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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. [Copyright &y& Elsevier]

Background: The patients with the infection by the human of immunodeficiency virus (HIV) commonly display diarrhea. Several opportunistic infections are responsible for this picture, among them the coccidia in particular Isospora belli, are responsible for a considerable number of cases. The objective of this study was to determine the prevalence of I. belli in a group of patients with HIV who displayed diarrhea. Methods: A cross-sectional study was made. To each patient a questionnaire created for this study was applied to him and three samples were taken in consecutive days for the search of I. belli through the technique of modified Kinyoun. Results: We studied 50 patients, 48 (96%) men and 2 (4%) women. The average of age was of 35.3 (19-73) years. The I. belli was founded in 6 patients for a prevalence of 12%. The unique variable associated to the presence of I. belli was the loss of greater weight between positive patients (7 versus 2.7 kg, p = 0.03). Conclusions: The prevalence of I. belli in this group of patients was similar to the reported one in other Latin American countries. In this study the variable epidemiological who have been related to the presence of I. belli were not present and the antiretroviral therapy did not have major influences. Perhaps the presence of I. belli in this group of patients contributed of significant way to a greater loss of weight and to a greater wasting syndrome. [ABSTRACT FROM AUTHOR]

Human infection by Cryptosporidium spp and other coccidia are due to opportunist non-host specific microorganisms. In HIV seropositive patients, the gastrointestinal symptoms accompanying such infections may be serious and prolonged and may include nausea, low-grade fever, abdominal cramps, anorexia and watery diarrhoea. We studied 188 stool samples from 111 patients (84 men and 27 women) with diarrhoea. A modified Ziehl-Nielsen technique for the detection of Cryptosporidium spp and Isospora belli was employed. The mean age of the patients was 31 years. Cryptosporidium spp was seen in 18% (n=20) of the patients, 90% (n=18) of whom were HIV seropositive. Isospora belli was recorded only from HIV seropositive patients (5.4% of all the patients studied and 6.5% of those who were HIV seropositive). These data confirm the good results obtained with this technique for the identification of Cryptosporidium spp and other coccidia and also reaffirm the clinical importance of correctly diagnosing the cause of diarrhoea, particularly in HIV seropositive patients.Infecção humana por Cryptosporidium spp e outros coccideos deve-se a microrganismos oportunistas hospedeiros não-específicos e, em pacientes HIV positivos, os sintomas gastro-intestinais podem ser sérios e prolongados incluindo náuseas, febre baixa, dores abdominais, anorexia e diarréia aquosa. Estudamos 188 amostras de fezes provenientes de 111 pacientes (84 homens e 27 mulheres, com idade média de 31 anos) com diarréia, atendidos no Hospital das Clínicas da Universidade Estadual de Campinas. Para detecção de Cryptosporidium spp e lsospora belli empregou-se a técnica de Ziehl-Nielsen modificada. Oitenta e três porcento dos pacientes (n=92) eram HIV positivos. Cryptosporidium spp foi observado em 18% de todos os pacientes, sendo que destes, noventa porcento eram HIV positivos, lsospora belli foi evidenciada somente em pacientes HIV positivos, com uma freqüência de 5.4% de todos os pacientes e de 6.5% considerando-se apenas os pacientes HIV positivos. Este estudo confirma os bons resultados obtidos com a técnica empregada para identificação de Cryptosporidium spp e outros coccideos, além de ressaltar a importância da investigação etiológica apropriada em casos de diarréia prolongada, especialmente em pacientes imunossuprimidos.

Persistent diarrhea is a major manifestation of Acquired Immunodeficiency Syndrome (AIDS) which might be more complicated in Human Immunodeficiency Virus (HIV) infected children especially those from developing countries. There are numerous reports showing the emergence of intestinal opportunistic coccidian parasites, mostly Cryptosporidium parvum and Isospora belli in HIV-infected individuals. The prevalence of isosporiasis is probably underestimated in developing countries because routinely not all HIV-infected patients are examined for the presence of this protozoan infection. Here we report a case of HIV-infected isosporiasis presenting with failure to thrive and persistent diarrhea. Since I. belli infection in children responds well to therapy with trimethoprim-sulfamethoxazole, isosporiasis should be considered as a treatable infection in AIDS, if it is detected at proper time. [ABSTRACT FROM AUTHOR]

