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Diagnostic and Therapeutic Difficulties of Chronic Diarrhea with Cystoisospora belli Inaugural Infection by the HIV at the NTHC-HKM of Cotonou: Literature Review

Received: 22 November 2021    Accepted: 17 December 2021    Published: 29 December 2021
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Abstract

Isosporosis is an opportunistic parasitosis caused by Cystoisospora belli. It was more or less frequently found during HIV immunodepression. Its prevalence has considerably decreased since the democratization of antiretroviral treatments and the implementation of a strategy of systematic global management of People Living with HIV (PLWH) and opportunistic infections. We report the case of a 49-year-old PLHIV patient discovered during the exploration of recurrent diarrhea. This diarrhea was found to be due to Cystoisospora belli. The patient was allergic to cotrimoxazole and was therefore initially treated with ciprofloxacin and tinidazole with poor evolution. The other treatments selected are limited by the lack of access to drugs, both geographically and financially. In view of the persistence of the clinical picture and the continuous presence of the parasite in the stools, several hypotheses have been put forward. That of an under-dosage of the molecule used, of a lack of therapeutic compliance, or of the resistance of the germ to the prescribed molecule. Although the coproculture and antibiogram revealed the sensitivity of the germ to the Ciprofloxacin already prescribed, and to the Cotrimoxazole to which the patient is very allergic, and which can therefore no longer be prescribed. After a second opinion and a review of the literature, the patient was put on Pyrimethamine tablets and Albendazole with folic acid. The evolution was favorable with a significant regression of stools, resumption of appetite, and weight gain after one month. A last coproculture of control did not find any more oocysts of cystoisospora belli. In the face of chronic diarrhea, the systematic search for opportunistic germs in PLWHIV is essential. Management is possible.

Published in International Journal of Infectious Diseases and Therapy (Volume 6, Issue 4)
DOI 10.11648/j.ijidt.20210604.17
Page(s) 161-164
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Chronic Diarrhea, NTHC-HKM Cotonou, Cystoisospora Belli, Internal Medicine

References
[1] Bartelt LA, Dillingham RA. Cystoisospora belli (syn. Isospora belli). In: Hunter’s Tropical Medicine and Emerging Infectious Diseases. Elsevier. 2020; 722-4.
[2] Getachew T, Hailu T, Alemu M. Prevalence of Opportunistic Intestinal Parasitic Infections Among HIV/AIDS Patients Before and After Commencement of Antiretroviral Treatment at Felege Hiwot Referral Hospital: A Follow-up Study. HIV. 2021; 13: 767-74.
[3] Kırkoyun Uysal H, Oner YA, Akgül Ö, Kart Yaşar K, Gursoy S, Çağlar S. Isospora belli associated recurrent diarrhea in a patient with AIDS. International Journal of Infectious Diseases. 2016; 45: 363-4.
[4] Isospora belli infection in HIV positive patients. Report of two cases and literature review. Rev chil infectol. 2010; 27 (3): 219-27.
