Chronic Cystoisospora belli infection in a Colombian patient living with HIV and poor adherence to highly active antiretroviral therapy
Abstract
Cystoisospora belli is an intestinal Apicomplexan parasite associated with diarrheal illness and disseminated infections in humans, mainly immunocompromised individuals such as those living with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). An irregular administration of highly active antiretroviral therapy (HAART) in HIV patients may increase the risk of opportunistic infections like cystoisosporiasis.
We describe here a case of C. belli infection in a Colombian HIV patient with chronic gastrointestinal syndrome and poor adherence to HAART. His clinical and parasitological cure was achieved with trimethoprim-sulfamethoxazole treatment. Although a reduction in the number of C. belli cases has been observed since the use of HAART, this parasite still has to be considered as a differential diagnosis of diarrheal disease in HIV/AIDS patients.
Effective interventions enhancing adherence to HAART should be included in HIV patient care programs.
Downloads
References
Barta JR, Schrenzel MD, Carreno R, Rideout BA. The genus Atoxoplasma (Garnham 1950) as a junior objective synonym of the genus Isospora (Schneider 1881) species infecting birds and resurrection of Cystoisospora (Frenkel 1977) as the correct genus for Isospora species Infecting Mammals. J Parasitol. 2005;91:726-7. https://doi.org/10.1645/GE-3341.1
Resende DV, Assis DC, Ribeiro MFB, Cabrine-Santos M, Frenkel JK, Correia D, et al. Ultrastructural aspects of Cystoisospora belli (syn. Isospora belli) in continuous cell lines. Microsc Res Tech. 2014;77:472-8. http://doi.wiley.com/10.1002/jemt.22372
Dubey JP, Almeria S. Cystoisospora belli infections in humans: The past 100 years. Parasitology. 2019;146:1490-527. https://doi.org/10.1017/S0031182019000957
Frenkel JK. Besnoitia wallacei of cats and rodents: With a reclassification of other cystforming isosporoid coccidia. J Parasitol. 1977;63:611. https://doi.org/10.2307/3279560
Frenkel JK, Smith DD. Determination of the genera of cyst-forming coccidia. Parasitol Res. 2003;91:384-9. https://doi.org/10.1007/s00436-003-0969-4
Lindsay DS, Houk AE, Mitchell SM, Dubey JP. Developmental biology of Cystoisospora (Apicomplexa: Sarcocystidae) monozoic tissue cysts. J Parasitol. 2014;100:392-8. https://doi.org/10.1645/13-494.1
Oliveira-Silva MB, Lages-Silva E, Resende DV, Prata A, Ramírez LE, Frenkel JK. Cystoisospora belli: In vitro multiplication in mammalian cells. Exp Parasitol. 2006;114:189-92. https://doi.org/10.1016/j.exppara.2006.03.004
Rowan DJ, Said S, Schuetz AN, Pritt BS. A case of Cystoisospora (Isospora) belli infection with multiple life stages identified on endoscopic small bowel biopsies. Int J Surg Pathol. 2020;28:884-6. https://doi.org/10.1177/1066896920901589
Lindsay DS. Cystoisospora species insights from development in vitro. Front Vet Sci. 2019;5:335. https://doi.org/10.3389/fvets.2018.00335
Wang ZD, Liu Q, Liu HH, Li S, Zhang L, Zhao YK, et al. Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: A global systematic review and meta-analysis. Parasit Vectors. 2018;11:28. https://doi.org/10.1186/s13071-017-2558-x
López MC, Moncada LI, Murcia MI, Saravia J, Nicholls RS. Frecuencia de parásitos intestinales en pacientes VIH+ en la ciudad de Santa Fe de Bogotá. Revista de la Facultad de Medicina. 1999;47:9-12.
Arzuza O, Arroyo B, Villegas S, Rocha A, Díaz H. Infecciones parasitarias intestinales en pacientes positivos para el virus de la inmunodeficiencia humana (VIH) en la ciudad de Cartagena de Indias, Colombia. Infectio. 2003;7:2003.
Botero JH, Montoya MN, Vanegas AL, Díaz A, Navarro-i-Martínez L, Bornay FJ, et al. Frecuencia de microsporidiosis intestinal en pacientes positivos para VIH mediante las técnicas de Gram cromotropo rápido y PCR. Biomédica. 2004;24:375-84. https://doi.org/10.7705/biomedica.v24i4.1287
Carmona-Fonseca J, Correa-Botero A. Parásitos intestinales, desnutrición y condiciones de vida de niños en Urabá (Colombia): soledad y olvido. Rev Salud Ambient. 2013;13:108-19.
