History

Fact Explanation
Diarrhea Isosporiasis is usually mild diarrheal disease caused by the coccidia Isospora belli. The parasite can be spread by ingesting contaminated food or water. Ingested mature oocysts liberate sporozoites which invade the enterocytes of the proximal small intestine. Later they are thought to release various toxins. It causes mild diarrhea in immunocompetent individuals. The diarrhea is mild watery/ mucous type and self limiting. It may smell offensively. In the immunocompromised individuals, this diarrhea usually gets more severe. It becomes more profuse, but still watery in nature. Isosporiasis can range in severity from a chronic intermittent illness to a severe life-threatening diarrheal illness in patients with AIDS[1,2,3,4,5]
Abdominal pain Patients may complain of crampy abdominal pain, which can last for weeks. This may accompany vomiting, malaise, anorexia and weight loss. [2,3,4]
Nonspecific symptoms Rarely diarrhea man abdominal pain may accompany with nonspecific symptoms such as insidiouds onset low grade fever, myalgias and headache. [1,3,5]
At risk population Isosporiasis is most common in tropical and subtropical areas of the world such as in latin America, tropical Africa, Middle East and South East Asia. The disease is more common and severe in the presence of immunocompromized conditions such patients with AIDS or malignancy, or in patients undergoing chemotherapy. [2,3,4,5]
References
  1. OLUSEGUN AF, OKAKA CE, LUIZ DANTAS MACHADO R. Isosporiasis in HIV/AIDS Patients in Edo State, Nigeria. Malays J Med Sci [online] 2009 Jul, 16(3):41-4 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22589664
  2. GAUTAM N, KHURANA S, SHARMA A, SEHGAL R. Isosporiasis in a tertiary care center of North India. Indian J Pathol Microbiol [online] 2014 Apr-Jun, 57(2):272-4 [viewed 11 August 2014] Available from: doi:10.4103/0377-4929.134707
  3. KIM MJ, KIM WH, JUNG HC, CHAI JW, CHAI JY. Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient. Korean J Parasitol [online] 2013 Apr, 51(2):207-12 [viewed 11 August 2014] Available from: doi:10.3347/kjp.2013.51.2.207
  4. HAIDER M, SHARMA A, DOGRA V, MISHRA B. Isospora spp. in chronic diarrhea: A case report. J Pharm Bioallied Sci [online] 2013 Oct, 5(4):327-8 [viewed 11 August 2014] Available from: doi:10.4103/0975-7406.120071
  5. SILVA GB, FERNANDES KP, SEGUNDO GR. Common variable immunodeficiency and isosporiasis: first report case. Rev Soc Bras Med Trop [online] 2012 Dec, 45(6):768-9 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295886

Examination

Fact Explanation
Fever Mild fever is rare and nonspecific sign of isosporiasis. It is more pronounced among immunocompromised individuals. [1,2,3]
Dehydration Signs of dehydration such as sunken eyes, extreme thirst, extreme fussiness or sleepiness in infants and children, irritability and confusion in adults, very dry mouth, skin and mucous membranes and little or no urination are also uncommon except those are immunocompromised. [1,3]
References
  1. GAUTAM N, KHURANA S, SHARMA A, SEHGAL R. Isosporiasis in a tertiary care center of North India. Indian J Pathol Microbiol [online] 2014 Apr-Jun, 57(2):272-4 [viewed 11 August 2014] Available from: doi:10.4103/0377-4929.134707
  2. SILVA GB, FERNANDES KP, SEGUNDO GR. Common variable immunodeficiency and isosporiasis: first report case. Rev Soc Bras Med Trop [online] 2012 Dec, 45(6):768-9 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295886
  3. OLUSEGUN AF, OKAKA CE, LUIZ DANTAS MACHADO R. Isosporiasis in HIV/AIDS Patients in Edo State, Nigeria. Malays J Med Sci [online] 2009 Jul, 16(3):41-4 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22589664

