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.
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.
Correspondence: King-Wah Chiu, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Kaohsiung, Taiwan (e-mail: email@example.com).
Abbreviations: IB = Isospora belli, NR = normal range, PCR = polymerase chain reaction
Author contributors: KWC cared for the patient; HLE performed the molecular study; all authors KWC, SSC, LSL, CKW, and HLE interpreted the data and helped in writing the report.
Written consent for publishing the data was obtained.
The authors have no funding and conflicts of interest to disclose.
The patient provided informed consent for this case report.
Ethical statement: all the procedures in this report have been approved by to the ethical standards on human experimentation by the Chang Gung Memorial Hospital committee, and performed according to the guidelines of the Helsinki Declaration of 2008.
This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Received November 12, 2015
Received in revised form February 17, 2016
Accepted February 22, 2016