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Year : 2003  |  Volume : 21  |  Issue : 2  |  Page : 137-138

Coinfection with cryptosporidium, isospora and s.stercoralis in a patient with aids - A case report

Department of Microbiology, BJ Medical College, Ahmedabad - 380 016, Gujarat, India

Correspondence Address:
Department of Microbiology, BJ Medical College, Ahmedabad - 380 016, Gujarat, India

 ~ Abstract 

A thirty eight year old lady, positive for human immunodeficiency virus (HIV) antibodies, was found to be positive for three different opportunistic parasitic infections. Cryptosporidium, Isospora and S.stercoralis were simultaneously detected from her stool samples. Her CD4 count was 116/cmm. The patient belonged to a slum area with poor sanitation.

How to cite this article:
Shah U V, Purohit B C, Chandralekha D, Mapara M H. Coinfection with cryptosporidium, isospora and s.stercoralis in a patient with aids - A case report. Indian J Med Microbiol 2003;21:137-8

How to cite this URL:
Shah U V, Purohit B C, Chandralekha D, Mapara M H. Coinfection with cryptosporidium, isospora and s.stercoralis in a patient with aids - A case report. Indian J Med Microbiol [serial online] 2003 [cited 2020 Aug 8];21:137-8. Available from:

Intestinal coccidial infection including Cryptosporidium, Isospora, Cyclospora and Microsporidia are increasingly becoming prevalent in acquired immunodeficiency syndrome (AIDS) patients.[1] Intestinal infection by Cryptosporidia is self limited, but leads to persistent diarrhoea in the advanced stage of AIDS and there is no effective treatment available for it. Isospora causes chronic diarrhoea in AIDS patient, but can be treated effectively with available antimicrobials. S.stercoralis is an important human parasitic infection primarily because of its potential for serious and even lethal disease in immunosuppressed patients.[2] These parasitic infections have been commonly reported from different centers of India.[1] Here, we are reporting a patient with AIDS, who was found to be co-infected with these three opportunistic parasites.

 ~ Case Report Top

A thirty-eight year old female patient, a resident of slum area in Ahmedabad, with HIV infection was admitted in medical ward of civil hospital, Ahmedabad, with complaints of fever, diarrhoea, weight loss and vomiting for four months. Two stool samples of the patient, collected on two consecutive days, were received in the microbiology department.
Sample was subjected to standard parasitological and bacteriological examination. A simple wet mount preparation revealed few larvae of S.stercoralis. The sample was concentrated by formol-ether oocyst concentration technique. A simple wet mount and a smear stained by modified Z-N staining method were prepared from the concentration material. Wet mount preparation revealed a number of cysts of Isospora belli measuring about 25-30 X 15-20 m in size with round granular center. Some of the cysts contained two sporocysts. The preparation also revealed the larvae of S.stercoralis. A smear stained by modified Z-N staining method revealed a large number of round pink cysts of Cryptosporidium parvum measuring 4-6 m in diameter. Oocysts of Isospora belli were also observed in the smear.
The second sample was subjected to water emergence semi-concentration technique. The wet mount preparation from it revealed a large number of actively motile larvae of S.stercoralis.
For bacteriological examination, A smear was prepared and stained by simple Z-N staining method, which did not reveal any acid fast structures or bacilli. The stool sample was also inoculated on the plates of MacConkey agar, nutrient agar and Shigella- Salmonella More Details agar. No pathogenic bacteria were isolated. Thus, the role of bacteria which may cause chronic diarrhoea, i.e. Mycobacteria, Shigella,  Salmonella More Details, were ruled out.
Blood CD4 count was 116/cmm; CD8 was 1018/cmm and CD3 was 1230/cmm.

 ~ Discussion Top

In India,[3] prevalence of Cryptosporidium has been found to be about 23% and that of Isospora belli infection is about 12% in AIDS patients. S.stercoralis causes heavy infection in AIDS patients with prevalence of about 2.5%. Co-infections with Cryptosporidium and Isospora as well as Isospora and S.stercoralis have been reported from AIDS patients.[4]
The patient might acquire multiple parasitic infections because of poor sanitary condition. Although cryptosporidiosis can be acquired at any time during the course of HIV infection, major mortality and morbidity occur almost exclusively in patients with CD4 counts below 180 cells/cmm. Above this level, generally spontaneous recovery occurs.[7] The present case of HIV infection was having a very low CD4 count (116/cmm), and this might be responsible for persistent intestinal parasitic infection with chronic diarrhoea. In such patients, frequent stool examination with appropriate concentration techniques may reveal the existence of parasitic infections. In the present case, the mentioned concentration techniques were found very useful for detection of all parasites. These may be useful in early diagnosis and treatment; which will help in improving the quality of life in AIDS patients. 

 ~ References Top

1.Prasad KN, Nag VL, Dhole TN, Ayyagari A. Identification of enteric pathogens in HIV positive patients with diarrhoea in Northern India. J Health Popul Nutr 2000;8(1):23-26.  Back to cited text no. 1    
2.Neva FA. Biology and Immunology of human strongyloidiasis. J Infect Dis 1986;153:397-406.  Back to cited text no. 2  [PUBMED]  
3.Lanjewar DN. Immunopathology of HIV: Proceedings of international symposium on AIDS, Pune, India, May 1995.  Back to cited text no. 3    
4.Ballal M, Prabhu T, Chandran A, Shivananda PG. Cryptosporidium and Isospora belli diarrhoea in immunocompromised host. Indian J Cancer 1999;36(1):38-42.  Back to cited text no. 4    
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2004 - Indian Journal of Medical Microbiology
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