Isospora belli superinfection in a patient with eosinophilic gastroenteritis—A diagnostic challenge

Abstract

Isospora belli infection, characterized by peripheral blood eosinophilia, is often seen as an opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). It is also reported in patients with underlying lymphoproliferative disorders including lymphoma and leukemia. Eosinophil-associated gastrointestinal disorders (EGID), including eosinophilic gastroenteritis (EGE), is characterized by eosinophilic infiltration of the gastrointestinal (GI) tract with various GI symptoms. We report a case of a 50-year-old male who developed Isospora superinfection of the small bowel while receiving systemic corticosteroids for EGE. He presented with worsening diarrhea, abdominal pain, nausea and vomiting with worsening peripheral eosinophilia. I. belli infection was diagnosed by the detection of oocysts in stool samples and by the presence of the parasite on duodenal biopsy in the background of tissue eosinophilia. I. belli can cause severe chronic diarrhea in immunocompromised patients on corticosteroids. Trimethoprim-sulfamethoxazole often provided rapid cure. Even though peripheral blood eosinophilia was seen in both EGE and Isospora infection, the identification of subnuclear protozoal inclusions as a new histologic finding, as well as the absence of this finding in previous duodenal biopsies coupled with the continued presence of tissue eosinophilia, favored a parasitic superinfection in the setting of underlying EGE.

Molecular Testing for Clinical Diagnosis and Epidemiological Investigations of Intestinal Parasitic Infections

“…While cystoisosporiasis may be common in nonhuman hosts, human infection by Cystoisospora appears to be relatively rare, and symptomatic infections are probably seen mostly in immunocompromised individuals, including patients with HIV/AIDS or lymphoproliferative disorders, in whom infections are often chronic and severe (198)(199)(200)(201). Superinfection of the small bowel during administration of systemic corticosteroids for eosinophilic gastroenteritis has been documented (202).…”

Dynamique de l'abondance des oocystes d'Isosporabellidans un milieu aquatique en zone tropicale (Cameroun)

“…belli dans le milieu aquatique en zone tropicale et traduisent la contamination fécale des eaux. De même, les résultats des travaux de Kenmogne et al (2010) sont responsables de l'hyperinfection chez l'hôte (Navaneethan et al, 2012). La forte densité des oocystes immatures serait le résultat de la faible oxygénation du plan d'eau.…”

“…Dans cette quête, elles s'exposent à des parasitoses d'origine hydrique et de nature diarrhéique dont la prévalence est autour de 14,4 % (Yongsi et al, 2008). Parmi les parasitoses, figure l'isosporose, causée par Isospora belli qui est responsable des maladies diarrhéiques chez les immuno-compétents et surtout les immuno-déprimés (VIH/SIDA) (Sasaki et al, 2004 ;Navaneethan et al, 2012). Cette entéropathologie est d'une gravité particulière chez les porteurs du VIH en raison d'une expression clinique sévère et superposable à celle de la cryptosporidiose (Cranenbonk et al, 2003) car ces deux pathologies présen-tent presque les mêmes symptômes.…”

Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient

“…In addition to immunocompromised conditions that include AIDS, adult T-cell leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma, thymoma, transplantation, and corticosteroid-treated patients [6,7,14-21], various immunocompetent conditions can also be the risk factors for symptomatic isosporiasis. These factors include poor hygiene [3], malnutrition [22], and debilitating infectious diseases, for example dengue fever [23].…”

“…Peripheral blood eosinophilia, up to 39.9% before treatment, was a characteristic feature for our patient. Though lesser in degree, eosinophilia had also been commonly noted in isosporiasis cases [3,14,18,21]. Therefore, in patients with intestinal inflammatory diseases with diarrhea and peripheral blood eosinophilia, isosporiasis should be included among the list of differential diagnosis.…”