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Background: Diarrhea in piglets directly affects commercial swine production. The disease results from the interaction of pathogens with the host immune system and is also affected by management procedures. Several pathogenic agents such as Campylobacter spp., Clostridium perfringens, Escherichia coli, Salmonella spp., group A rotavirus (RV-A), coronaviruses (transmissible gastroenteritis virus; porcine epidemic diarrhea virus), as well as nematode and protozoan parasites, can be associated with disease cases., Results: All bacterial, viral, protozoan, and parasitic agents here investigated, with the exception of Salmonella spp. as well as both coronaviruses, were detected in varying proportions in piglet fecal samples, and positive animals were equally distributed between case and control groups. A statistically significant difference between case and control groups was found only for Cystoisospora suis (p = 0.034) and Eimeria spp. (p = 0.047). When co-infections were evaluated, a statistically significant difference was found only for C. perfringens β2 and C. suis (p = 0.014)., Conclusions: The presence of pathogens in piglets alone does not determine the occurrence of diarrhea episodes. Thus, the indiscriminate use of antibiotic and anthelminthic medication should be re-evaluated. This study also reinforces the importance of laboratory diagnosis and correct interpretation of results as well as the relevance of control and prophylactic measures.

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.

Isospora belli is a coccidian protozoon that can cause serious diarrhea especially in immunocompromised patients. The laboratory diagnosis depends primarily on the identification of oocysts in stool specimens by direct microscopic examination with iodine or special stains. This case is presented in order to draw attention to isosporiasis among the diarrheas that can be seen in elderly patients with several chronic diseases. A 81 year-old debilitated male, who had a history of hypertension, Alzheimer's disease, previous cerebrovascular accident and right hemiplegia, was admitted to our hospital complaining of malaise, anorexia, chills, abdominal pain, dysuria, cough, sputum and diarrhea of ten days duration. I. belli oocysts were detected by microscopic examination of the sample with iodine after concentration by formalin-ethyl acetate sedimentation. Then, modified acid-fast and trichrome stains were performed and I. belli oocysts were detected with both methods. Similar to this case, infections caused by I. belli can occur in elderly immunocompromised patients with several chronic diseases and inadequate nutrition and care. Consequently, in individuals with persistent diarrhea, examinations and tests should be carried out by taking their immune status into consideration and stool examinations should be done at frequent intervals using the concentrations methods and special stains.

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 © 2011 Elsevier Inc. All rights reserved.)

A 35-year-old male, positive for Human Immunodeficiency Virus (HIV) antibodies, was found to have heavy infestation by Isospora belli, leading to gastrointestinal opportunistic infection. Stool sample of the patient presenting with diarrhea of 2 months duration showed numerous oocysts of I. belli. His blood CD4 count was 85/cmm. The patient was from a slum area with poor sanitation. He was put on antimicrobial agent trimethoprim-sulfamethoxazole and was followed up. However, he died after 1 month of treatment.

Travel-related diarrhea is common among tourists to developing countries. We report two cases of diarrhea due to Cryptosporidium hominis and Isospora belli, respectively, in a child and an adult returning from Africa, without other associated microorganisms. We emphasize the need to detect underdiagnosed coccidiosis in diarrheic travelers with specific methods.

Opportunistic isosporidial infection of the gastrointestinal tract is frequently encountered in patients with acquired immunodeficiency syndrome (AIDS) and is considered to be an AIDS-defining illness. Chronic severe watery diarrhea due to Isospora belli has also been reported in other immunodeficiency states. This report describes severe chronic debilitating diarrhea due to isosporiasis in a patient with mediastinal thymoma, a common tumor of the anterior mediastinum, originating from the epithelial cells of the thymus. Numerous oocysts of I. belli were detected in direct smear preparation of the diarrheic stool sample of the patient, who had an 8-month history of recurrent diarrhea. Duodenal and colonic mucosal biopsies revealed slight degrees of atrophic changes associated with infiltration of the lamina propria by an appreciable number of eosinophiles and the presence of unizoit tissue cysts of I. belli in the surface epithelium of the duodenal mucosa. The patient was first treated with trimethoprim-sulfamethoxazole and subsequently underwent complete thymectomy. Later, due to recurrence of the diarrhea, he was treated with ciprofloxacin.

A 14-month-old intact, female Abyssinian cat was presented for chronic intermittent diarrhea and bilateral enlargement of the mammary glands. Gastrointestinal coccidiosis was diagnosed; therapy with sulfadi-methoxine was unsuccessful in the elimination of Isospora felis and clinical signs. Infection with Tritrichomonas foetus was diagnosed by fecal polymerase chain reaction (PCR) and successfully treated with ronidazole and dietary modification.

Patients with AIDS are particularly susceptible to infection with intestinal coccidia. In this study the prevalence of infections with Cryptosporidium sp and Cystoisospora belli were evaluated among HIV/AIDS patients in the Triângulo Mineiro region, Brazil. Between July 1993 and June 2003 faecal samples from 359 patients were collected and stained by a modified Ziehl-Neelsen method, resulting in 19.7% of positivity for coccidian (8.6% with Cryptosporidium sp, 10.3% with Cystoisospora belli and 0.8% with both coccidian). Patients with diarrhoea and T CD4+ lymphocyte levels < or =200 cells/mm3 presented higher frequency of these protozoans, demonstrating the opportunistic profile of these infections and its relationship with the immunological status of the individual. It was not possible to determine the influence of HAART, since only 8.5% of the patients positive for coccidian received this therapy regularly. Parasitism by Cryptosporidium sp was more frequent between December and February and thus was characterised by a seasonal pattern of infection, which was not observed with Cystoisospora belli.

Isospora belli, a coccidian parasite usually causes a self limiting illness of acute onset with fever, diarrhoea and colicky pain in a normal host. In immunocompromised patients human isosporiasis becomes chronic. We report a case of a malnourished 9 year old female child who presented with complaints of loose stools, nausea, vomiting and weight loss for the past three months. Stool examination revealed immature oocysts of Isospora belli. The patient was successfully treated with TMP-SMX.