 percent (36/608) had liquid consistency. Modified Ziehl-Neelsen demonstrates 12 positive IC (8 percent) for: Isospora belli (5.33. percent; 8/150), Cryptosporidium spp (2 percent; 3/150) and Cyclospora cayetanensis (0.66 percent; 1/150). The only case of cyclosporidiosis was co-infected with Blastocystis hominis and had normal feces. These results agrees with the idea for clinicians to ask for additional, low cost, serial parasitological test in feces, to evaluate urban inmunocompetent outpatients, with gastrointestinal symptoms/eosinophilia, even without diarrhea, because the basic feces techniques, used routinely, fails to make the precise parasite diagnostic, underestimating coccidiosis

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.

Study of the gastrointestinal parasites in felines from Itaipu Binacional wild animal nursery, Brazil / Estudo dos parasitas gastrointestinais em felinos do berçário de animais selvagens da Itaipu Binacional, Brasil / Estudio de parásito gastrointestinales en felinos del vivero de animales silvestres en Itaipu Binacional, Brasil

The felines are animals that have great importance for the ecosystem, because they do the control of several species, like small mammals, birds, insects and so on. These predators have been threatened due to the destruction of their habitats and a way to preserve them is their breeding in captivities. This study aims to discover what kinds of intestinal parasites infected the felines (Leopardus pardalis, L. wiedii, L. tigrinus, Herpailurus yagouarondi, Panthera onca) of the Itaipu Binacional wild animal nursery (CASIB). Two methods were processed in the feline’s faecal samples: Sedimentation (HPJ) and Rithie. Among the forty-two felines’ enclosures analyzed, 38.09% (16/42) were positive and 61.90% (26/42) negative for intestinal parasites. The genus of parasites found were: Isospora, Toxocara, Ancylostoma, Toxoplasma (like oocysts), Taenia, Toxoascaris and Spirometra, in spite of the control of hygiene in the company. This can be due to the visit of intermediate hosts infected in the felines’ enclosures.

Os felinos são animais de grande importância para o ecossistema, pois realizam o controle populacional de diversas espécies, tais como pequenos mamíferos, pássaros, insetos entre outros. Estes predadores tem sido ameaçados devido à destruição de seus habitats e uma maneira de preservá-los é sua criação em cativeiros. O objetivo deste estudo foi descobrir que espécies de parasitos intestinais infectam os felinos (Leopardus pardalis, L. wiedii, L. tigrinus, Herpailurus yagouarondi, Panthera onca) do criadouro de animais silvestres da Itaipu Binacional (CASIB). As amostras fecais dos felinos foram analisadas por dois métodos: Sedimentação (HPJ) e Rithie. Dos quarenta e dois recintos de felinos analisados, 38.09% (16/42) estavam positivos e 61.90% (26/42) negativos para parasitos intestinais. Os gêneros dos parasitos encontrados foram: Isospora, Toxocara, Ancylostoma, Toxoplasma (oocistos semelhantes), Taenia, Toxoascaris e Spirometra, apesar do controle de higiene realizado pela empresa. Este parasitismo possivelmente está relacionado à visita de hospedeiros intermediários infectados nos recintos dos felinos.

Los felinos son animales de gran importancia para el ecosistema, pues realizan el control de población de diversas especies, tales como pequeños mamíferos, aves, insectos y otros. Estos depredadores han sido amenazados debido a la destrucción de su hábitat y una forma de preservarlos es su creación en cautiverios. Este estudio tuvo como objetivo descubrir qué especies de parásitos intestinales infectan a los felinos (Leopardus pardalis, L. wiedii, L. tigrinus, Herpailurus yagouarondi, Panthera onca), del vivero de animales silvestres en Itaipu Binacional (CASIB). Las muestras de heces de felinos fueron examinadas por dos métodos: Sedimentación (HPJ) y Rithie. De los cuarenta y dos lugares del cautiverio analizados, 38,09% (16/42) estaban positivas y 61,90% (26/42) negativos para parásitos intestinales. Los géneros de parásitos encontrados fueron: Isospora, Toxocara, Ancylostoma, Toxoplasma (ooquistes similares), Taenia, Toxoascaris y Spirometra, a pesar del control de higiene realizado por la empresa. Este parasitismo posiblemente está relacionado con la visita de huéspedes intermediarios infectados en los recintos de los felinos.

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.

