Related Experiment Videos
[Isospora belli infection in a patient with adult T cell leukemia]
T Yamane1, K Takekawa, K Tanaka
1Department of Clinical and Laboratory Medicine, Osaka City University of Medicine.
Insights
Adult T-cell leukemia (ATL) patients can develop opportunistic infections like Isospora belli. This case highlights the need to consider I. belli in chronic diarrhea among ATL patients, even with aggressive leukemia.
Area of Science:
- Infectious Diseases
- Oncology
- Gastroenterology
Background:
- Adult T-cell leukemia (ATL) is a lymphoproliferative disorder associated with Human T-lymphotropic virus type 1 (HTLV-1).
- Patients with ATL often experience opportunistic infections due to profound immunosuppression.
Observation:
- A 53-year-old man with ATL presented with watery diarrhea, anorexia, and weight loss.
- Stool examination revealed Isospora belli (I. belli) oocysts, an opportunistic pathogen.
Findings:
- The patient received trimethoprim-sulfamethoxazole for I. belli, which initially resolved the diarrhea.
- Recurrence of I. belli necessitated a prolonged and intensified treatment regimen.
- Despite successful treatment of the parasitic infection, the patient's ATL was refractory to chemotherapy, leading to complications and death.
Implications:
- Isospora belli should be considered in the differential diagnosis of chronic diarrhea in patients with ATL.
- Prompt diagnosis and treatment of opportunistic infections are crucial for managing patients with ATL.
- This case underscores the challenges in treating opportunistic infections in immunocompromised individuals with aggressive hematologic malignancies.
Abstract:
A 53-year-old man was hospitalized for the development of watery diarrhea associated with decreased appetite and progressive weight loss and was found to have leukocytosis. The white blood cell count was 14,600/microliters with 66 percent abnormal lymphocytes. Serum anti-HTLV-I was positive and monoclonal insertion of HTLV-I provirus into the atypical cell genome was confirmed with the southern blotting hybridization technique. A diagnosis of ATL was made. Examination of fresh stool specimens revealed Isospora belli (I. belli) oocysts. Initial treatment for I. belli consisted of oral trimethoprim 160mg and sulfamethoxazole 400mg given twice daily for nine days. Diarrhea ceased within 2 days of the start of treatment, but I. belli oocysts were again detected after 20 days. Trimethoprim 160mg and sulfamethoxazole 400mg were reinstituted four times daily for 10 days, and then twice daily for 21 days. The clinical response was again dramatic, with rapid clearance of oocysts from the stool. There has been no recurrence of diarrhea. The patient's leukemia was refractory to chemotherapy; the white blood cell count continued to rise, pneumonia developed, and the patient died. I. belli is a previously unrecognized opportunistic pathogen that must be considered in the clinical setting of chronic diarrhea in patients with ATL.