Differential Diagnoses

Fact Explanation
Amebiasis Amoebiasis, or Amebiasis, refers to infection caused by the amoeba Entamoeba histolytica. Most infected people are asymptomatic. Severe amoebiasis infections (known as invasive or fulminant amoebiasis) occur in two major forms. Invasion of the intestinal lining causes amoebic dysentery or amoebic colitis. Symptoms can range from mild diarrhea to severe dysentery with blood and mucus. [1]
Ascariasis Ascariasis is caused by Ascaris lumbricoides (large roundworm of humans) It is extremely common infection worldwide and associated with poor sanitation (lack of latrines) in slum areas and estate line rooms. Ascariasis affects more in children than in adults. Mild infection of adult worms does not show symptoms or signs. Increasing worm loads result in worsening of chronic malnutrition especially in children with a poor diet, poor weight gain and stunting. Symptoms may include shortness of breath and fever in the beginning of the disease. These may be followed by symptoms of abdominal swelling, abdominal pain and diarrhea. [2]
Fascioliasis Fasciola hepatica or the sheep liver fluke is a common parasite of sheep and cattle kept on damp pastures in many parts of the world, but is only occasionally found in men. Most cases have been reported from from sheep rearing countries such as South America, Europe and North America. People usually become infected by eating raw watercress or other water plants contaminated with immature parasite larvae. From the ingestion of metacercariae to the appearance of the first symptoms, it may take few days to 3 months. The immature larval flukes migrate through the intestinal wall, the abdominal cavity, and the liver tissue, into the bile ducts, where they develop into mature adult flukes. Symptoms like abdominal pain, dyspepsia and nausea are caused by localized and or generalized toxic and allergic reactions triggered by this migration. In the chronic phase, abdominal pain may be attributed to painful enlargement of the liver secondary to the adult flukes in the bile ducts which cause obstruction, inflammation and hyperplasia of its epithelium (cholangitis and cholecystitis). This abdominal pain is a biliary colic characterized by an intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula. [3]
Giardiasis Giardiasis is caused by Giardia intestinalis, a flagellate protozoan which decreases expression of brush-border enzymes namely disaccharidases and lipase. It causes impairment of carbohydrate and lipid digestion resulting osmotic diarrhea.Travelers to countries where giardiasis is common, People in child care settings, those who are in close contacts with patients, people who swallow contaminated or untreated water,men who have sex with men have a greater risk of becoming infected. Diarrhea is the most common symptom in acute giardiasis. It is more specifically, a steatorrhoea which contains pale, bulky, frothy, foul smelling stools which are floating in the lavatory pan due to fat content. [4]
Gastroenteritis Viral gastroenteritis is the most common cause of watery diarrhea.It is associated with abdominal pain,nausea and vomiting. Bacterial gastroenteritis usually results in watery diarrhea and sometimes blood and mucous diarrhea.Dehydration is common . Bacterial disease responds to antibacterial agents. [5]
References
  1. ARCHAMPONG EQ, CLARK CG. Surgical problems in amoebiasis. Ann R Coll Surg Engl [online] 1973 Jan, 52(1):36-48 [viewed 27 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/4568445
  2. WANG J, PAN YL, XIE Y, WU KC, GUO XG. Biliary ascariasis in a bile duct stones-removed female patient. World J Gastroenterol [online] 2013 Sep 28, 19(36):6122-4 [viewed 27 July 2014] Available from: doi:10.3748/wjg.v19.i36.6122
  3. KARADAğ-ÖNCEL E, OZSüREKçI Y, OZKAYA-PARLAKAY A, CELIK M, CENGIZ AB, HALILOğLU M, CEYHAN M, KARA A. Fasciola hepatica infection: clinical and radiological findings in pediatric patients. Turk J Pediatr [online] 2012 Jul-Aug, 54(4):362-7 [viewed 27 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23692716
  4. VESY , PETERSON . Review article: the management of Giardiasis. Aliment Pharmacol Ther [online] 1999 July, 13(7):843-850 [viewed 27 July 2014] Available from: doi:10.1046/j.1365-2036.1999.00537.x
  5. GODANA W, MENGISTIE B. Determinants of acute diarrhoea among children under five years of age in Derashe District, Southern Ethiopia. Rural Remote Health [online] 2013, 13(3):2329 [viewed 27 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/24016301

