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Cystoisosporiasis Medication

  • Author: Venkat R Minnaganti, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Dec 02, 2015
 

Medication Summary

Cystoisosporiasis does not respond well to most antibiotics used to treat diarrhea. Oral trimethoprim-sulfamethoxazole (TMP-SMZ) is the drug of choice. In patients who are intolerant to sulfonamides, pyrimethamine with folinic acid may be given for 2-4 weeks. Patients with AIDS may require long-term maintenance therapy with TMP-SMZ for suppression of C belli. Alternatively, pyrimethamine with sulfadoxine may be given.

Anecdotal case reports document improvement with albendazole, bismuth subsalicylate, diclazuril, furazolidone, metronidazole, and quinacrine; however, clinical trials are lacking.

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Antibiotics

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

TMP-SMZ is the drug of choice because it is the best-studied and most readily available agent. An alternative for long-term prophylaxis is pyrimethamine with sulfadiazine or sulfadoxine (either of which should be accompanied by folinic acid). Studies have proposed the veterinary agent diclazuril as a possible drug of choice if further studies confirm its use and safety.

Trimethoprim-sulfamethoxazole (Bactrim DS, Septra DS)

 

TMP-SMZ inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. It is the drug of choice and is curative in the immunocompetent host. It can be used for treatment and then ongoing prophylaxis in the immunocompromised host.

Pyrimethamine (Daraprim)

 

Pyrimethamine is a folic acid antagonist that selectively inhibits plasmodial dihydrofolate reductase. It is the second drug of choice and is particularly useful for those who cannot tolerate sulfonamides. It can also be used for prophylaxis when combined with sulfadiazine or sulfadoxine. Administer it with folinic acid to prevent hematologic toxicities.

Diclazuril

 

Diclazuril is investigational in the United States. This benzene acetonitrile derivative is a veterinary antiparasitic that has shown good safety and efficacy in a small number of studies involving a small number of humans. Clinical trials have been completed for use in patients with AIDS and cryptosporidial-related diarrhea. 

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Vitamins

Class Summary

Vitamins are used to correct folic acid deficiency resulting from use of folic acid antagonists.

Leucovorin

 

A derivative of folic acid, which is used with folic acid antagonists such as sulfonamides and pyrimethamine.

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Contributor Information and Disclosures
Author

Venkat R Minnaganti, MD, FACP Consulting Staff, Department of Medicine, Winthrop University Hospital; Clinical Instructor, Department of Internal Medicine, Division of Infectious Disease, SUNY Stony Brook University School of Medicine

Venkat R Minnaganti, MD, FACP is a member of the following medical societies: All India Ophthalmological Society, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Glenn Fennelly, MD, MPH Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

References
  1. Woodcock HM. Notes on Protozoan parasites in the excreta. BMJ. 1915;2:709.

  2. Goodgame R. Emerging Causes of Traveler's Diarrhea: Cryptosporidium, Cyclospora, Isospora, and Microsporidia. Curr Infect Dis Rep. 2003 Feb. 5(1):66-73. [Medline].

  3. Sorvillo FJ, Lieb LE, Seidel J, Kerndt P, Turner J, Ash LR. Epidemiology of isosporiasis among persons with acquired immunodeficiency syndrome in Los Angeles County. Am J Trop Med Hyg. 1995 Dec. 53(6):656-9. [Medline].

  4. Rowe JS, Shah SS, Motlhagodi S, Bafana M, Tawanana E, Truong HT, et al. An epidemiologic review of enteropathogens in Gaborone, Botswana: shifting patterns of resistance in an HIV endemic region. PLoS One. 2010 Jun 2. 5(6):e10924. [Medline]. [Full Text].

  5. DeHovitz JA, Pape JW, Boncy M, Johnson WD Jr. Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1986 Jul 10. 315(2):87-90. [Medline].

  6. Sasaki M, Tanaka A, Nishimura T, Tsujikawa T, Andoh A, Ishizuka I, et al. A case of malabsorption syndrome caused by isosporiasis in an immunocompetent patient. J Gastroenterol. 2004 Jan. 39(1):88-9. [Medline].

  7. ten Hove RJ, van Lieshout L, Brienen EA, Perez MA, Verweij JJ. Real-time polymerase chain reaction for detection of Isospora belli in stool samples. Diagn Microbiol Infect Dis. 2008 Jul. 61(3):280-3. [Medline].

  8. Malik S, Samantaray JC, Bagga A, Das A. Refractory isosporiasis. Indian J Pediatr. 2005 May. 72(5):437-9. [Medline].

  9. Limson-Pobre RN, Merrick S, Gruen D, Soave R. Use of diclazuril for the treatment of isosporiasis in patients with AIDS. Clin Infect Dis. 1995 Jan. 20(1):201-2. [Medline].

  10. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis. 2005 Apr 15. 40(8):1173-80. [Medline].

  11. Gilles HM, Hoffman PS. Treatment of intestinal parasitic infections: a review of nitazoxanide. Trends Parasitol. 2002 Mar. 18(3):95-7. [Medline].

  12. Silva GB, Fernandes KP, Segundo GR. Common variable immunodeficiency and isosporiasis: first report case. Rev Soc Bras Med Trop. 2012 Dec. 45(6):768-9. [Medline].

  13. Sahu AR, Koticha AH, Kuyare SS, Khopkar US. Isospora induced diarrhea in a pemphigus vulgaris patient. Indian J Dermatol Venereol Leprol. 2014 Jul-Aug. 80 (4):342-3. [Medline].

  14. Stein J, Tannich E, Hartmann F. An unusual complication in ulcerative colitis during treatment with azathioprine and infliximab: Isospora belli as 'Casus belli'. BMJ Case Rep. 2013 May 24. 2013:[Medline].

  15. Kim MJ, Kim WH, Jung HC, Chai JW, Chai JY. Isospora belli Infection with Chronic Diarrhea in an Alcoholic Patient. Korean J Parasitol. 2013 Apr. 51 (2):207-12. [Medline].

  16. Mohanty I, Panda P, Sahu S, Dash M, Narasimham MV, Padhi S, et al. Prevalence of isosporiasis in relation to CD4 cell counts among HIV-infected patients with diarrhea in Odisha, India. Adv Biomed Res. 2013. 2:61. [Medline].

 
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Oocyst of Cystoisospora belli with 2 sporoblasts. From the Image Library, Division of Parasitic Diseases at the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
 
 
 
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