Yamane T, Takekawa K, Tanaka K, Hasuike T, Hirai M, Misu K, Ota K, Ohira H, Nakao Y, Yasui Y
Department of Clinical and Laboratory Medicine, Osaka City University of Medicine.
Rinsho Byori. 1993 Mar;41(3):303-6.
A 53-year-old man was hospitalized for the development of watery diarrhea associated with decreased appetite and progressive weight loss and was found to have leukocytosis. The white blood cell count was 14,600/microliters with 66 percent abnormal lymphocytes. Serum anti-HTLV-I was positive and monoclonal insertion of HTLV-I provirus into the atypical cell genome was confirmed with the southern blotting hybridization technique. A diagnosis of ATL was made. Examination of fresh stool specimens revealed Isospora belli (I. belli) oocysts. Initial treatment for I. belli consisted of oral trimethoprim 160mg and sulfamethoxazole 400mg given twice daily for nine days. Diarrhea ceased within 2 days of the start of treatment, but I. belli oocysts were again detected after 20 days. Trimethoprim 160mg and sulfamethoxazole 400mg were reinstituted four times daily for 10 days, and then twice daily for 21 days. The clinical response was again dramatic, with rapid clearance of oocysts from the stool. There has been no recurrence of diarrhea. The patient's leukemia was refractory to chemotherapy; the white blood cell count continued to rise, pneumonia developed, and the patient died. I. belli is a previously unrecognized opportunistic pathogen that must be considered in the clinical setting of chronic diarrhea in patients with ATL.
一名53岁男性因出现水样腹泻、食欲减退和体重渐进性减轻而住院，检查发现白细胞增多。白细胞计数为14,600/微升，其中66%为异常淋巴细胞。血清抗人类嗜T淋巴细胞病毒I型（HTLV-I）呈阳性，采用Southern印迹杂交技术证实HTLV-I前病毒单克隆插入非典型细胞基因组。确诊为成人T细胞白血病（ATL）。新鲜粪便标本检查发现贝氏等孢球虫（I. belli）卵囊。I. belli的初始治疗方案为口服甲氧苄啶160mg和磺胺甲恶唑400mg，每日两次，共九天。治疗开始后2天内腹泻停止，但20天后再次检测到I. belli卵囊。重新采用甲氧苄啶160mg和磺胺甲恶唑400mg，每日四次，共10天，然后每日两次，共21天。临床反应再次显著，粪便中的卵囊迅速清除。腹泻未再复发。患者的白血病对化疗耐药；白细胞计数持续升高，并发肺炎，患者死亡。I. belli是一种以前未被认识的机会性病原体，在ATL患者慢性腹泻的临床情况下必须予以考虑。
