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CORRESPONDENCE
Year : 2013  |  Volume : 31  |  Issue : 2  |  Page : 204-205
 

Cystisospora belli infection in a non-human immunodeficiency virus immunosuppressed patient


Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Date of Submission06-Apr-2013
Date of Acceptance06-May-2013
Date of Web Publication19-Jul-2013

Correspondence Address:
S Mohanty
Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.115241

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How to cite this article:
Chopra S, Mohanty S, Deb M. Cystisospora belli infection in a non-human immunodeficiency virus immunosuppressed patient. Indian J Med Microbiol 2013;31:204-5

How to cite this URL:
Chopra S, Mohanty S, Deb M. Cystisospora belli infection in a non-human immunodeficiency virus immunosuppressed patient. Indian J Med Microbiol [serial online] 2013 [cited 2019 Oct 16];31:204-5. Available from: http://www.ijmm.org/text.asp?2013/31/2/204/115241


Dear Editor,

Cystisospora belli (formerly, Isospora belli) is a coccidian parasite that parasitizes the intestinal tract of wild and domestic animals. [1] Human infections with these parasites were rare and sporadic before human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). [2] C. belli became one of the most commonly recognized causes of diarrhoea in patients with AIDS since 1981, with an incidence ranging from approximately 0.2% to 20% in tropical areas. It has been reported rarely in other immunosuppressive diseases such as lymphoblastic leukaemia, Hodgkin's and non-Hodgkin's lymphoma, adult T-cell leukaemia, renal and liver transplant recipients and malnourished children. [3],[4] We report a case of cystisoporiasis in a patient with Evan's syndrome, a haematological disorder, with autoimmune haemolytic anaemia and immune thrombocytopenia sometimes together with immune neutropenia in the absence of known underlying aetiology.

A 48-year-old male, a diagnosed case of Evan's syndrome, presented to the out-patient department (OPD) with complaints of moderate watery diarrhoea (7-8 times/day without blood and mucous), abdominal pain and occasional vomiting of 2 months duration. He also complained of loss of appetite and progressive loss of weight. He was on treatment with steroids and azathioprine for the past 1 year. On examination, the patient was afebrile with a pulse rate of 94/min and a blood pressure of 110/70 mm Hg. He had generalized weakness, significant weight loss of 14-15 kg during the past 6 months, mild dehydration and nausea without vomiting. Laboratory investigations revealed a total leucocytes count of 6.6 × 10 9 /L (38% polymorphs, 59% lymphocytes and 3% monocytes), red blood cell count of 3.2 × 10 12 /L, haematocrit of 28.5% and haemoglobin of 92 g/L. The reports of routine biochemical investigations were within normal limits. Microscopic examination of a fresh stool sample in wet mount preparations showed mature and immature sporulated oocysts of C. belli. Modified kinyoun acid fast stain also showed light pink to deep red coloured sporulated oocysts [Figure 1]. Stool culture for enteric bacterial pathogens was negative. The patient had tested negative for anti-HIV-1/2 antibodies. He was advised a 10-day course of high dose trimethoprim-sulfamethoxazole (160/800 mg) 4 times daily, with instructions to report back to the OPD for further evaluation on completion of treatment. The patient, however, never reported back and was lost to follow-up.
Figure 1: Modifi ed kinyoun acid fast stain showing oocyst of Cystisospora belli in a non-human immunodeficiency virus immunosuppressed patient

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Intestinal infection due to C. belli is distributed worldwide and the highest incidence has been reported from developing countries. In India, the prevalence of isosporiasis is about 12% in AIDS patients. [5] Other than HIV/AIDS, it has also been reported in association with nephrotic syndrome, malnourishment and lymphomas from Indian population. [4],[6] In the present case, an immunosuppressive state in the patient may have resulted from the underlying disorder itself or from intake of immune-suppressive agents which in turn may have increased the patient's susceptibility to this parasitic infection. Unlike cryptosporidiosis, cystisosporiasis responds promptly to treatment. Unfortunately, in the present case, we could not determine the efficacy of treatment since the patient never reported back.

C. belli, an opportunistic pathogen, can cause severe chronic diarrhoea in patients with haematological disorders on immunosuppressive therapy. Haematologists should be aware of this cause of diarrhoea in a patient with haematological disorder in an area where the pathogen is endemic like India.

 
 ~ References Top

1.Heyworth MF. Giardiasis, balantidiasis, isosporiasis and microsporidiosis. In: Warrell DA, Cox TM, Firth JD, Torok E, editors. Oxford Textbook of Medicine. 5 th ed. United Kingdom: Oxford University Press; 2012. p. 1111-8.  Back to cited text no. 1
    
2.DeHovitz JA, Pape JW, Boncy M, Johnson WD Jr. Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome. N Engl J Med 1986;315:87-90.  Back to cited text no. 2
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3.Lindsay DS, Dubey JP, Blagburn BL. Biology of Isospora spp. from humans, nonhuman primates, and domestic animals. Clin Microbiol Rev 1997;10:19-34.  Back to cited text no. 3
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4.Mirdha BR, Kabra SK, Samantray JC. Isosporiasis in children. Indian Pediatr 2002;39:941-4.  Back to cited text no. 4
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5.Mudholkar VG, Namey RD. Heavy infestation of Isospora belli causing severe watery diarrhea. Indian J Pathol Microbiol 2010;53:824-5.  Back to cited text no. 5
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6.Kochhar A, Saxena S, Malhotra VL, Deb M. Isospora belli infection in a malnourished child. J Commun Dis 2007;39:141-3.  Back to cited text no. 6
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