Cystoisospora spp. infection at a dog breeding facility in the Madrid region: Infection rate and clinical management based on toltrazuril metaphylaxis.

Canine coccidiosis caused by Cystoisospora canis and Cystoisospora ohioensis-complex is common in kennels. While often underestimated, coccidiosis may cause severe clinical signs in puppies and sometimes even lead to death, so preventative measures are important. This study examines Cystoisospora spp. infection at a Labrador retriever breeding facility in Madrid, Spain. To identify environmental factors associated with infection, dams were examined throughout a reproductive cycle (from oestrus to 60 days postpartum) and their puppies during their first 60 days of life. Also assessed was the efficacy of combined treatment with emodepside (0.9 mg/ml) and toltrazuril (18 mg/ml) at a dose of 0.5 ml/kg of weight, equivalent to 0.45 mg/kg and 9 mg/kg, respectively, in puppies on day 35 of life. Oocyst shedding was detected in 4.6-18.6% of 45 dams examined and in 2.2-9.1% of their litters (315 puppies). In both cases, peak opg elimination was recorded on day 30 postpartum/of life. The species of Cystoisospora detected were C. canis (91.3%) and C. ohioensis-complex (8.7%). While in both dams and puppies opg counts were higher in autumn when rainfall was at its highest, correlation between opg and rainfall emerged as significant only in puppies (p = 0.031). The treatment of 35 day-old puppies with toltrazuril was 100% effective in controlling this infection in the kennel. Our findings therefore suggest the need for a strict hygiene regime and the use of toltrazuril as blanket treatment to reduce Cystoisospora transmission in dog breeding facilities.

Parasitological and molecular investigation of consequences of raw meat feeding (BARF) in dogs and cats: implications for other pets living nearby.

Considering the original nature of carnivorism among dogs and cats, nowadays these pets are increasingly fed BARF (Biologically Appropriate Raw Food/Bone And Raw Food) diet to improve their health conditions. However, this diet may also carry health risks, such as vitamin or mineral deficiencies, and infection with pathogens including parasites. In our study, fecal samples of 89 pet animals kept on BARF diet were subjected to coprological examination followed by molecular analyses. Six of them shed eggs of Dicrocoelium dendriticum. This result was confirmed with PCR and sequencing, and in one case, the DNA of Fasciola hepatica was also demonstrated. In addition, oocysts of Cystoisospora canis, a Cystoisospora ohioensis-like sp. and Eimeria stiedai, as well as sporocysts of a Sarcocystis sp. were also detected. All samples were negative for Neospora caninum and Toxoplasma gondii. In conclusion, no evidence was found for the infection of BARF-fed dogs and cats with parasites that are usually associated with this diet and considered as clinico-pathological risk factors for these pets themselves (e.g., N. caninum, T. gondii). However, fluke eggs (probably originating from ruminants) and oocysts of E. stiedai (from rabbit liver in the food) were demonstrated as pseudoparasites. These species are usually not considered among parasite-associated risks of BARF-feeding, implying that other animals living near BARF-fed pets are neglected in this context. However, where intermediate hosts of D. dendriticum occur in urban areas, BARF-feeding may indirectly affect later other dogs and cats. It was also shown here that BARF-feeding may contribute to the contamination of the environment with E. stiedai oocysts, thus increasing the risks of biliary coccidiosis in nearby living pet rabbits that would otherwise not have access to oocysts of E. stiedai.

On the efficacy of preventive toltrazuril treatments and the diagnosis of Cystoisospora suis infections in intensively raised piglets in farms from southeast Spain.

This study investigated the presence and abundance of Cystoisospora suis oocysts in faecal samples from 131 one- to three-week-old pig litters belonging to eight intensively raised, indoor herds in Spain. Seven herds used preventive anticoccidial toltrazuril treatments administered orally or by intramuscular injection, and one did not use preventive anticoccidial treatments. The diagnosis was performed using two oocyst flotation-concentration methods, Bailenger's method in every herd and the more recent Joachim's method in four herds. Oocysts were detected in every farm, the proportion of oocyst-positive samples was higher with Bailenger's technique, and the estimated overall prevalence (95% confidence interval) was 40 (32-49)%, including 47 (29-65)% in non-medicated litters, 52 (38-67)% in orally medicated litters and 28 (16-40)% in intramuscularly medicated litters (p < 0.05). However, mixed logistic regression models indicated that the risk of infection was not significantly associated with preventive anticoccidial treatments (p > 0.05), and increased with age, was higher in herds with partially compared to fully slatted dung floors in farrowing pens and in litters with pigs with diarrhoea (p < 0.05). The median (range) oocysts per gram of faeces (OpG) in infected litters by Bailenger's method was 623 (35-49048) and mixed negative binomial models revealed no significant association between infection intensity in positive litters and pen's floor type and piglets age, faecal consistency and treatment status (p > 0.05). The apparent low efficacy of Toltrazuril suggests treatment administration failures, reduced residual efficacy or low susceptibility of C. suis strains in study farms and needs further investigation.

