Encyclopedia of Parasitology

DOI 10.1007/978-3-642-27769-6_1630-2
# Springer-Verlag Berlin Heidelberg 2015

Isospora belli
Heinz Mehlhorn*
Institut f€
ur Zoomorphologie, Zellbiologie und Parasitologie Universitätsstraße 1, D€usseldorf, Germany

1. Name: Greek: isos = similar, identical; sporos = spore; kystos = cyst: Latin: bellum = belly.
2. Geographic Distribution/Epidemiology: Worldwide occurrence; several 100 millions infected
people, not occurring as true epidemics.
3. Morphology/Life Cycle: This organism belongs to the so-called ▶ Coccidia, which are members of
the former phylum Sporozoa/Apicomplexa in the newly created ▶ Alveolata. It parasitizes intracel-
lularly the epithelial cells of the intestine of humans being situated inside a ▶ parasitophorous
vacuole. Infection of humans occurs by oral uptake of oocysts of the Isospora type from remnants
of human feces. The oocysts, which appear ovoid with a flattened pole (Figs. 1 and 3), are excreted
non-sporulated. Outside of the host’s body, two sporocysts are developed within 2–3 days inside the
oocyst finally containing each four sporozoites, which are the infectious stages after oral uptake of the
oocyst by another human being (Figs. 2 and 3). These oocysts measure 25–35  18–20 mm and keep
their infectivity for at least 1 year, even when temperatures are low or even close to the freezing point.
4. Symptoms of Disease: Oral uptake of these oocysts within contaminated food or drinking water leads
to diarrhea called either coccidiosis, isosporiasis, or more common traveler’s disease. In many cases
there occur very quickly (about 2 days after the infection) severe symptoms of disease: repeated
diarrheas combined with strong abdominal pain, nausea, and vomiting which persist for several days
or even weeks. On the other hand, other persons excrete oocysts without significant symptoms and
may infect whole groups of persons (e.g., during common excursions in nature). AIDS patients are
especially endangered, since these parasites do not only attack the intestinal cells but are also found in
masses intra- and extracellularly in lymph nodes far from the intestine. In AIDS patients in addition to
the increased diarrheas, other symptoms occur additionally: malabsorption and steatorrhea (Restrepo
et al. 1987). In AIDS patients as well as in immunocompetent travelers, diarrheas due to these
parasites may start again 2–20 weeks after the excretion of oocysts and symptoms had stopped due to
a successful treatment (relapse with unknown reason).
5. Diagnosis: The oocysts can easily be diagnosed by microscopic investigation after the use of
concentration methods: ▶ M.I.F.C., S.A.F.C., ▶ flotation. At first the oocysts are unsporulated
(Figs. 1 and 3), but within 2–3 days, two sporocysts each with four sporozoites have developed
(Figs. 2). In biopsy material of the intestinal wall, also schizonts, merozoites, and gametocytes can be
found, but their structure is not species specific. In some cases, the blood status shows a mild
eosinophilia.
6. Infection: Oral uptake of sporulated oocysts (Figs. 2) within contaminated food or drinking water.
7. Incubation Period: 2–13 days, when the production of schizonts inside the intestine occurs and may
lead to first symptoms.
8. Prepatency: 7–9 days.
9. Patency: 2 weeks up to 1–2 years (in AIDS patients).
10. Therapy: The acute isosporiasis (traveler’s disease) is often self-limiting in case the patient ingests
enough drinking water. However, in severe cases and under chronically repeated outbreaks

*Email: [email protected]
*Email: [email protected]

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Encyclopedia of Parasitology
DOI 10.1007/978-3-642-27769-6_1630-2
# Springer-Verlag Berlin Heidelberg 2015

Fig. 1 Light micrograph of an unsporulated oocyst of Isospora belli

Fig. 2 Light micrograph of a sporulated oocyst of Isospora belli showing inside two globular sporocysts within which four
sporozoites are finally formed

(especially in the case of immunocompromised persons), the following cure is effective:

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Encyclopedia of Parasitology
DOI 10.1007/978-3-642-27769-6_1630-2
# Springer-Verlag Berlin Heidelberg 2015

Fig. 3 Diagrammatic representations of an unsporulated (a) and a sporulated and thus infectious (b) oocyst of I. belli. N
nucleus, OW oocyst wall, R residual body, SP sporozoite, SW sporocyst wall, arrow points at an apical flattening

successfully cured by application of diclazuril (1  daily 200 mg for 7 days). Also ciprofloxacin
(2  daily 500 mg for 7 days) limits the number of parasites.

References
Restrepo C et al (1987) Disseminal extraintestinal isosporiasis in a patient with acquired immune
deficiency syndrome. Am J Pathol 87:536–542

Further Reading
Legua P, Seas C (2013) Cystoisospora and Cyclospora. Inf Dis 26:479–483
Montalvo R et al (2013) Recurrent diarrhea due to Cystoisospora belli in HIV/AIDS patients receiving
Haart. Rev Peru Exp Salud Publ 30:326–330

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