Cystoisosporiasis
Cystoisospora belli, formerly Isospora belli
Treatment
Diagnosis of cystoisosporiasis is made in persons with chronic, mostly watery diarrhoea by UV fluorescence or microscopy of stools, duodenal aspirates or intestinal tissue biopsy. If the diarrhea lasts > 4 weeks, the diagnosis of cystoisosporiasis is an AIDS defining illness
Besides antiprotozoal treatment, additional measures are symptomatic treatment, rehydration and electrolyte management
Drug / Dose | Comments | |
---|---|---|
Preferred therapy |
TMP-SMX |
Treat minimally 10 days, increase duration to 3-4 weeks if symptoms worsen or persist. Treat minimally 10 days, Increase dose to 2 x 2 tablet/day, if symptoms worsen or persist |
Alternative therapy, if TMP-SMX is not tolerated |
pyrimethamine |
10 days |
or ciprofloxacin 500 mg bid po |
7 days |
Secondary Prophylaxis / Maintenance Therapy
Stop: if CD4 count > 200 cells/μL and HIV-VL undetectable over 6 months and no signs of persistent cystoisosporiasis
Drug / Dose | Comments | |
---|---|---|
Preferred therapy |
TMP-SMX |
|
Alternative therapy, if TMP-SMX is not tolerated |
pyrimethamine |
Monitor for myelotoxicity, mostly neutropenia, for pyrimethamine |