Isosporiasis

Isosporiasis
Other names: Cystoisospora belli infectious disease, cystoisosporiasis
Oocyst in epithelial cyst of mammalian host
Specialty	Infectious disease, gastroenterology
Symptoms	Sudden onset watery acute non-bloody diarrhea
Complications	Dehydration
Risk factors	Immunosuppression
Diagnostic method	Stool microscopy or PCR (both methods detect the oocysts)
Differential diagnosis	Cholera, Clostridium difficile infection, cytomegalovirus infection, hookworm infection
Prevention	Hand hygiene, avoid contaminated food and water
Treatment	Trimethoprim-sulfamethoxazole

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.

Treatment is generally with trimethoprim-sulfamethoxazole.

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).

Complications

As to complications of Isosporiasis we find the following:

• Dehydration
• Acalculous cholecystitis
• Colitis(rare)

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).

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.

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

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.

Diagnosis

C. belli stained with safranin, containing a single sporoblast.

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:

• Microscopy
• Morphologic comparison with other intestinal parasites
• Bench aids for Cystoisospora

Hookworm infection

Differential diagnosis

As to the DDx of Isosporiasis we find the following:

• Bacterial overgrowth syndrome
• Cholera
• Clostridium difficile infection
• Cytomegalovirus infection
• Hookworm infection

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 . It is also important to teach children the importance of washing their hands, and how to properly wash their hands.

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

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

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.

Isospora infection in HIV-infected individuals worldwide

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

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

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

• 

  C.M. Wenyon PhD

• 

  Rudolf Virchow MD

See also

• List of parasites (human)
• Human parasite

External links

Classification	ICD-10: A07.3 ICD-9-CM: 007.2 MeSH: D021865 DiseasesDB: 29775 SNOMED CT: 360427001
External resources	eMedicine: med/1194 ped/1213 Orphanet: 472