Lucero-Garzón TA, Álvarez-Motta LA, Chicue-López JF, López-Zapata D, Mendoza-Bergaño CA. Parasitosis intestinal y factores de riesgo en niños de los asentamientos subnormales, Florencia-Caquetá, Colombia. Rev Fac Nac Salud Pública. 2015;33:171-80. https://doi.org/10.17533/udea.rfnsp.v33n2a04
Sherman DS, Fish DN. Management of protease inhibitor--associated diarrhea. Clin Infect Dis. 2000;30:908-14. https://doi.org/10.1086/313826
Shimelis T, Tassachew Y, Lambiyo T. Cryptosporidium and other intestinal parasitic infections among HIV patients in southern Ethiopia: Significance of improved HIV-related care. Parasit Vectors. 2016;9:270. https://doi.org/10.1186/s13071-016-1554-x
Derouin F, Lagrange-Xelot M. Treatment of parasitic diarrhea in HIV-infected patients. Expert Rev Anti Infect Ther. 2008;6:337-49. https://doi.org/10.1586/14787210.6.3.337
Duran S, Spire B, Raffi F, Walter V, Bouhour D, Journot V, et al. Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clin Trials. 2001;2:38-45. https://doi.org/10.1310/R8M7-EQ0M-CNPW-39FC
Batista F, Miranda L, Silva MB, Taborda RL, Soares MC, Matos N. Chronic Cystoisospora belli infection in an HIV/AIDS patient treated at the specialized assistance service in Porto Velho County - Rondônia. Rev Soc Bras Med Trop. 2019;52:e20180204. https://doi.org/10.1590/0037-8682-0204-2018
Lagrange-Xélot M, Porcher R, Sarfati C, de Castro N, Carel O, Magnier JD, et al. Isosporiasis in patients with HIV infection in the highly active antiretroviral therapy era in France. HIV Med. 2008;9:126-30. https://doi.org/10.1111/j.1468-1293.2007.00530.x
Some similar items:
- Jorge Botero-Garcés, Esteban Villegas-Arbeláez, Sofía Giraldo, Johanna Urán-Velásquez, Laura Arias-Agudelo, Juan Carlos Alzate-Ángell, Gisela María García-Montoya, Ana Luz Galván-Díaz, Prevalence of intestinal parasites in a cohort of HIVinfected patients from Antioquia, Colombia , Biomedica: Vol. 41 No. Sp. 2 (2021): Octubre, Infecciones bacterianas y virales
- María Patricia Arbeláez, Alexánder Arbeláez, Rubén Darío Gómez, Carlos Rojas, Lázaro Vélez, Sonia Luz Arias, Jorge Nagles, Luz Marina Peláez, Gloria Betancourt, Gloria Velásquez, Effectiveness of prophylaxis against tuberculosis in patients infected with HIV , Biomedica: Vol. 27 No. 4 (2007)
- Nélida Muñoz, María Elena Realpe, Elizabeth Castañeda, Clara Inés Agudelo, Characterization by pulsed-field gel electrophoresis of Salmonella Typhimurium isolates recovered in the acute diarrheal disease surveillance program in Colombia, 1997-2004 , Biomedica: Vol. 26 No. 3 (2006)
- Leonardo F. Jurado, Martha I. Murcia, Patricia Hidalgo, John E. Leguizamón, Lorena R. González, Phenotypic and genotypic diagnosis of bone and miliary tuberculosis in an HIV+ patient in Bogotá, Colombia , Biomedica: Vol. 35 No. 1 (2015)
- Myrtha Arango, Elizabeth Castañeda, Clara Inés Agudelo, Catalina De Bedout, Carlos Andrés Agudelo, Angela Tobón, Melva Linares, Yorlady Valencia, Ángela Restrepo, The Colombian Histoplasmosis Study Group, Histoplasmosis: results of the Colombian National Survey, 1992-2008 , Biomedica: Vol. 31 No. 3 (2011)
- Zulbey Rivero-Rodríguez, Amparo Hernández, Ángela Bracho, Solneumar Salazar, Rafael Villalobos, Prevalence of intestinal microsporidia and other intestinal parasites in HIV positive patients of Maracaibo, Venezuela , Biomedica: Vol. 33 No. 4 (2013)
- Ángela Liliana Londoño-Franco, Juliana Loaiza-Herrera, Fabiana María Lora-Suárez, Jorge Enrique Gómez-Marín, Blastocystis sp. frequency and sources among children from 0 to 5 years of age attending public day care centers in Calarcá, Colombia , Biomedica: Vol. 34 No. 2 (2014)
- Iván Darío Flórez, Esteban Ramos, Carlos Bernal, Olga Juliana Cuéllar, José William Cornejo, Intravenous rehydration for diarrheal dehydration of eutrophic children: survey of protocols provided at Colombian medical schools , Biomedica: Vol. 31 No. 3 (2011)
- Mauricio Beltrán, María Cristina Navas, María Patricia Arbeláez, Jorge Donado, Sergio Jaramillo, Fernando De la Hoz, Cecilia Estrada, Lucía del Pilar Cortés, Amalia de Maldonado, Gloria Rey, Seroprevalence of hepatitis B virus and human immunodeficiency virus infection in a population of multiply-transfused patients in Colombia , Biomedica: Vol. 29 No. 2 (2009)
- María Teresa Rugeles, Paula A. Velilla, Carlos J. Montoya, Mechanisms of human natural resistance to HIV: A summary of ten years of research in the Colombian population , Biomedica: Vol. 31 No. 2 (2011)
Funding data
-
Ministerio de Ciencia, Tecnología e Innovación Productiva
Grant numbers 1115-777-57608
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
