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Chronic Cystoisospora belli infection in an immunocompetent Myanmar refugee - microscopy is not sensitive enough

Woon, S-A, Yang, R.ORCID: 0000-0003-2563-2015, Ryan, U.ORCID: 0000-0003-2710-9324, Boan, P. and Prentice, D. (2016) Chronic Cystoisospora belli infection in an immunocompetent Myanmar refugee - microscopy is not sensitive enough. BMC Infectious Diseases, 16 (1). Article number 221.

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Abstract

Background: Cystoisosporiasis is an opportunistic infection seen more commonly in patients with acquired immunodeficiency syndrome. Although uncommon, Cystoisospora infection can occur in immunocompetent individuals but tend to be benign and self-limiting. Chronic infection however, has been described but diagnosis can often be challenging and requires a high clinical index of suspicion. Case presentation: We present a case of delayed diagnosis of Cystoisospora belli (C. belli) in an immunocompetent 28-year-old refugee from Myanmar. She had a history of chronic diarrhea where exhaustive investigations over many years failed to reveal a diagnosis. Cystoisospora belli cysts were finally detected in stool 4 years after investigation commenced, and PCR testing on stored colon biopsies amplified a molecular product with 99 % sequence homology to C. belli. The patient improved promptly with trimethoprim-sulfamethoxazole treatment. Conclusion: In the appropriate clinical context we suggest molecular testing for C. belli or an empirical therapeutic trial.

Item Type: Journal Article
Murdoch Affiliation(s): School of Veterinary and Life Sciences
Publisher: BioMed Central
Copyright: © 2016 Woon et al.
URI: http://researchrepository.murdoch.edu.au/id/eprint/31419
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