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Isosporiasis is a human intestinal disease caused by the parasite Isospora 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.

Causal Agent

The coccidian parasite Isospora 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 Isospora).

Life cycle

At time of excretion, the immature oocyst contains usually one sporoblast (more rarely two). 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. Upon rupture of the schizonts, the merozoites are released, invade new epithelial cells, and continue the cycle of asexual multiplication. Trophozoites develop into schizonts which contain multiple merozoites. After a minimum of one week, the sexual stage begins with the development of male and female gametocytes. Fertilization results in the development of oocysts that are excreted in the stool. Isospora belli infects both humans and animals.

Clinical Features

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 (differently from other protozoan infections).^[1]

Laboratory Diagnosis

Microscopic demonstration of the large typically shaped oocysts is the basis for diagnosis. Because the oocysts may be passed in small amounts and intermittently, repeated stool examinations and concentration procedures are recommended. If stool examinations are negative, examination of duodenal specimens by biopsy or string test (Enterotest) may be needed. The oocysts can be visualized on wet mounts by microscopy with bright-field, differential interference contrast (DIC), and epifluorescence. They can also be stained by modified acid-fast stain.

Typical laboratory analyses include:

Microscopy
Morphologic comparison with other intestinal parasites
Bench aids for Isospora

Treatment

Trimethoprim-sulfamethoxazole is the usual treatment choice.^[2] See recommendations in The Medical Letter (Drugs for Parasitic Infections) for complete information.

References

^ Isosporiasis at the CDC website.
^ 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.

UpToDate Contents

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1. 二核アメーバ dientamoeba fragilis

English Journal

Morphological and molecular characterization of Isospora manorinae n. sp. in a yellow-throated miner (Manorina flavigula wayensis) (Gould, 1840).

Yang R1, Brice B2, Jian F3, Ryan U4.
Experimental parasitology.Exp Parasitol.2016 Apr;163:16-23. doi: 10.1016/j.exppara.2016.01.013. Epub 2016 Jan 26.
A new Isospora (Apicomplexa:Eimeriidae) species is described from a single yellow-throated miner bird (Manorina flavigula) (subspecies M. f. wayensis) in Western Australia. Sporulated oocysts (n = 32) of this isolate are spherical to subspherical, 22.8 (20.3-23.8) × 18.3 (17.7-18.7) μm, with a sha
PMID 26821297

Molecular Identification of Biliary Isospora Belli: A Case Report.

Chiu KW1, Chiou SS, Lu LS, Wu CK, Eng HL.
Medicine.Medicine (Baltimore).2016 Mar;95(10):e3071. doi: 10.1097/MD.0000000000003071.
This report describes the novel sampling of bile from the biliary endoscopic intervention for the molecular identification of parasite infection.A 63-year-old Vietnamese man underwent travel health examination in our hospital. Physical examination showed that his height was 159 cm and weight was 4
PMID 26962840

Intestinal parasitic infections in relation to CD4(+) T cell counts and diarrhea in HIV/AIDS patients with or without antiretroviral therapy in Cameroon.

Nsagha DS1, Njunda AL2, Assob NJ3, Ayima CW4, Tanue EA5, Kibu OD6, Kwenti TE7.
BMC infectious diseases.BMC Infect Dis.2016 Jan 11;16:9. doi: 10.1186/s12879-016-1337-1.
BACKGROUND: Intestinal parasitic infections (IPI) are a major public health concern in HIV/AIDS patients particularly in resource-limited settings of Sub-Saharan Africa. Studies investigating the relationship between intestinal parasitic infections and CD4(+) T cell counts and diarrhea in HIV/AIDS p
PMID 26754404

Japanese Journal

イソスポーラ症による下痢を初発症状とした外国人AIDSの1例

坂本光男,足立拓也,相楽裕子,井関基弘
感染症学雑誌 72(6), 643-646, 1998
… We reported a Thailander patient with isosporiasis accompanied by AIDS. … Although isosporiasis is rarely found in Japan, it is stressed that in the AIDS patient with persistent diarrhea who may develop a parasitic disease as did in this case, frequent fecal examinations should be conducted. …
NAID 130004330681

Parasitic diseases in immunocompromised hosts. Cryptosporidiosis, isosporiasis, strongyloidiasis

HEYWORTH MF.
Gastroenterol Clin N Am 25, 691-707, 1996
NAID 30016962643

Related Pictures

Isosporiasis Isosporiasis | Health24 Isosporiasis - Wikipedia About Isosporiasis - Assignment Point Hematología y Parasitología Morphology Isosporiasis parasite life cycle - Stock Image C009/6276 - Science Photo Library

★リンクテーブル★

リンク元	「イソスポラ症」「イソスポーラ症」

「イソスポラ症」

Isosporiasis
	Oocyst in epithelial cyst of mammalian host
Classification and external resources
Specialty	Infectious disease
ICD-10	A07.3
ICD-9-CM	007.2
DiseasesDB	29775
eMedicine	med/1194 ped/1213
MeSH	D021865

　　[★]

英: isosporiasis
関: イソス・ーラ症

「イソスポーラ症」

　　[★]

英: isosporiasis
関: イソス・ラ症

[1] Isosporiasis at the CDC website.

[pmid18257775-2] 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.

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isosporiasis