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ISOSPORA BELLI
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Distribution
The name belli (from bellium meaning war) was given for its association with war, because several cases of infection with this parasite were seen among troops stationed in Middle East d u ring the First World War.
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Morphology
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On maturation, the sporoblasr convert into sporocysts. Each sporocyst contains four crescent-shaped sporozoites.
Clinical Features
Clinical illness includes abdominal discomfort, mild fever, diarrhea and malabsorption.
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Diarrhea, lasting for several years can be seen in immunocompromised persons, particularly in the HIV infected.
Life Cycle
In the epithelium, the sporozoites transform in to trophozoites, which multiply asexually (schizogony) to produce a number of (merozoites).
When a sporulated oocyst is swallowed, eight sporozoites are released from the two sporocysts in the small intestine
Some of the trophozoites undergo sexual cycle (gametogony) in the cytoplasm of enterocytes and transform into macrogametocyles and microgametocytes.
After fertilization, a zygote is formed, which secretes a cyst wall and develops into an immature oocyst.
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Laboratory Diagnosis
After repeatedly negative s tool examinations, duodenal aspirate examination or entero test can be performed to demonstrate oocyst.
The staining techniques used are modified Ziehl-Neelsen (ZN) stain or Kinyoun acid-fast staining of stool smear.
Intestinal Biopsy - Upper gastrointestinal endoscopy may provide biopsy specimens for demonstration of oocysts.
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Treatment
For patients intolerant to sulfonamides, pyrimethamine is given
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