Isosporiasis, also known as cystoisosporiasis, is a human intestinal disease caused by the parasiteIsospora belli. It is found worldwide, especially in tropical and subtropical areas. Infection often occurs in immuno-compromised individuals, notably AIDS patients, and outbreaks have been reported in institutionalized groups in the United States. The first documented case was in 1915. It is usually spread indirectly, normally through contaminated food or water.
The coccidian parasite Isospora belli infects the epithelial cells of the small intestine, and is the least common of the three intestinal coccidia that infect humans.
Transmission
People become infected by swallowing the mature parasite; this normally occurs through the ingestion of contaminated food or water. The infected host then produces an immature form of the parasite in their feces, and when the parasite matures, it is capable of infecting its next host, via food or water containing the parasite.
Life cycle
At time of excretion, the immature oocyst contains usually one sporoblast. In further maturation after excretion, the sporoblast divides in two, so the oocyst now contains two sporoblasts. The sporoblasts secrete a cyst wall, thus becoming sporocysts; and the sporocysts divide twice to produce four sporozoites each. Infection occurs by ingestion of sporocyst-containing oocysts: the sporocysts excyst in the small intestine and release their sporozoites, which invade the epithelial cells and initiate schizogony. Upon rupture of the, the merozoites are released, invade new epithelial cells, and continue the cycle of asexual multiplication. Trophozoites develop into which contain multiple merozoites. After a minimum of one week, the sexual stage begins with the development of male and female gametocytes. Fertilization results in the development of oocysts that are excreted in the stool. Isospora belli infects both humans and animals.
Diagnosis
Microscopic demonstration of the large typically shaped oocysts is the basis for diagnosis. Because the oocysts may be passed in small amounts and intermittently, repeated stool examinations and concentration procedures are recommended. If stool examinations are negative, examination of duodenal specimens by biopsy or string test may be needed. The oocysts can be visualized on wet mounts by microscopy with bright-field, differential interference contrast, and epifluorescence. They can also be stained by modified acid-fast stain. Typical laboratory analyses include:
Avoiding food or water that may be contaminated with stool can help prevent the infection of Cystoisospora. Good hand-washing, and personal-hygiene practices should be used as well. One should wash their hands with soap and warm water after using the toilet, changing diapers, and before handling food. It is also important to teach children the importance of washing their hands, and how to properly wash their hands.
While isosporiasis occurs throughout the world, it is more common in tropical and subtropical areas. Cystoisospora infections are more common in individuals with compromised immune systems, such as HIV or leukemia.