[5] Tefera T, Abera D, Teklu DS, Wolde M. Intestinal parasites and risk awareness of people living with HIV/AIDS in Debre Brehan Referral Hospital, Debre Brehan, Ethiopia: Intestinal parasites and risk awareness of people living with HIV/AIDS in Debre Brehan Referral Hospital, Debre Brehan, Ethiopia Ethiop Med J. 2021; 59 (04): 325-36.
[6] Gebrecherkos T, Kebede H, Gelagay AA. Intestinal parasites among HIV/AIDS patients attending University of Gondar Hospital, northwest Ethiopia. Ethiop J Health Dev. 2019; 33 (2): 64-72.
[7] Pape JW, Verdier RI, Johnson WD Jr. Treatment and prophylaxis of Isospora belli infection in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1989; 320: 1044-7.
[8] Straatmann A, Bahia F, Pedral-Sampaio D, Brites C. A randomized, pilot trial comparing full versus escalating dose regimens for the desensitization of AIDS patients allergic to sulfonamides. Braz J Infect Dis. 2002; 6 (6): 276-80.
[9] Wang Z-D, Liu Q, Liu H-H, Li S, Zhang L, Zhao Y-K, et al. Prevalence of Cryptosporidium, microsporidia and Isospora infection in HIV-infected people: a global systematic review and meta-analysis. Parasites Vectors. 2018; 11 (1): 28.
[10] Guiget M, Furco A, Tattevin P, Costagliola D, Molina J M, French Hospital database on HIV Clinical Epidemiology Group. HIV-associated Isospora belli infection: incidence and risk factors in the French Hospital database on HIV. HIV Medicine 2007; 8: 124-30.
[11] Batista FS, de Souza Miranda L, de Oliveira Silva MB, Taborda RLM, Soares MGF and Matos NB. Chronic Cystoisospora belli infection in an HIV/AIDS patient treated at the specialized assistance service in Porto Velho County – Rondônia. Rev Soc Bras Med Trop. 2019; 52: e20180204.
[12] Alemu A, Shiferaw Y, Getnet G, Yalew A, Addis Z. Opportunistic and other intestinal parasites among HIV/AIDS patients attending Gambi higher clinic in Bahir Dar city, North West Ethiopia. Asian Pacific Journal of Tropical Medicine. 2011; 4 (8): 661-5.
[13] Verdier R-I, Fitzgerald DW, Johnson WD, Pape JW. Trimethoprim–Sulfamethoxazole Compared with Ciprofloxacin for Treatment and Prophylaxis of Isospora belli and Cyclospora cayetanensis Infection in HIV-Infected Patients: A Randomized, Controlled Trial. Ann Intern Med. 2000; 132 (11): 885.
[14] Weiss LM. Isospora belli Infection: Treatment with Pyrimethamine. Ann Intern Med. 1988; 109 (6): 474.
[15] Maggi P, Larocca A, Quarto M, Serio G, Brandonisio O, Angarano G, et al. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. European Journal of Clinical Microbiology and Infectious Diseases. 2000; 19 (3): 213-7.
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    Angèle Azon Kouanou, Yolande Sissinto Savi De Tovè, Agbodandé Kouessi Anthelme, Adélakoun Ange Géoffroy Falade, Yves Morel Sokadjo, et al. (2021). Diagnostic and Therapeutic Difficulties of Chronic Diarrhea with Cystoisospora belli Inaugural Infection by the HIV at the NTHC-HKM of Cotonou: Literature Review. International Journal of Infectious Diseases and Therapy, 6(4), 161-164. https://doi.org/10.11648/j.ijidt.20210604.17

