Abstract
Introduction Cystoisospora belli (previously Isospora belli) is a parasitic protozoan of the human gastrointestinal system. It rarely causes symptoms in immunocompetent hosts but can cause severe diarrhea in immunocompromised patients, with a rate of recurrence and risk of dissemination. Gallbladder infections are however rare. The treatment of choice for symptomatic patients is a 7–10-day course of trimethoprim-sulfamethoxazole. Case In this case, we report on an incidental finding of Cystoisospora belli organisms in the donor gallbladder following a transplant cholecystectomy. There was no report of symptoms in the donor. The recipient was treated with a course of trimethoprim-sulfamethoxazole, without evidence of cystoisosporiasis. Given the risk of recurrence in immunocompromised hosts, the patient will continue to be monitored for reactivation in the future. Conclusion Despite advances in transplant protocols and screening, disease transmission from the donor to recipient still occurs in about 0.2% of all organ transplants. With the increased use of organs from drug overdose victims and other high-risk donors, practitioners (including pathologists, hepatologists, and surgeons) must maintain a high index of suspicion for such potentially harmful organisms.
Highlights
Cystoisospora belli is a parasitic protozoan of the human gastrointestinal system
In the West, Cystoisospora belli is associated with HIV/AIDS infection and occasionally diarrhea in travelers [4,5,6,7,8]
C. belli infection is a rare cause of diarrhea, even in immunocompromised individuals. is is likely due to the rarity of the organism especially in the West, as well as improvement in prophylaxis in transplant patients and severely immunocompromised HIV patients
Summary
Cystoisospora belli, previously called Isospora belli (C. belli), is an intracellular protozoan of the intestinal epithelium Present worldwide, it is a less common cause of protozoal diarrhea, compared to Toxoplasma and Cryptosporidium. There are growing reports of biliary infection in immunocompetent individuals as well, including cases of acute and chronic cholecystitis [18,19,20]. There was a case of C. belli infection reported in a patient who underwent a small bowel transplant [25]. Given the need for chronic immunosuppression use in these patients, reactivation remains a concern [26] It is not clear whether C. belli infections in these solid organ transplant recipients were derived from the donor or contracted independently by the recipient.
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