Isospora belli Infection Associated with Acalculous Cholecystitis in a Patient with AIDS

Benator, Debra; French, Audrey L.; Beaudet, Lisa M.; Levy, Charles S.; Orenstein, Jan M.

doi:10.7326/0003-4819-121-9-199411010-00006

Cited by 70 publications

(37 citation statements)

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“…38,39 It may also be related to biliary disease, causing manifestations of acalculous cholecystitis. 37 Isospora belli differs morphologically from Cryptosporidium sp not only because of its intrinsic morphology (elliptical oocyst measuring 22 x 15 µm in diameter, containing two sporocysts with four sporozooites), but also for the intracellular location in the absorptive cell, while Cryptosporidium is restricted to the brush borders, immediately under the apical membrane of absorptive cells. 40 Laboratory diagnosis is carried out in the same way as for Cryptosporidium parvum, using the Kinyoun and auramine-rhodamine techniques, 41 although common processes such as Faust's are often enough for the diagnosis.…”

Section: Isosporiasismentioning

confidence: 99%

“…36 The diarrheic condition is also noteworthy and is accompanied by fever, intestinal colic, anorexia, abdominal pain, loss of weight and peripheral eosinophilia. 37 Isosporiasis can also show extraintestinal dissemination features, affecting the mesenteric, periaortic, mediastinal and tracheobronchial lymph nodes. 38,39 It may also be related to biliary disease, causing manifestations of acalculous cholecystitis.…”

Section: Isosporiasismentioning

confidence: 99%

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Enteric parasites and AIDS

Cimerman

Lewi

1999

Sao Paulo Med. J.

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Amongst the causes of diarrhea in developing countries, those of a parasitic origin are prominent in patients with AIDS.Opportunistic infections caused by intestinal parasites also vary according to the geographical area and the endemic levels in each location.The progressive decline of immunological and mucous defense mechanisms predisposes patients to early, intermediary and late gastrointestinal manifestations of HIV infection. 6 At later stages of the disease, the alterations in non-specific defense mechanisms in the production of Ig A and the reduction in local immune cell response also progress, thus increasing the susceptibility to a number of intestinal opportunistic pathogens, among which Cryptosporidium parvum, Isospora belli and Microsporidia species are the most prominent. 7After the emergence of AIDS, these parasites, until then known solely in veterinary medicine, were no longer considered as commensal organisms and are nowadays recognized as opportunistic pathogens common to these patients. Infections by these agents constitute a major secondary aggravating factor of the disease, often responsible for worsening the general health conditions, due to manifestations of diarrhea which are difficult to control, sometimes resulting in the death of the patient. CRYPTOSPORIDIASISCryptosporidiasis, a disease caused by an intracellular protozoan named Cryptosporidium sp, was described for the first time in 1907 by Tyzzer. This parasite was considered a commensal up to 1975, when it was identified as the cause of diarrhea in animals. 8 The first manifestation of cryptosporidiasis was reported by Nine et al. in 1976, and the disease became a major concern when the notification of the first 21 patients was given, 14 of whom died of chronic diarrhea caused by Cryptosporidium sp infection. 9 It is worth noting that outbreaks of epidemic linked to contaminated water are of extreme importance for the dissemination of this parasite such as the 1993 Milwaukee (USA) cryptosporidiasis outbreak, in which 403,000 human cases were reported, thereby becoming a relevant public health concern.10-12 After this outbreak, it was recommended that immunocompromised patients should be extremely careful with water, foodstuffs and contact with animals.Cryptosporidiasis is distributed over all continents. In Haiti and the African continent the prevalence is 50%, 13 while in the USA it ranges from 3 to 4%.14 In Brazil, due to the continental size of the country, the rates of incidence vary with the location. In the city of São Paulo, for instance, reports have referred to levels around 12.1 to 24.44%. [15][16][17] However, the latest epidemiological report on Brazil, dated February 1998, shows a cryptosporidiasis rate of only 3.5%. 18Cryptosporidiasis in AIDS patients usually causes chronic, bulky and intermittent diarrhea, with liquid non-bloody stools, accompanied by pain and abdominal colic, and a noticeable loss of weight can be observed. 8Asymptomatic cases are rarely described, occurring mostly in developing countries with pati...

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Section: Isosporiasismentioning

confidence: 99%

Section: Isosporiasismentioning

confidence: 99%

Enteric parasites and AIDS

Cimerman

Lewi

1999

Sao Paulo Med. J.

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“…Celiac was not confirmed in our patient, however celiac disease is one of the most frequent causes of malabsorption as reported previously (Behera et al 2008). Isosporiasis might manifest itself as a systemic disseminated infection in patients with AIDS, I. belli was detected within the cells of mediastinal, periaortic and mesenteric lymph nodes at autopsy (Restrepo et al 1987), and in gallbladder biopsy samples of a patient presenting with cholecystitis (Benator et al 1994). A number of studies have reported I. belli as an etiologic agent of diarrhea in other groups of immunodeficient patients (Koru et al 2007;Meamar et al 2009;Resiere et al 2003).…”

Section: Discussionmentioning

confidence: 63%

Isospora belli associated recurrent diarrhea in a child with AIDS

et al. 2013

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“…Coccidian organisms usually comprise a single merozoite-like stage, and many thousands of these organisms may be present. Except for Sarcocystis, infection with other gut coccidian parasites in the gallbladder epithelium has been reported (Pitlik et al 1983, Benator et al 1994, French et al 1995, Zar et al 2001. Clinical signs in patients with parasites in these locations are not specific for coccidiosis, and parasites are diagnosed after tissue biopsy as part of a diagnostic workup (French et al 1995).…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, cholecystitis is increasingly being recognized as a complication of AIDS (Chui andOwen 1994, Vakil et al 1996). The parasitic opportunistic agents that have been most commonly associated with this disorder are Cryptosporidium, Isospora and Cyclospora ( Benator et al 1994, Ackers 1997, Zar et al 2001, Walther and Topazian 2009.…”

Section: Introductionmentioning

confidence: 99%

First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS

Agholi

Heidarian

Moghadami

et al. 2014

Acta Parasitologica

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Acalculous cholecystitis and cholangitis are increasingly being recognized as complications of AIDS. The opportunistic parasites that have been most commonly associated with these disorders are Cryptosporidium species, Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi. The authors performed a parasitological survey on the gallbladder tissue sections of patients underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. In the best of our knowledge it's the first documented case of chronic non-calculous cholecystitis due to Sarcocystis parasite in an Iranian AIDS patient from worldwide.

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Isospora belli Infection Associated with Acalculous Cholecystitis in a Patient with AIDS

Cited by 70 publications

References 0 publications

Enteric parasites and AIDS

Enteric parasites and AIDS

Isospora belli associated recurrent diarrhea in a child with AIDS

First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS

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