Video:Isosporiasis

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Description

Isosporiasis, also known as cystoisosporiasis, is a human intestinal disease caused by the parasite Cystoisospora 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.[1][2]Treatment is generally with trimethoprim-sulfamethoxazole.[3]

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.[4][2]

Complications

As to complications of Isosporiasis we find the following: dehydration, Acalculous cholecystitis and though rare colitis.[5]

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).[6][7]

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.[8][9]

Mechanism

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.[8][10]

Differential diagnosis

As to the differential diagnosis of Isosporiasis we find the following:bacterial overgrowth syndrome, Cholera, Clostridium difficile infection , Cytomegalovirus infection and Hookworm infection.[11]

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 .[1] It is also important to teach children the importance of washing their hands.[6][12]

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.[13][14]

Epidemiology 1

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.[15][16]

Epidemiology 2

According to the Centers for Disease Control and Prevention more than 800 thousand cases are reported annually in United States, with 10 percent due to international travel.[17]

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.[18]In 1923 Wenyon names the parasite Isospora belli based on the shape of its oocysts found in human feces.[19]

References

  1. 1.0 1.1 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.
  2. 2.0 2.1 "Orphanet: Isosporiasis". web.archive.org. 12 December 2024. Retrieved 27 January 2025.
  3. "Cystoisosporiasis Treatment & Management: Approach Considerations, Supportive Care, Pharmacologic Therapy". eMedicine. 29 October 2024. Retrieved 27 January 2025.
  4. Isosporiasis Archived 2008-09-16 at the Wayback Machine at the CDC website.
  5. "Cystoisosporiasis Clinical Presentation: History and Physical Examination, Complications". emedicine.medscape.com. Retrieved 29 January 2025.
  6. 6.0 6.1 "Cystoisosporiasis - Infectious Diseases". Merck Manual Professional Edition. Archived from the original on 5 March 2024. Retrieved 16 January 2025.
  7. 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.
  8. 8.0 8.1 "Cystoisosporiasis (formerly Isosporiasis)". Red Book. 1 January 2021. doi:10.1542/9781610025782-S3_036
  9. "Cystoisosporiasis". HIV.info. Retrieved 20 January 2025.
  10. 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.
  11. "Cystoisosporiasis Differential Diagnoses". emedicine.medscape.com. Archived from the original on 30 August 2022. Retrieved 12 January 2025.
  12. Dionisio, Daniele (6 December 2012). Textbook-Atlas of Intestinal Infections in AIDS. Springer Science & Business Media. p. 429. ISBN 978-88-470-2091-7.
  13. 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.
  14. "Cystoisosporiasis (Formerly Isosporiasis)" (PDF). HIV.gov. Archived (PDF) from the original on 20 December 2024. Retrieved 17 January 2025.
  15. 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.
  16. "About Cystoisosporiasis". Cystoisosporiasis. 4 September 2024. Retrieved 22 January 2025.
  17. "Cryptosporidiosis | CDC Yellow Book 2024". wwwnc.cdc.gov. Archived from the original on 2024-12-16. Retrieved 2025-02-05.
  18. "Cystoisosporiasis: Background, Pathophysiology, Etiology". eMedicine. 29 October 2024. Archived from the original on 26 May 2019. Retrieved 17 January 2025.
  19. 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.