Effectiveness of Roxitbromycin for Treating Isospora belli Infection

Musey, K. L.; Chidiac, C.; Beaucaire, G.; S, Houriez; Fourrier, A

doi:10.1093/infdis/158.3.646

Cited by 17 publications

(7 citation statements)

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“…Pyrimethamine can also produce side-effects such as pancytopenia or allergies (Veldhuyzen van Zanten et al ., 1984; Musey et al ., 1988; Weiss et al ., 1988) and as with TMP-SMX, recurrences have also been observed in patients treated with pyrimethamine, therefore long-term treatment with pyrimethamine might be needed (Modigliani et al ., 1985; Jongwutiwes et al ., 2002). In cases when an oral pyrimethamine formulation did not work, intravenous pyrimethamine was successfully used (Bialek et al ., 2001).…”

Section: Treatmentmentioning

confidence: 99%

Cystoisospora belliinfections in humans: the past 100 years

Dubey

Almerı́a

2019

Parasitology

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Cystoisospora belli is a coccidian parasite of humans, with a direct fecal–oral transmission cycle. It is globally distributed, but mainly found in tropical and subtropical areas. Many cases of C. belli infections have been reported in patients with HIV, and in patients undergoing immunosuppressive therapy for organ transplants or those treated for tumours worldwide. Unsporulated or partially sporulated oocysts of C. belli are excreted in feces. When sporulated oocysts in contaminated water or food are ingested, asexual and sexual stages of C. belli are confined to the epithelium of intestines, bile ducts and gallbladder. Monozoic tissue cysts are present in extra-intestinal organs (lamina propria of the small and large intestine, lymph nodes, spleen, and liver) of immunosuppressed humans. However, a paratenic host has not been demonstrated. Cystoisospora belli infections can be persistent, lasting for months, and relapses are common; the mechanism of relapse is unknown. Recently, the endogenous stages of C. belli were re-examined and attention was drawn to cases of misidentification of non-protozoal structures in the gallbladder of patients as C. belli. Here, we review all aspects of the biology of C. belli, including morphology, endogenous stages, prevalence, epidemiology, symptoms, diagnosis and control.

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Section: Treatmentmentioning

confidence: 99%

Cystoisospora belliinfections in humans: the past 100 years

Dubey

Almerı́a

2019

Parasitology

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“…This leads to a reduction in the number of discharges and the recovery of body weight. 36 In recurrent situations or in non-responding patients it is necessary to administer other drugs such as pyrimethamine, in isolation or in association with sulfadiazine, 42 roxithromycin 43 and metronidazole. 44 Drugs such as tetracycline, ampicillin, nitrofurantoin, quinacrine and furazolidone have already been used but showed no therapeutic success.…”

Section: Isosporiasismentioning

confidence: 99%

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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“…A treatment course with pyrimethamine-sulfadiazine was initiated after the relapse, but little improvement was observed. Roxithromycin (2.5 mg/kg every 12 h) was used successfully to treat an African AIDS patient who was suffering from chronic I. belliinduced diarrhea that did not respond to TMP-SMX or pyrimethamine treatments (136). Roxithromycin was given orally for 15 days, and the diarrhea became intermittent and less severe.…”

Section: Treatmentmentioning

confidence: 99%

Biology of Isospora spp. from humans, nonhuman primates, and domestic animals

1997

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Coccidial parasites of the genus Isospora cause intestinal disease in several mammalian host species. These protozoal parasites have asexual and sexual stages within intestinal cells of their hosts and produce an environmentally resistant cyst stage, the oocyst. Infections are acquired by the ingestion of infective (sporulated) oocysts in contaminated food or water. Some species of mammalian Isospora have evolved the ability to use paratenic (transport) hosts. In these cases, infections can be acquired by ingestion of an infected paratenic host. Human intestinal isosporiasis is caused by Isospora belli. Symptoms of I. belli infection in immunocompetent patients include diarrhea, steatorrhea, headache, fever, malaise, abdominal pain, vomiting, dehydration, and weight loss, blood is not usually present in the feces. The disease is often chronic, with parasites present in the feces or biopsy specimens for several months to years. Recurrences are common, Symptoms are more severe in AIDS patients, with the diarrhea being more watery. Extraintestinal stages of I. belli have been observed in AIDS patients but not immunocompetent patients. Treatment of I. belli infection with trimethoprim-sulfamethoxazole usually results in a rapid clinical response. Maintenance treatment with trimethoprim-sulfamethoxazole is needed because relapses often occur once treatment is stopped.

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Effectiveness of Roxitbromycin for Treating Isospora belli Infection

Cited by 17 publications

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Cystoisospora belliinfections in humans: the past 100 years

Cystoisospora belliinfections in humans: the past 100 years

Enteric parasites and AIDS

Biology of Isospora spp. from humans, nonhuman primates, and domestic animals

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