Isospora belli

Aka: Isospora belli, Cystoisospora belli, Isosporiasis

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II. Epidemiology

  1. Seen primarily in advanced HIV in Caribbean, SW USA

III. Pathophysiology

  1. Gastrointestinal infection

IV. Differential Diagnosis

  1. See Diarrhea in HIV
  2. Cryptosporidium parvum

V. Diagnosis

  1. Stool acid fast stain

VI. Management

  1. Trimethoprim-sulfamethoxazole (Bactrim, Septra, TMP-SMZ) DS
    1. Dose: Septra DS one tab twice daily for 7-10 days
    2. Longer course (for 3-4 weeks) or increased frequency (four times daily) may be required in HIV or AIDS
  2. Alternative agents
    1. Pyrimethamine 50 to 75 mg orally daily and folinic acid 10-25 mg orally daily
    2. Ciprofloxacin 500 mg twice daily for 7 days (limited evidence)

VII. Course

  1. Relapse in 50% of patients
  2. Chronic suppressive therapy may be necessary
    1. Example: Septra DS 1 tab orally three times weekly or once orally daily

VIII. References

  1. Gilbert (2016) Sanford Guide, on IOS, accessed 9/12/2016

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