The occurrence of intestinal parasites, its relation with the transmission mechanism of HIV, and the clinical state of the AIDS patients, were analyzed in 99 Group IV patients (CDC, 1986), treated at "Hospital Universitário Pedro Ernesto" (HUPE), between 1986 and 1988. The group consisted of 79 (79.8%) patients whose HIV transmission mechanism took place through sexual contact and of 16 (20.2%) who were infected through blood. Feces samples from each patient were examined by four distincts methods (Faust et al, Kato-Katz, Baermann-Moraes and Baxby et al.). The moste occuring parasites were: Cryptosporidium sp., Entamoeba coli and Endolimax nana (18.2%), Strongyloides stercoralis and Giardia lambia (15.2%). E. histolytica and/or E. hartmanni (13.1%), Ascaris lumbricoides (11.1%) and Isospora belli (10.1%). Furthermore, 74.7% of the patients carried at least one species. Intestinal parasites were found in 78.5% of the patients who acquired the HIV through sexual intercourse and in 56,3% of those infected by blood contamination. The difference, was not statistically significant (p > 0.05). In the group under study, the increase of the occurrence of parasitc infections does not seem to depend on the acquisiton of HIV through sexual contact. It appears that in developing countries, the dependancy is more related to the classic mechanisms of parasites transmission and its endemicity.A ocorrência de parasitas intestinais, sua relação com o mecanismo de transmissão do HIV e a apresentação clínica da AIDS foram analisadas em 99 pacientes do grupo IV (CDC, 1986), atendidos no Hospital Universitário Pedro Ernesto (HUPE) entre 1986 e 1988. O grupo era constituído de 79 (79,9%) pacientes cujo mecanismos de transmssão do HIV se deu por via sexual e de 16 (20,2%) que se infectaram por via sanguínea. Amostras de fezes de cada paciente foram examinadas por quatro métodos distintos (Faust et al., Kato-Katz, Baermann-Moraes e Baxby et al.). Os parasitos mais frqüentemente encontrados foram: Cryptosporidium sp., Entamoeba coli e Endolimax nana (18,2%) seguidos de Strongyloides stercoralis e Giardia lamblia (15,2%), E. histolytica e/ou E. hartmanni (13,1%), Ascaris lumbricoides (11,1%) e Isospora belii (10,1%), sendo que 74,4% dos pacientes com AIDS albergavam pelo menos uma espécie. Observamos que 78,5% dos pacientes que adquiriram o HIV por via sexual e 56,3% dos que foram infectados por via sanguínea albergavam parasitos intestinais, mas a diferença não foi estatisticamente significativa (p>0,05). O mecanisto de infecção por via sexual não parece contribuir de forma importante para o aumento da ocorrência de infecções parasitárias no grupo estudado e sim os mecanismos clássicos de transmissão de parasitos em nosso meio.

Abstract: Background: Hypokalemia of clinical significance, severe enough to cause paralysis and cardiac dysrhythmias, is an uncommon life-threatening medical disorder. Hypokalemic periodic paralysis (HPP), where an abrupt intracellular shift of potassium has occurred, must be distinguished from hypokalemic non-periodic paralysis (non-HPP), where a total body potassium deficit exists. The challenge for emergency physicians is to swiftly and accurately differentiate disease etiology and institute prompt treatment. Aggressive potassium repletion, required in non-HPP etiologies, may predispose HPP patients to dangerous and potentially fatal rebound hyperkalemia as the intracellular potassium shift resolves. Objectives: Describe the process by which HPP and non-HPP can be differentiated on clinical and laboratory grounds leading to appropriate resuscitation from severe and clinically relevant hypokalemia. Chronic diarrhea syndromes and possibly normal alkaline phosphatase levels alert the clinician to the potential for non-HPP. Case Report: A case of HIV/AIDS-associated isospora belli diarrheal illness with severe hypokalemia of the non-HPP type is presented. Historical, laboratory, and clinical findings, which assisted in the differentiation from HPP, are emphasized. Clinical progression and treatment strategies, as well as electrocardiogram findings with T-U-P fusion waves, are described in detail. Conclusion: The history, especially the time course of disease, is essential in differentiating HPP and non-HPP, allowing treatment to proceed without overcorrection and rebound hyperkalemia. Although other infectious diseases have been linked to non-HPP, to our knowledge this is the first report linking non-HPP to isospora belli diarrheal illness. [Copyright &y& Elsevier]