Investigations - for Diagnosis

Fact Explanation
Full blood count Parasitic infestation is characterized by high degree of eosinophilia in half of the patients. Leukocytosis and anemia (rarely) may also occur. [1,2]
Stool examination Examination of stool smears (wet smears) for oocysts is the diagnostic investigation. Because the oocysts may be passed in small amounts and intermittently, repeated stool examinations and concentration procedures are recommended. The oocyte is elongated in shape. Average size is 25-33 x 12-16µm. Each has a thin translucent wall with two round sporocysts, each of which has four crescentic sporozoites. If stool examinations are negative, examination of duodenal specimens by biopsy or string test (Enterotest) may be needed. [1,2,3]
References
  1. SILVA GB, FERNANDES KP, SEGUNDO GR. Common variable immunodeficiency and isosporiasis: first report case. Rev Soc Bras Med Trop [online] 2012 Dec, 45(6):768-9 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295886
  2. HAIDER M, SHARMA A, DOGRA V, MISHRA B. Isospora spp. in chronic diarrhea: A case report. J Pharm Bioallied Sci [online] 2013 Oct, 5(4):327-8 [viewed 11 August 2014] Available from: doi:10.4103/0975-7406.120071
  3. KIM MJ, KIM WH, JUNG HC, CHAI JW, CHAI JY. Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient. Korean J Parasitol [online] 2013 Apr, 51(2):207-12 [viewed 11 August 2014] Available from: doi:10.3347/kjp.2013.51.2.207

Management - General Measures

Fact Explanation
Fluid replacement Fluid replacement and therapy for dehydration may be the most urgently required. correction of electrolyte imbalance is also helpful Fluid losses may range from 2-20 Liters per day. Patients with severe diarrhea may require hospitalization. [1,2,3]
Prevention Practicing hygienic measures and avoidance of possible exposure to contaminated food and water are the effective methods of prevention. [2,3]
References
  1. KIM MJ, KIM WH, JUNG HC, CHAI JW, CHAI JY. Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient. Korean J Parasitol [online] 2013 Apr, 51(2):207-12 [viewed 11 August 2014] Available from: doi:10.3347/kjp.2013.51.2.207
  2. OLUSEGUN AF, OKAKA CE, LUIZ DANTAS MACHADO R. Isosporiasis in HIV/AIDS Patients in Edo State, Nigeria. Malays J Med Sci [online] 2009 Jul, 16(3):41-4 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22589664
  3. SILVA GB, FERNANDES KP, SEGUNDO GR. Common variable immunodeficiency and isosporiasis: first report case. Rev Soc Bras Med Trop [online] 2012 Dec, 45(6):768-9 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295886

Management - Specific Treatments

Fact Explanation
Trimethoprim-sulfamethoxazole (Co-trimoxazole) The condition does not respond well to most of the antibiotics used to treat diarrhea. Trimethoprim-sulfamethoxazole is the usual treatment choice. Patients with AIDS may require long-term maintenance therapy for suppression of the infection. [1,2,3]
References
  1. GAUTAM N, KHURANA S, SHARMA A, SEHGAL R. Isosporiasis in a tertiary care center of North India. Indian J Pathol Microbiol [online] 2014 Apr-Jun, 57(2):272-4 [viewed 11 August 2014] Available from: doi:10.4103/0377-4929.134707
  2. SILVA GB, FERNANDES KP, SEGUNDO GR. Common variable immunodeficiency and isosporiasis: first report case. Rev Soc Bras Med Trop [online] 2012 Dec, 45(6):768-9 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295886
  3. OLUSEGUN AF, OKAKA CE, LUIZ DANTAS MACHADO R. Isosporiasis in HIV/AIDS Patients in Edo State, Nigeria. Malays J Med Sci [online] 2009 Jul, 16(3):41-4 [viewed 11 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/22589664