Abstract

Background: Cholecystitis is one of the common surgical cases affecting human beings in many countries. A variety of microorganisms can be associated with acute and chronic cholecystitis especially in AIDS patients. Unfortunately, in as many as half of cases, no microorganism can be identified by pathological examination. Methods: Retrospective histopathologic review of 75 immunocompetent and immunocompromised patients with symptomatic cholecystitiswho underwent cholecystectomy fromMarch 2010 to December 2010 at some hospitals of Shiraz, southern Iran. Results: In all patients, no specific symptoms have been observed to be predictive of coccidian infection of the gall bladder, but have been significantly associated with an abnormal gall bladder ultrasound reported by radiologist. Pathologic investigation revealed an abnormal gall bladder with thick wall in all cases. Onmicroscopic examination of archived cholecystectomy samples using H&E stain, we found two cases of chronic cholecystitis without cholelithiasis due to infections with Sarcocystis sp. and Isospora belli in an AIDS female patient and amale patient respectively. Only the sexual stages of these coccidian parasites were detected in the gall bladder epithelium. Genus-specific PCR amplification was performed on archived paraffin-embedded sections. The microscopic and molecular characteristics of these microorganisms were consistent with Sarcocystis sp. and I. belli. Conclusion: To the best of authors’ knowledge, this is the first report of Sarcocystisand I. belli-associated chronic cholecystitis in patients from worldwide and Iran respectively. It is recommended that, the physicians should pay attention to the enteric coccidian parasites as possible causes of cholecystitis especially in immunocompromised patients.

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