Prevalence of Giardia intestinalis and other zoonotic intestinal parasites in private household dogs of the Hachinohe area in Aomori prefecture, Japan in 1997, 2002 and 2007

An epidemiological study on canine intestinal parasites was undertaken to evaluate changes in the prevalence among private household dogs from the Hachinohe region of Aomori prefecture, Japan, in 1997, 2002 and 2007, using the formalin-ethyl acetate sedimentation technique. The risk of zoonotic transmission from household dogs to humans was also discussed. All intestinal parasites detected in the present study (Giardia intestinalis, Isospora spp., Toxocara canis, Ancylostoma caninum, Trichuris vulpis and Strongyloides stercoralis) showed no changes in prevalence over the past 10 years based on analysis considering canine epidemiological profiles. In particular, prevalence of Giardia intestinalis in dogs under 1 year old, derived from pet shops/breeding kennels and kept indoors was unchanged, remaining at a high level of >15.0% at each time point. Toxocara canis also showed no changes in the group of dogs under 1 year old, bred by private owners and kept outdoors, and the prevalence was >10.0% every year. The present results indicate that the prevalence of Giardia intestinalis and other intestinal parasites in private household dogs has not always decreased, and the potential for direct parasitic zoonotic transmission from dogs to humans may be relatively high level, than from the environment (indoors and outdoors). We recommend careful surveillance of intestinal parasites and aggressive use of anthelminthic in private household dogs under considering the epidemiological factors.

Prevalence of Cryptosporidium, Cyclospora cayetanensis and Isospora belli infection among diarrheal patients in South India

The emerging protozoan parasites <I>Cryptosporidium, Cyclospora cayetanensis and Isospora belli</I> have altered the etiological spectrum of diarrhea. The progressive decline in CD4 cell count in AIDS patients and lack of active immunity in the face of exposure to contaminated food and water in young children make these groups of persons particularly susceptible to protracted and severe diarrhea caused by the above parasites. Cryptosporidiosis is caused by human as well as several zoonotic species. The present study was undertaken to examine the prevalence of <I>Cryptosporidium</I> species, C. <I>cayetanensis</I> and <I>I .belli</I> among these two susceptible populations in comparison with adult immunocompetent individuals with diarrhea and to identify the <I>Cryptosporidium</I> species prevalent in these populations. A total of 447 children under the age of 5 years, 175 HIV-seropositive adults and 200 HIV seronegative adults with diarrhea attending tertiary care hospitals located in the twin cities of Secunderabad and Hyderabad in South India were included in the study. Single fecal samples were collected. Wet mounts and modified Ziehl Neelsen stained smears made from concentrated fecal specimens were screened microscopically for oocysts of <I>Cryptosporidium, Cyclospora cayetanensis and Isospora belli.</I> DNA extracted from fecal samples positive for <I>Cryptosporidium</I> was subjected to PCR RFLP for species identification. <I>Cryptosporidium</I> was detected in all the three groups, I.e. children (8.7%), HIV-seropositive adults (6.85%), and HIV-seronegative adults (1%). <I>Isospora and Cyclospora</I> were detected only among HIV- seropositive persons at a frequency of 16% and 1% respectively. <I>C. hominis</I> (71.7%) and <I>C. parvum</I> (18.9%) were the only 2 species of <I>Cryptosporidium</I> detected.

Isospora vanriperorum Levine, 1982 (apicomplexa: eimeriidae) in the green-winged saltator, Saltator similis Lafresnaye and D'orbigny, 1837 (passeriformes: cardinalinae) in southeastern Brazil / Isospora vanriperorum Levine, 1982 (apicomplexa: eimeriidae) no trinca-ferro Saltator similis Lafresnaye and D'orbigny, 1837 (passeriformes: cardinalinae) no sudeste do Brasil

Isospora vanriperorum from the green-winged saltator (Saltator similis) is described in Southeastern Brazil. Oocysts are spherical to subspherical, 19.4-26 by 18.3-26μm (23.1 by 22.4μm), shape index 1.04 with a single layered wall, fine, smooth and yellowish. Micropyle and residuum are absents, but one elliptical polar granule is present. Sporocysts are ovoid, 14.5-20.2 by 8.1-12.5μm (16.3 by 10.8μm), shape index 1.53 with prominent Stieda body, barely discernible substieda body and residuum centered and granulated.

Isospora vanriperorum de trinca-ferro verdadeiro (Saltator similis) é descrita no sudeste do Brasil. Os oocistos são esféricos a subesféricos medindo 19,4-26 por 18,3-26μm (23,1 por 22,4μm), índice morfométrico de 1,04 com parede única, fina, lisa e amarelada. A micrópila e o resíduo estão ausentes, mas um grânulo polar elíptico está presente. Os esporocistos são ovóides medindo 14,5-20,2 por 8,1-12,5μm (16,3 por 10,8μm), índice morfométrico de 1,53 com corpo de Stieda proeminente, corpo de substieda mal discernível e resíduo central e granular.

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)