Isosporiasis

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Isosporiasis
Other names: Cystoisospora belli infectious disease,[1] cystoisosporiasis
Oocyst in epithelial cyst of mammalian host
SpecialtyInfectious disease, gastroenterology
SymptomsSudden onset watery acute non-bloody diarrhea[2]
ComplicationsDehydration[2]
Risk factorsImmunosuppression[3]
Diagnostic methodStool microscopy or PCR (both methods detect the oocysts)[4]
Differential diagnosisCholera, Clostridium difficile infection, cytomegalovirus infection, hookworm infection[5]
PreventionHand hygiene, avoid contaminated food and water[6]
TreatmentTrimethoprim-sulfamethoxazole[7]

Isosporiasis, also known as cystoisosporiasis, is a human intestinal disease caused by the parasite Cystoisospora belli (previously known as Isospora belli). It is found worldwide, especially in tropical and subtropical areas. Infection often occurs in immuno-compromised individuals, notably AIDS patients, and outbreaks have been reported in institutionalized groups in the United States. The first documented case was in 1915. It is usually spread indirectly, normally through contaminated food or water.[8][9]

Treatment is generally with trimethoprim-sulfamethoxazole.[7]

Signs and symptoms

Infection causes acute, non-bloody diarrhea with crampy abdominal pain, which can last for weeks and result in malabsorption and weight loss. In immunodepressed patients, and in infants and children, the diarrhea can be severe. Eosinophilia may be present (differently from other protozoan infections).[10][9]

Complications

As to complications of Isosporiasis we find the following:[2]

Cause

The coccidian parasite Cystoisospora belli infects the epithelial cells of the small intestine, and is the least common of the three intestinal coccidia that infect humans (Toxoplasma, Cryptosporidium, and Cystoisospora).[11][12]

Life cycle

Life cycle of cystoisosporiasis

At time of excretion, the immature oocyst contains usually one sporoblast . In further maturation after excretion, the sporoblast divides in two, so the oocyst now contains two sporoblasts. The sporoblasts secrete a cyst wall, thus becoming sporocysts; and the sporocysts divide twice to produce four sporozoites each. Infection occurs by ingestion of sporocyst-containing oocysts: the sporocysts excyst in the small intestine and release their sporozoites, which invade the epithelial cells and initiate schizogony.[13][14]

Upon rupture of the schizonts, the merozoites are released, invade new epithelial cells, and continue the cycle of asexual multiplication. Trophozoites develop into schizonts which contain multiple merozoites. After a minimum of one week, the sexual stage begins with the development of male and female gametocytes. Fertilization results in the development of oocysts that are excreted in the stool. Cystoisospora belli infects both humans and animals[13][14]

Transmission

People become infected by swallowing the mature parasite; this normally occurs through the ingestion of contaminated food or water. The infected host then produces an immature form of the parasite in their feces, and when the parasite matures, it is capable of infecting its next host, via food or water containing the parasite.[15][16]

Diagnosis

C. belli stained with safranin, containing a single sporoblast.[13]

Microscopic demonstration of the large typically shaped oocysts is the basis for diagnosis. Because the oocysts may be passed in small amounts and intermittently, repeated stool examinations and concentration procedures are recommended. If stool examinations are negative, examination of duodenal specimens by biopsy or string test may be needed. The oocysts can be visualized on wet mounts by microscopy with bright-field, differential interference contrast , and epifluorescence. They can also be stained by modified acid-fast stain.Typical laboratory analyses include:[4][11]

  • Microscopy
  • Morphologic comparison with other intestinal parasites
  • Bench aids for Cystoisospora
Hookworm infection[17]

Differential diagnosis

As to the DDx of Isosporiasis we find the following:[5]

Prevention

Avoiding food or water that may be contaminated with stool can help prevent the infection of Cystoisospora . Good hand-washing, and personal-hygiene practices should be used as well. One should wash their hands with soap and warm water after using the toilet, changing diapers, and before handling food .[8] It is also important to teach children the importance of washing their hands, and how to properly wash their hands.[11][6]

Treatment

The treatment of choice is trimethoprim-sulfamethoxazole (Bactrim),for those individuals experiencing severe diarrhea, rest and plenty of fluids to prevent dehydration are important[18][3]

Additionally, the nutritional needs are important in any management, especially for immunocompromised individuals[3]

Epidemiology

While isosporiasis occurs throughout the world, it is more common in tropical and subtropical areas. Cystoisospora infections are more common in individuals with compromised immune systems, such as HIV or leukemia.[19][20]

Isospora infection in HIV-infected individuals worldwide[19]

823,000 cases are reported annually in United States, with 10% due to international travel.[21]

History

As to history we find that the parasite was first described by Rudolf Virchow in 1860. The first documented case of human infection was reported in 1915[22]

In 1923 Wenyon names the parasite Isospora belli based on the shape of its oocysts found in human feces[23]

