Case Report: Molecular Diagnosis of Cystoisospora belli in a Severely Immunocompromised Patient with HIV and Kaposi Sarcoma

Authors

Roumen Borilov Iordanov
Lauren M Leining
Meng Wu
Galant Chan
Andrew R DiNardo
Rojelio Mejia

Publication Date

11-29-2021

Journal

American Journal of Tropical Medicine and Hygiene

DOI

10.4269/ajtmh.21-0289

PMID

34844211

PMCID

PMC8832916

PubMedCentral® Posted Date

11-29-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Anti-Infective Agents, Diarrhea, Eosinophilia, Female, Gastrointestinal Hemorrhage, HIV Infections, Humans, Immunocompromised Host, Isospora, Isosporiasis, Middle Aged, Sarcoma, Kaposi, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination

Abstract

Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim-sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting trimethoprim-sulfamethoxazole, her diarrhea and eosinophilia improved, and she had undetectable Cystoisospora belli DNA on repeat stool quantitative polymerase chain reaction. This case highlights the importance of a thorough workup for diarrhea, including parasites, especially for immunocompromised patients. Antibiotic prophylaxis is recommended in patients with Cystoisospora belli and HIV/AIDS.