Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series

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dc.contributor.authorBoyles, Tom Hen_ZA
dc.contributor.authorBlack, Johnen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorMendelson, Marcen_ZA
dc.date.accessioned2016-01-11T06:53:17Z
dc.date.available2016-01-11T06:53:17Z
dc.date.issued2012en_ZA
dc.description.abstractIsospora belli causes diarrhoea in patients with AIDS. Most respond to targeted therapy and recommendations are that secondary prophylaxis can be stopped following immune reconstitution with ART. We report eight cases of chronic isosporiasis that persisted despite standard antimicrobial therapy, secondary prophylaxis, and good immunological and virological response to ART. Median CD4 nadir was 175.5 cells/mm 3 and median highest CD4 while symptomatic was 373 cells/mm 3 . Overall 34% of stool samples and 63% of duodenal biopsy specimens were positive for oocytes. Four patients died, two remain symptomatic and two recovered. Possible explanations for persistence of symptoms include host factors such as antigen specific immune deficiency or generalised reduction in gut immunity. Parasite factors may include accumulating resistance to co-trimoxazole. Research is required to determine the optimum dose and duration of co-trimoxazole therapy and whether dual therapy may be necessary. Mortality was high and pending more data we recommend extended treatment with high-dose co-trimoxazole in similar cases.en_ZA
dc.identifier.apacitationBoyles, T. H., Black, J., Meintjes, G., & Mendelson, M. (2012). Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series. <i>PLoS One</i>, http://hdl.handle.net/11427/16267en_ZA
dc.identifier.chicagocitationBoyles, Tom H, John Black, Graeme Meintjes, and Marc Mendelson "Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/16267en_ZA
dc.identifier.citationBoyles, T. H., Black, J., Meintjes, G., & Mendelson, M. (2012). Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series. PloS one, 7(8), e42844. doi:10.1371/journal.pone.0042844en_ZA
dc.identifier.ris TY - Journal Article AU - Boyles, Tom H AU - Black, John AU - Meintjes, Graeme AU - Mendelson, Marc AB - Isospora belli causes diarrhoea in patients with AIDS. Most respond to targeted therapy and recommendations are that secondary prophylaxis can be stopped following immune reconstitution with ART. We report eight cases of chronic isosporiasis that persisted despite standard antimicrobial therapy, secondary prophylaxis, and good immunological and virological response to ART. Median CD4 nadir was 175.5 cells/mm 3 and median highest CD4 while symptomatic was 373 cells/mm 3 . Overall 34% of stool samples and 63% of duodenal biopsy specimens were positive for oocytes. Four patients died, two remain symptomatic and two recovered. Possible explanations for persistence of symptoms include host factors such as antigen specific immune deficiency or generalised reduction in gut immunity. Parasite factors may include accumulating resistance to co-trimoxazole. Research is required to determine the optimum dose and duration of co-trimoxazole therapy and whether dual therapy may be necessary. Mortality was high and pending more data we recommend extended treatment with high-dose co-trimoxazole in similar cases. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0042844 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series TI - Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series UR - http://hdl.handle.net/11427/16267 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16267
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0042844
dc.identifier.vancouvercitationBoyles TH, Black J, Meintjes G, Mendelson M. Failure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case series. PLoS One. 2012; http://hdl.handle.net/11427/16267.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© Boyles et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherIsosporaen_ZA
dc.subject.otherBiopsyen_ZA
dc.subject.otherIsosporiasisen_ZA
dc.subject.otherProphylaxisen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherOocytesen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherHIVen_ZA
dc.titleFailure to eradicate Isospora belli diarrhoea despite immune reconstitution in adults with HIV--a case seriesen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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