Iranian Journal of Parasitology 2016. 11(1):121-125.

Severe Diarrhea Due To Cystoisospora belli Infection in an HTLV-1 Woman


Cystoisospora belli, formerly Isospora belli, as an opportunistic infection agent, is seen in immunocompromised patients like HTLV-1. We describe here cystoiso­sporiasis in an HTLV1 Iranian female in Mashhad, northwestern Iran in 2012 who presented with a debilitating diarrheal illness and great weight loss. C. belli was de­tected in her stool by modified acid-fast staining and then by molecular detection. Serologic testing was negative for HIV but she showed positivity for HTLV-1 in­fection. Treatment with TMP/SMX led to improvement of her diarrhea but she died after one year due to malabsorption syndrome. Adequate detection of C. belli diarrhea in immunocompromise patients of HTLV1 in endemic area can be cured by TMP/SMX.


Cystoisospora belli; HTLV-1; Diarrhea; Iran

Full Text:



Alemu A, Shiferaw Y, Getnet G, Yalew A, Addis Z. Opportunistic and other intestinal parasites among HIV/AIDS patients attending Gambi higher clinic in Bahir Dar city, North West Ethiopia. Asian Pac J Trop Med. 2011; 4: 661-5.

Certad G, Arenas-Pinto A, Pocaterra L, Ferrara G, Castro J, Bello A, et al. Isosporiasis in Venezuelan adults infected with human immunodeficiency virus: clinical characterizati-on. Am J Trop Med Hyg. 2003; 69: 217-22.

Abbaszadegan MR, Gholamin M, Tabatabaee A, Farid R, Houshmand M, Abbaszadegan M. Prevalence of human T-lymphotropic virus type 1 among blood donors from Mashhad, Iran. J Clin Microbiol. 2003; 41: 2593-5.

Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC, Murphy EL. Global epidemiology of HTLV-I infection and associated diseases. Oncogene. 2005; 24: 6058-68.

Verdonck K, Gonzalez E, Van Dooren S, Vandamme AM, Vanham G, Gotuzzo E. Human T-lymphotropic virus 1: recent knowledge about an ancient infection. Lancet Infect Dis. 2007; 7: 266-81.

Greenberg SJ, Davey MP, Zierdt WS, Waldmann TA. Isospora belli enteric infection in patients with human T-cell leukemia virus type I-associated adult T-cell leukemia. Am J Med. 1988; 85: 435-8.

Kawano F, Nishida K, Kurisaki H, Tsukamoto A, Satoh M, Sanada I, et al. Isospora belli infection in a patient with adult T-cell leukemia. Rinsho Ketsueki. 1992; 33: 683-7.

Ud Din N, Torka P, Hutchison RE, Riddell SW, Wright J, Gajra A. Severe Isospora (Cystoisospora) belli diarrhea preceding the diagnosis of human T-cell-leukemia-virus-1-associated T-cell lymphoma. Case Rep Infect Dis. 2012; 640104.

Yamane T, Takekawa K, Tanaka K, Hasuike T, Hirai M, Misu K, et al. Isospora belli infection in a patient with adult T cell leukemia. Rinsho Byori. 1993; 41: 303-6.

Agholi M, Hatam GR, Motazedian MH. Microsporidia and coccidia as causes of persistence diarrhea among liver transplant children: incidence rate and species/genotypes. Pediatr Infect Dis J. 2013; 32: 185-7.

Lindsay DS, Dubey JP, Blagburn BL. Biology of Isospora spp. from humans, nonhuman primates, and domestic animals. Clin Microbiol Rev. 1997; 10: 19-34.

Meamar AR, Rezaian M, Mohraz M, Zahabiun F, Hadighi R, Kia EB. A comparative analysis of intestinal parasitic infections between HIV+/AIDS patients and non-HIV infected individuals. Iran J Parasitol. 2007; 12: 1-6.

Atambay M, Bayraktar MR, Kayabas U, Yilmaz S, Bayindir Y. A rare diarrheic parasite in a liver transplant patient: Isospora belli. Transplant Proc. 2007; 39: 1693-5.

Koru O, Araz RE, Yilmaz YA, Ergüven S, Yenicesu M, Pektaş B, et al. Case report: Isospora belli infection in a renal transplant recipent. Turkiye Parazitol Derg. 2007; 31: 98-100.

Marathe A, Parikh K. Severe diarrhoea due to Cystoisospora belli in renal transplant patient on immunosuppressive drugs. Indian J Med Microbiol. 2013; 31: 185-7.

Hazrati Tappeh Kh, Mohammad Zadeh H, Mohammedi A, Yousefi MH. A case report of Isospora belli from west Azerbayjan province, Iran. Urmia Med J. 2001; 3: 288-95.

Meamar AR, Rezaian M, Mirzaei AZ, Zahabiun F, Faghihi AH, Oormazdi H, et al. Severe diarrhea due to Isospora belli in a patient with thymoma. J Microbiol Immunol Infect. 2009; 42: 526-9.

Nahrevanian H, Assmar M. A case report of cryptosporidiosis and isosporiasis in AIDS patients in Iran. J Trop Med Parasitol. 2006; 29: 33-6.

Ghorbani M, Rezaian M. Human Infection with Isospora hominis, a case repot. Iran J Public Health. 1985;14: 9-15.

Agholi M, Hatam GR, Motazedian MH. HIV/AIDS-associated opportunistic protozoal diarrhea. AIDS Res Hum Retroviruses. 2013; 29: 35-41.

Rafatpanah H, Hedayati-Moghaddam MR, Fathimoghadam F, Bidkhori HR, Shamsian SK, Ahmadi S, et al. High prevalence of HTLV-I infection in Mashhad, Northeast Iran: a population-based seroepidemiology survey. J Clin Virol. 2011; 52: 172-6.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.