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A Case of HIV Infection Who Had Enterocolitis and Biliary Disease Due to Cyclospora after Traveling to India
1)Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, 2)Toshima Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, 3)Department of Parasitology, The National Institute of Infectious Diseases
Ryoko SEKIYA1), Kazuaki FUKUSHIMA1), Masaru TANAKA1), Keishiro YAJIMA1), Kenji YAGITA3), Atsushi AJISAWA2) & Akifumi IMAMURA1)
(Received March 27, 2017)
(Accepted December 14, 2017)
Key words: Cyclospora, HIV, Cholangiosis

A 48-year-old HIV-positive female had discontinued her hospital visits for about 1.5 years. Immediately after returning from a 1.5-month stay in India, she suffered from diarrhea about four times a day and, therefore, visited our outpatient department. Liver dysfunction was noted on blood sampling, and bileduct dilatation was detected by magnetic resonance imaging (MRI). Using feces, duodenum, and large intestine specimens, neon blue autofluorescence of the oocyst wall was detected under UV excitation with a fluorescence microscope. These specimens were molecularly biologically identified as Cyclospora cayetanensis using PCR sequencing. Since approval could not be obtained for the treatment of Cyclospora, only antiretroviral therapy (ART) was resumed. The CD4-positivity was above 180/μL for about 4 months, but alkaline phosphatase became exacerbated. Subsequently, the treatment of Cyclospora was started by prescribing trimethoprim/sulfamethoxazole (ST) (80/160 mg, 4 tablets) for 10 days. The liver dysfunction and diarrhea were promptly alleviated, and the bileduct dilatation was improved on MRI.

In the present study, biliary disease and enteritis due to Cyclospora could be effectively treated with an ST formulation. Although it is well-known that C. cayetanensis causes not only enteritis, but also bile duct/biliary tract lesions in immunocompromised HIV-infected patients, such cases have rarely been reported in recent years.

[ Kansenshogaku Zasshi 92: 371-375, 2018 ]

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