We present a clinical case of travelers’ diarrhea due

to I belli in a patient with transient lymphopenia secondary to dengue infection. Isospora belli is a well-known parasitic cause of human disease, usually associated with immunosuppression or malnutrition. Acute and chronic diarrhea due to this coccidial parasite has been extensively see more reported in patients with AIDS, lymphomas or other lymphocyte disorders, with a higher incidence in tropical countries.1,2Isospora belli infection in immunocompetent patients has also been described as a cause of acute self-limiting diarrhea. Few cases of travelers’ diarrhea due to this agent have been reported to date.3 We present a case of self-limited diarrhea due to I belli in a traveler to Senegal with

transient lymphopenia due to dengue. A 32-year-old male tourist presented, 8 days after returning from a 5-day trip to Senegal, with a 7-day history of biphasic fever, headache, ocular and musculoskeletal pain, bilateral conjunctivitis, a thoracic rash, and cervical lymphadenopathy. A complete blood count revealed a total white blood cell count of 6.7 × 103µL−1, with 0.8 × 103µL−1 lymphocytes ROCK inhibitor (11.9%). The only abnormal finding on serum biochemical analysis was a slight elevation of transaminases (44 IU GOT, 50 IU GPT). Serological tests for HBV, HAV, HCV, HIV, CMV, EBV, toxoplasmosis, and peripheral blood smear for malaria were all negative. Dengue virus serology was positive (IgM). Five days after the fever started, the patient suffered four loose stools a day

without mucus, blood, or pus and mild abdominal pain. Bacterial culture for intestinal pathogens was negative, and a fresh unstained stool culture revealed numerous immature I belli locusts, which were verified with a modified Kinyoun stain. The patient did not receive any specific treatment for this parasite. Two days later the diarrhea had improved, and a second fresh stool test showed persistence of I belli, Ribonucleotide reductase although the number of oocysts had decreased substantially. The diarrhea resolved completely after a total of 9 days. After 4 weeks, the lymphocyte count was normal (1.9 × 103µL−1), and a new stool culture was negative for I belli. A second HIV test was also negative, and dengue virus serology was positive for IgM and IgG. The role of I belli in travelers’ diarrhea or gastrointestinal infection in immunocompetent patients from endemic areas has rarely been reported. Isospora belli is still considered an opportunistic parasite mainly found in patients with immunological disorders.4 We describe an incidence of self-limiting I belli gastrointestinal infection in a patient returning from Senegal with dengue. Moreover, the patient had transient lymphopenia, probably related to the viral infection and which may have had a role in I belli infection, as the latter resolved spontaneously once the lymphocyte count became normal.