Isospora belli

Mary Christelle Aquitania, Mark Bryan Fauni, Dan Koa,

Mary Ann Limbo, Keen Zherene Manalastas,
Jose Paulo Mendoza,
Nico Joy Ridulme and Kristen Therese Whaley
 
Group 13E Medical Technology Parasitology Lecture
 Parasite Biology

Pathogenesis and Clinical Manifestations

Isospora belli

Diagnosis

Treatment

Epidemology

Prevention and Control

 Isospora belli
Parasite Biology

→Opportunistic unicellular Coccidian parasite

→Infects the gastrointestinal tract of the human and animal
hosts
→Commonly observed in immunocompromised individuals

→Infection: Ingestion of an
infective/sporulated oocyst
containing two sporocysts with each
containing four sporozoites
→Both sexual and asexual cycle
Isospora belli oocyst with 2 sporoblasts. (Imature oocyst)
(Direct wet preparation without staining). The sporoblast
divides itself into 2 identical round masses x990.
 Isospora belli
Parasite Biology

An oocyst of Isospora belli showing 2 sporocysts

An oocyst of Isospora belli showing 1 sporocyst

 Isospora belli
Parasite Biology

Isospora belli Life Cycle From CDC 04AUG2010: http://www.dpd.cdc.gov/DPDx/HTML/Isosporiasis.htm

 Isospora belli
Parasite Biology

Isospora belli Life Cycle 04AUG2010: www.vet.uga.edu/vpp/clerk/Sheridan/Fig2.jpg

 Isospora belli
Pathogenesis and Clinical Manifestations

 May or may not have a detectable pathogenic

effect
– Debilitated or immunocompromised patients (very
young and very old) experience a much severe
damage compared to an immunocompetent
individual.
✓Asymptomatic, but occur as symptomatic infections

• [normal host] undergo self limiting infection with

mild diarrhea or no symptoms at all.

Pathogenesis and Clinical Manifestations
ASYMPTOMATIC
• Gastrointestinal illness
– loose stools or watery
diarrhea
• Often associated with
abdominal pain
• Malabsorption
• Weight loss
• Peripheral eosinophilia
Isospora belli
SYMPTOMATIC
• Diarrhea [may be
intermittent for months]
• Fever, malaise, anorexia,
abdominal pain, and
flatulence.
• AIDS and other
immunodeficient states:
– Chronic & severe dehydration
and debilitation
– Isosporiasis: cause biliary
diseases in patients with AIDS.
 Isospora belli
Diagnosis

→Intestinal Tract: Oocyst

– stool containing spherical mass of protoplasm
– modified acid-fast positive
• whole oocyst may stain pink if immature
• internal sporocysts stain if oocyst is mature.
→Infections are seen more frequently in
compromised patients.

Immature oocyst Isospora belli

(20-30 µm long by10-19 µm)
Modified acid fast stain.
 Isospora belli
Diagnosis

 Modified acid-fast stains of concentrated stool (Kinyoun’s

stain and auramine-rhodamine)
 Stool immunoassays
 Concentration wet preparation
 Direct microscopy
 Formalin-ethyl acetate concentration
 Concentration techniques such as ZnSO4 and sugar flotation
 String capsule (Entero test)
 Duodenal aspirate examinations and molecular based
techniques are also useful diagnostic tools.
 Isospora belli
Diagnosis

Immature oocyst Isospora belli oocyst with 2 Oocysts of Isospra belli stained with phenol auramine
sporoblasts (Direct wet preparation without
staining). The sporoblast divides itself into 2
identical round masses x990.
 Isospora belli
Treatment

ASYMPTOMATIC SYMPTOMATIC

→ No sign or symptoms [with severely immunocompromised

individuals such as AIDS patients]

• trimethoprim-sulfamethoxazole
[standard treatment, isosporiasis]
– co-trimoxazole
• Bed rest – 1 part trimethoprim and 5 parts
• Bland diet [soft, lightly sufamethoxazole
– 160/800 mg co-trimoxazole
spiced, and low in fiber – 4x a day, 10 days then 2x a day for 3 weeks
• pyrimethamine therapy + sulfadiazine -
and acidity ] 7 weeks
• Warning: have ↑risk of recurrence
 Isospora belli
Epidemology

→genus Toisospora
→previously known as Isospora belli infecting man >>
Cystoisospora belli

→MOT: Ingestion of water and food that was

contaminated with oocyst

→More frequent in tropical and subtropical countries

→Acquired by travelers to these countries
 Isospora belli
Epidemology

Research:
• Isosporiasis occurred in 15% (20 of 131) of such patients in Haiti
• US: More commonly observed in Hispanics, foreign-born patients,
and HIV-positive homosexual men
• Most common parasitic cause of diarrhea in HIV-infected subjects,
India [December 2006]
• Parasitic etiology was observed in 91 (37.1%) cases.
• France: Prevalence of isosporiasis (diarrhea)
– Increased and seen more frequently in patients originating in sub-Saharan
Africa and in children, women and heterosexual individuals. [Retrospective
study from 1995-2003 in two hospitals in Paris]
– increased from 0.4 per 1000 patients in the year 1995-1996 to 4.4 per 1000
patients in the year 2001-2003.
 Isospora belli
Prevention and Control

→Good sanitary practices:

✓habitual washing of hands thoroughly
✓eating only well cooked food with sanitary
procedures
✓ drinking safe water without contaminants
✓avoiding physical/sexual contact with infected
persons
✓proper disposal of waste with sanitary methods to
reduce fecal-oral transmission
Isospora belli

THANK YOU!!