title: Molecular Identification of Biliary Isospora Belli: A Case Report.
abstract: This report describes the novel sampling of bile from the biliary endoscopic intervention for the molecular identification of parasite infection.A 63-year-old Vietnamese man underwent travel health examination in our hospital. Physical examination showed that his height was 159 cm and weight was 41 kg. He had a 15-year history of intermittent abdominal pain and frequent episodes of diarrhea. Laboratory tests revealed raised eosinophil count (23%, normal range [NR] 0-5), absolute eosinophil count (1899/μL, NR 50-350), and levels of serum immunoglobulin E (3770 IU/mL, NR < 100), aspartate transaminase (270 U/L, NR 0-37), alanine transaminase (210 U/L, NR 0-40), and total bilirubin (1.8 mg/dL, NR 0.2-1.4); however, the serum alkaline phosphatase level was normal (65 U/L, NR 28-94) and non-reactive result for serum human insufficiency virus antibody.Magnetic resonance cholangiopancreatography revealed diffuse dilatation of the biliary tree; the common hepatic and pancreatic duct diameters increased to 1.86 cm and 0.61 cm, respectively.Endoscopic retrograde cholangiopancreatography was performed and a 10-Fr model plastic biliary stent was inserted and flushed with 20 cc normal saline; thereafter, the bile was collected and sent for DNA sequencing. Isospora belli (IB) infection was identified by a polymerase chain reaction.Trimethoprim-sulfamethoxazole 800 mg q6h was administered for 1 month. Liver enzyme levels normalized and negative for concentration method of ova study. The patient was doing well and weighed 51 kg at the outpatient clinic visit 3 months later.This bile sampling with molecular identification has not been described in the literature. We believe that an acute IB infection through fecal-oral transmission may progress to chronic infection of the hepatobiliary system, leading to biliary obstruction and jaundice.
authors.affiliation: From the Division of Gastroenterology and Hepatology, Department of Internal Medicine (K-WC, SSC, L-SL, C-KW), Department of Pathology (H-LE); Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan, Republic of China.
authors.forename: King-Wah
authors.initials: KW
authors.lastname: Chiu
authors.forename: Shue-Shian
authors.initials: SS
authors.lastname: Chiou
authors.forename: Lung-Sheng
authors.initials: LS
authors.lastname: Lu
authors.forename: Cheng-Kun
authors.initials: CK
authors.lastname: Wu
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
mesh_terms: D000818:Animals; D001646:Bile / Q000737:chemistry* / Q000469:parasitology; D015415:Biomarkers / Q000032:analysis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D007549:Isospora / Q000302:isolation & purification*; D021865:Isosporiasis / Q000175:diagnosis* / Q000378:metabolism / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*
chemical_list: D015415:Biomarkers