See also

References

  1. "Isosporiasis". GARD. Retrieved 10 January 2025.{{cite web}}: CS1 maint: url-status (link)
  2. 2.0 2.1 2.2 "Cystoisosporiasis Clinical Presentation: History and Physical Examination, Complications". emedicine.medscape.com. Archived from the original on 24 June 2024. Retrieved 15 January 2025.
  3. 3.0 3.1 3.2 "Cystoisosporiasis (Formerly Isosporiasis)" (PDF). HIV.gov. Archived (PDF) from the original on 20 December 2024. Retrieved 17 January 2025.
  4. 4.0 4.1 "Cystoisosporiasis Workup: Approach Considerations, Stool Examination, Radiography". emedicine.medscape.com. Archived from the original on 30 August 2022. Retrieved 15 January 2025.
  5. 5.0 5.1 "Cystoisosporiasis Differential Diagnoses". emedicine.medscape.com. Archived from the original on 30 August 2022. Retrieved 12 January 2025.
  6. 6.0 6.1 Dionisio, Daniele (6 December 2012). Textbook-Atlas of Intestinal Infections in AIDS. Springer Science & Business Media. p. 429. ISBN 978-88-470-2091-7.
  7. 7.0 7.1 "Cystoisosporiasis Treatment & Management: Approach Considerations, Supportive Care, Pharmacologic Therapy". eMedicine. 29 October 2024. Archived from the original on 4 December 2024. Retrieved 15 January 2025.
  8. 8.0 8.1 Prevention, CDC - Centers for Disease Control and. "CDC - Cystoisosporiasis - Frequently Asked Questions (FAQs)". www.cdc.gov. Archived from the original on 2019-06-15. Retrieved 2016-03-28.
  9. 9.0 9.1 "Orphanet: Isosporiasis". www.orpha.net. Archived from the original on 12 December 2024. Retrieved 18 January 2025.
  10. Isosporiasis Archived 2008-09-16 at the Wayback Machine at the CDC website.
  11. 11.0 11.1 11.2 "Cystoisosporiasis - Infectious Diseases". Merck Manual Professional Edition. Archived from the original on 5 March 2024. Retrieved 16 January 2025.
  12. Cama, Vitaliano A.; Mathison, Blaine A. (June 2015). "Infections by Intestinal Coccidia and Giardia duodenalis". Clinics in Laboratory Medicine. 35 (2): 423–444. doi:10.1016/j.cll.2015.02.010. PMC 4724871. PMID 26004650.
  13. 13.0 13.1 13.2 "CDC - DPDx - Cystoisosporiasis". www.cdc.gov. 3 June 2024. Archived from the original on 10 January 2025. Retrieved 10 January 2025.
  14. 14.0 14.1 Velásquez, Jorge Néstor; Etchart, Cristina Beatriz; Astudillo, Osvaldo Germán; Chertcoff, Agustín Víctor; Pantano, María Laura; Carnevale, Silvana (January 2022). "Cystoisospora belli, liver disease and hypothesis on the life cycle". Parasitology Research. 121 (1): 403–411. doi:10.1007/s00436-021-07406-2. hdl:11336/197316. ISSN 1432-1955. PMID 34993637.
  15. "Cystoisosporiasis (formerly Isosporiasis)". Red Book. 1 January 2021. doi:10.1542/9781610025782-S3_036 (inactive 21 January 2025). Archived from the original on 20 January 2022. Retrieved 16 January 2025.{{cite journal}}: CS1 maint: DOI inactive as of January 2025 (link)
  16. "Cystoisosporiasis". HIV.info. Retrieved 20 January 2025.
  17. Ghodeif, Alhassan O.; Jain, Hanish (15 June 2023). [Figure, Hookworm infection Image courtesy O.Chaigasame].
  18. Lagrange-Xélot M, Porcher R, Sarfati C, et al. (February 2008). "Isosporiasis in patients with HIV infection in the highly active antiretroviral therapy era in France". HIV Med. 9 (2): 126–30. doi:10.1111/j.1468-1293.2007.00530.x. PMID 18257775. S2CID 26120155.
  19. 19.0 19.1 Wang, Ze-Dong; Liu, Quan; Liu, Huan-Huan; Li, Shuang; Zhang, Li; Zhao, Yong-Kun; Zhu, Xing-Quan (9 January 2018). "Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis". Parasites & Vectors. 11 (1): 28. doi:10.1186/s13071-017-2558-x. ISSN 1756-3305. PMC 5759777. PMID 29316950.
  20. "About Cystoisosporiasis". Cystoisosporiasis. 4 September 2024. Retrieved 22 January 2025.
  21. "Cryptosporidiosis | CDC Yellow Book 2024". wwwnc.cdc.gov. Archived from the original on 2024-12-16. Retrieved 2025-02-05.
  22. "Cystoisosporiasis: Background, Pathophysiology, Etiology". eMedicine. 29 October 2024. Archived from the original on 26 May 2019. Retrieved 17 January 2025.
  23. Dubey, J. P.; Almeria, S. (October 2019). "Cystoisospora belli infections in humans: the past 100 years". Parasitology. 146 (12): 1490–1527. doi:10.1017/S0031182019000957. ISSN 0031-1820. PMID 31303182. Archived from the original on 2025-01-17. Retrieved 2025-01-19.

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