Cystoisosporiasis-related human acalculous cholecystitis: the need for increased awareness

Abstract

Cholecystitis is one of the common surgical indications affecting human beings in many countries. A variety of infectious agents can be associated with acute or chronic acalculous cholecystitis, especially in HIV/AIDS patients. In this investigation, the authors aim to describe two cases of histologically and molecularly documented cystoisosporiasis (syn. isosporiasis) as the cause of chronic acalculous cholecystitis in two immunodeficient patients. During microscopic examinations of more than 2500 diarrheic patients' samples, 11 cases of cystoisosporiasis-related recurrent persistent/chronic diarrhea were detected. A review of the medical records of Cystoisospora belli (syn. Isospora belli)-positive patients showed that two of them, i.e. a patient with prolonged corticosteroid therapy and an AIDS patient, several months prior to fecal examinations had undergone cholecystectomy due to acalculous cholecystitis. The study was continued by a review of the histopathological investigation of the recuts prepared from the excised gallbladder tissue sections and stained with hematoxylin and eosin in order to detect a possible specific clinical correlation with cystoisosporiasis. Light microscopic examination revealed the presence of various developmental stages of a coccidial parasite, namely Cystoisospora belli, in both patients' gallbladder tissue sections. To the best of our knowledge, C. belli-associated cholecystitis has not been previously reported in a patient with prolonged corticosteroid therapy.

Epidemiology of Coccidian Parasites in HIV Patients of Northern Uganda

“…was 3/3 (100%) in 10-19 age group and 1/2 (50%) among ages 20-39 years. As regards to I. belli, it was the least common species with 1/1 (100%) occurrence in age group 40-69 years, ½ (25%) in ages 20-39 and none in children 0/3 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). There was no significant relationship between I. belli and age (P = 0.15).…”

“…From Table 2.out of the study group it was shown that the distribution of coccidian parasites was greater in females with an occurrence of 7.1% as compared to 2.4% among the male population. For both Cryptosporidiosis and I. belli, univariate analysis did not show any significant differences in infection between males and females, (P = 0.19), however, HIV seropositive children with diarrhea (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) were three times more likely to be infected with coccidian parasites than the HIV seropositive age groups 20-39 and 40-69 years i.e. 13.6%, 3.4% and 3.3% respectively.…”

“…Some of the patients presented with mixed infections and commonest parasite found was G. lamblia and E. Histolytica / E. dispar,. Tendency to show higher prevalence was seen to be among children (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) as shown in Table 5.…”

“…Intestinal parasitic infections are classified today as the leading causes of mortality and morbidity among patients infected with HIV [6]. Studies from Iran, Ethiopia and Australia have showed that cryptosporidiosis is a common opportunistic infection in HIV disease [16,4,17]. In a recent research, a comparative study was done comparing prevalence of gastrointestinal protozoa among HIV positive and HIV-negative men in Australia.…”

Cytoplasmic Fibrillar Aggregates in Gallbladder Epithelium Are a Frequent Mimic of Cystoisospora in Pediatric Cholecystectomy Specimens

“…5 Cystoisospora in the gallbladder and biliary tract has been reported in both immunocompetent and immunosuppressed individuals. [6][7][8][9][10][11][12] Recently, the identity of these structures in the gallbladder has been questioned based on negative nucleic acid studies using primers directed against C belli. 13 To understand the prevalence of this histologic finding, we examined cholecystectomy specimens from a pediatric institution and performed electron microscopy from paraffin-embedded specimens to investigate the ultrastructure of the eosinophilic structures that have been attributed to Cystoisospora, with the hypothesis that parasitic inclusion would be demonstrable by electron microscopy, similar to previous examples of Cystoisospora.…”