Treatment and Prophylaxis of<i>Isospora belli</i>Infection in Patients with the Acquired Immunodeficiency Syndrome

Pape, Jean William; Verdier, Rose-Irene; Johnson, Warren D.

doi:10.1056/nejm198904203201604

Cited by 181 publications

(65 citation statements)

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“…17,35 The lower prevalence of Isosporiasis may be ascribed to the secondary prophylaxis for pneumocystosis through administration of sulfamethoxazole-trimethoprim during the course of AIDS, since Isospora belli is sensitive to this therapy. 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.…”

Section: Isosporiasismentioning

confidence: 99%

“…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%

See 1 more Smart Citation

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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“…Prophylaxis has been shown to be effective in HIV-infected patients with isosporiasis. 6 In February 1998, the patient was admitted with severe diarrhea, a 10-kg loss of weight despite 3.6 g cotrimoxazole orally per day, typical signs of vitamin A and D deficiencies, and an eosinophilia of 18% (1,250/L). Malabsorption was indicated by pathological results of xylose and lactose resorption assays.…”

Section: Case Reportmentioning

confidence: 99%

Case report: Nitazoxanide treatment failure in chronic isosporiasis.

Bialek¹,

Overkamp²,

Rettig³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. We report a 60-year-old immunocompetent patient with chronic biliary isosporiasis who failed to respond to orally administered cotrimoxazole prophylaxis and orally administered treatment with nitazoxanide, a 5-nitrothiazole benzamide compound. Severe malabsorption was regarded as responsible for the subtherapeutic levels of nitazoxanide in plasma and bile, resulting in treatment failure. Intravenously administered cotrimoxazole stopped the shedding of Isospora belli oocysts in bile within 5 days, excluding initially suspected resistance to cotrimoxazole. Patients with malabsorption and cholangitis due to Coccidia such as Isospora belli and Cryptosporidium spp. or due to protozoa that cause microsporidiasis seem to be predisposed to fail to respond to otherwise effective treatment.

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“…Histopathological examination of the small bowel in patients with Isospora belli reveals shortened villi, hypertrophic crypts and infiltration of the lamina propria with inflammatory cells, particularly eosinophils. [8] A highly sensitive and specific method of diagnosis has employed PCR with primers for small subunit rRNA sequences of Isospora belli.…”

mentioning

confidence: 99%