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Published on: December 8, 2014
Chronic Cyclospora infection in a heart transplant patient with intestinal malabsorption: a case report
Katie Ambrose1,2, Robert Hamilton-Seth2, Mollie Jackson3
1University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA.
Background:
Cyclosporiasis is a rare cause of chronic diarrhea and malabsorption in immunosuppressed patients.
Case Summary:
We report an unusual case of chronic Cyclospora infection in a heart transplant patient with a five-month history of watery diarrhea and weight loss. Initial stool testing failed to discover a causative pathogen. Duodenal biopsy showed histologic findings of intraepithelial lymphocytosis and partial villous blunting, raising the possibility of celiac disease. A repeat duodenal biopsy five months later revealed intracellular parasites with gametocyte, meront, and schizont forms, and the diagnosis of Cyclospora infection was confirmed by BIOFIRE Gastrointestinal (GI) Pathogen Panel.
Conclusion:
Morphologic diagnosis of enteric parasite infections is challenging and requires a high level of clinical suspicion in immunosuppressed patients. In addition to significant exposures and travel history, chronic immunosuppression should prompt extensive microbial testing, including stool ova and parasite, acid-fast testing, and/or multiplex PCR for GI pathogens in post-transplant patients with unexplained diarrhea.
Insights
Cyclosporiasis, a rare cause of chronic diarrhea in transplant patients, was diagnosed in a heart transplant recipient after extensive testing. Early diagnosis requires high clinical suspicion and comprehensive microbial evaluation in immunosuppressed individuals.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Transplant Medicine
Background:
- Cyclosporiasis is an uncommon cause of chronic diarrhea and malabsorption.
- Immunosuppressed patients, particularly transplant recipients, are at higher risk.
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