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    ACS Style

    Angèle Azon Kouanou; Yolande Sissinto Savi De Tovè; Agbodandé Kouessi Anthelme; Adélakoun Ange Géoffroy Falade; Yves Morel Sokadjo, et al. Diagnostic and Therapeutic Difficulties of Chronic Diarrhea with Cystoisospora belli Inaugural Infection by the HIV at the NTHC-HKM of Cotonou: Literature Review. Int. J. Infect. Dis. Ther. 2021, 6(4), 161-164. doi: 10.11648/j.ijidt.20210604.17

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    AMA Style

    Angèle Azon Kouanou, Yolande Sissinto Savi De Tovè, Agbodandé Kouessi Anthelme, Adélakoun Ange Géoffroy Falade, Yves Morel Sokadjo, et al. Diagnostic and Therapeutic Difficulties of Chronic Diarrhea with Cystoisospora belli Inaugural Infection by the HIV at the NTHC-HKM of Cotonou: Literature Review. Int J Infect Dis Ther. 2021;6(4):161-164. doi: 10.11648/j.ijidt.20210604.17

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  • @article{10.11648/j.ijidt.20210604.17,
      author = {Angèle Azon Kouanou and Yolande Sissinto Savi De Tovè and Agbodandé Kouessi Anthelme and Adélakoun Ange Géoffroy Falade and Yves Morel Sokadjo and Mahoutin Semassa Ghislain Missiho and Olamidé Gloria Marlene Marie Dénise Kouanou and Marcelle Vodounou and Richard Oba and Djimon Marcel Zannou},
      title = {Diagnostic and Therapeutic Difficulties of Chronic Diarrhea with Cystoisospora belli Inaugural Infection by the HIV at the NTHC-HKM of Cotonou: Literature Review},
      journal = {International Journal of Infectious Diseases and Therapy},
      volume = {6},
      number = {4},
      pages = {161-164},
      doi = {10.11648/j.ijidt.20210604.17},
      url = {https://doi.org/10.11648/j.ijidt.20210604.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20210604.17},
      abstract = {Isosporosis is an opportunistic parasitosis caused by Cystoisospora belli. It was more or less frequently found during HIV immunodepression. Its prevalence has considerably decreased since the democratization of antiretroviral treatments and the implementation of a strategy of systematic global management of People Living with HIV (PLWH) and opportunistic infections. We report the case of a 49-year-old PLHIV patient discovered during the exploration of recurrent diarrhea. This diarrhea was found to be due to Cystoisospora belli. The patient was allergic to cotrimoxazole and was therefore initially treated with ciprofloxacin and tinidazole with poor evolution. The other treatments selected are limited by the lack of access to drugs, both geographically and financially. In view of the persistence of the clinical picture and the continuous presence of the parasite in the stools, several hypotheses have been put forward. That of an under-dosage of the molecule used, of a lack of therapeutic compliance, or of the resistance of the germ to the prescribed molecule. Although the coproculture and antibiogram revealed the sensitivity of the germ to the Ciprofloxacin already prescribed, and to the Cotrimoxazole to which the patient is very allergic, and which can therefore no longer be prescribed. After a second opinion and a review of the literature, the patient was put on Pyrimethamine tablets and Albendazole with folic acid. The evolution was favorable with a significant regression of stools, resumption of appetite, and weight gain after one month. A last coproculture of control did not find any more oocysts of cystoisospora belli. In the face of chronic diarrhea, the systematic search for opportunistic germs in PLWHIV is essential. Management is possible.},
     year = {2021}
    }
    

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    T1  - Diagnostic and Therapeutic Difficulties of Chronic Diarrhea with Cystoisospora belli Inaugural Infection by the HIV at the NTHC-HKM of Cotonou: Literature Review
    AU  - Angèle Azon Kouanou
    AU  - Yolande Sissinto Savi De Tovè
    AU  - Agbodandé Kouessi Anthelme
    AU  - Adélakoun Ange Géoffroy Falade
    AU  - Yves Morel Sokadjo
    AU  - Mahoutin Semassa Ghislain Missiho
    AU  - Olamidé Gloria Marlene Marie Dénise Kouanou
    AU  - Marcelle Vodounou
    AU  - Richard Oba
    AU  - Djimon Marcel Zannou
    Y1  - 2021/12/29
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijidt.20210604.17
    DO  - 10.11648/j.ijidt.20210604.17
    T2  - International Journal of Infectious Diseases and Therapy
    JF  - International Journal of Infectious Diseases and Therapy
    JO  - International Journal of Infectious Diseases and Therapy
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    EP  - 164
    PB  - Science Publishing Group
    SN  - 2578-966X
    UR  - https://doi.org/10.11648/j.ijidt.20210604.17
    AB  - Isosporosis is an opportunistic parasitosis caused by Cystoisospora belli. It was more or less frequently found during HIV immunodepression. Its prevalence has considerably decreased since the democratization of antiretroviral treatments and the implementation of a strategy of systematic global management of People Living with HIV (PLWH) and opportunistic infections. We report the case of a 49-year-old PLHIV patient discovered during the exploration of recurrent diarrhea. This diarrhea was found to be due to Cystoisospora belli. The patient was allergic to cotrimoxazole and was therefore initially treated with ciprofloxacin and tinidazole with poor evolution. The other treatments selected are limited by the lack of access to drugs, both geographically and financially. In view of the persistence of the clinical picture and the continuous presence of the parasite in the stools, several hypotheses have been put forward. That of an under-dosage of the molecule used, of a lack of therapeutic compliance, or of the resistance of the germ to the prescribed molecule. Although the coproculture and antibiogram revealed the sensitivity of the germ to the Ciprofloxacin already prescribed, and to the Cotrimoxazole to which the patient is very allergic, and which can therefore no longer be prescribed. After a second opinion and a review of the literature, the patient was put on Pyrimethamine tablets and Albendazole with folic acid. The evolution was favorable with a significant regression of stools, resumption of appetite, and weight gain after one month. A last coproculture of control did not find any more oocysts of cystoisospora belli. In the face of chronic diarrhea, the systematic search for opportunistic germs in PLWHIV is essential. Management is possible.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Parasitology-Mycology Laboratory, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

  • Unit of Internal Medicine-Medical Oncology, National Teaching Hospital Center (NTHC)-Hubert Koutougou Maga (HKM), Cotonou, Republic of Benin

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