Morphological and molecular biology identification of Cystoisospora sp. in the blue fox, Alopex lagopus (Linnaeus, 1758).

To investigate the prevalence and molecular characteristics of Cystoisospora sp. in blue fox (Alopex lagopus), Sheather's sugar floatation method was conducted to detect coccidia in 423 fresh fecal samples randomly collected from blue fox farms from three cities in China. The overall prevalence of coccidia was 1.4% (6/423), and three Cystoisospora sp. (Cystoisospora fennechi, Cystoisospora sp. I and Cystoisospora vulpina) were identified by their morphological characteristics. The 18S ribosomal RNA (rRNA) and cytochrome c oxidase subunit I (COI) locus sequences were sequenced for molecular biological identification, homology comparison, and phylogenetic analysis of Cystoisospora sp. by single-oocyst selection technology and multi-locus-nested PCR amplification. At the 18S rRNA and COI loci, C. vulpina had 99.48% and 99.59% homology, respectively, with Cystoisospora canis and Cystoisospora ohioensis from canines. Phylogenetic analysis indicated that C. vulpina was clustered in a clade with Cystoisospora sp. from Canidae, which the relatives are consistent with the hosts. To our knowledge, this is the first report on molecular identification and evolutionary analysis of C. vulpina at two different loci.

SARCOCYSTIS AND OTHER PARASITES IN FECES OF BOBCATS (LYNX RUFUS) FROM MISSISSIPPI.

Rectal contents of 56 adult bobcats (Lynx rufus) in 2014 and 2017 from remote areas of Mississippi were examined microscopically for parasite stages after the sugar flotation method. Among the helminths, eggs/larvae found were: Paragonimus sp. in 12, Toxocara cati-like in 16, trichurid-capillarid-like in 3, hookworms in 27, and lungworms in 28. Among the protozoa, oocysts/cysts found were: Cystoisospora felis-like in 2, Cystoisospora rivolta-like in 4, Cryptosporidium sp. in 1, and Giardia sp. in 1. Additionally, numerous Sarcocystis sporocysts were detected in the feces of 12 bobcats; sporocysts were described morphologically. The status of C. felis derived from the bobcat and other wild felids is reviewed and compared with C. felis from the domestic cat. It is the first record of C. rivolta from the bobcat. The presence of eggs of Paragonimus sp. and T. cati in feces of 21.4% and 28.5%, respectively, suggests a role for the bobcat in the dissemination of these zoonotic helminths in the environment in the wild. Taxonomy of coccidia of wild Felidae is discussed and Isospora lyncisLevine and Ivens, 1981 from the Lynx is now regarded as a species inquirenda.

Cystoisospora suis infection in suckling piglets in Brazil: Prevalence and associated factors.

Piglet coccidiosis is a parasitic disease caused by the protozoan Cystoisospora suis, which is regarded as the most prevalent gastrointestinal parasite in intensive pig farms. Despite the availability of highly effective chemo-metaphylaxis (toltrazuril), coccidiosis is still prevalent in European and other countries. We conducted a cross-sectional study on swine farms in Brazil, to assess the prevalence of Cystoisospora suis in fecal samples and determined the associated factors. In total, 666 litters from 50 farms were sampled twice within one week between samplings (mean age at sampling: 10.75 and 17.7 days). Of 666 litters, 225 (33.8%) were positive at least once, and the expected within farm prevalence of C. suis oocysts was 32.9% (25.4-41.3%; 95% confidence interval). Oocysts were more prevalent in fecal samples collected from farms with diarrhea (odds ratio = 6.75). The room temperature was also positively associated with oocyst detection; a one-degree increase in room temperature increased the chance of a litter being positive by 23.2%. Up-to-date, this is the most comprehensive technical evidence of factors associated with C. suis infection in Brazilian industrial piglet farms.

The transcriptome from asexual to sexual in vitro development of Cystoisospora suis (Apicomplexa: Coccidia).

The apicomplexan parasite Cystoisospora suis is an enteropathogen of suckling piglets with woldwide distribution. As with all coccidian parasites, its lifecycle is characterized by asexual multiplication followed by sexual development with two morphologically distinct cell types that presumably fuse to form a zygote from which the oocyst arises. However, knowledge of the sexual development of C. suis is still limited. To complement previous in vitro studies, we analysed transcriptional profiles at three different time points of development (corresponding to asexual, immature and mature sexual stages) in vitro via RNASeq. Overall, transcription of genes encoding proteins with important roles in gametes biology, oocyst wall biosynthesis, DNA replication and axonema formation as well as proteins with important roles in merozoite biology was identified. A homologue of an oocyst wall tyrosine rich protein of Toxoplasma gondii was expressed in macrogametes and oocysts of C. suis. We evaluated inhibition of sexual development in a host-free culture for C. suis by antiserum specific to this protein to evaluate whether it could be exploited as a candidate for control strategies against C. suis. Based on these data, targets can be defined for future strategies to interrupt parasite transmission during sexual development.

Detection of enteroparasites in foliar vegetables commercialized in street- and supermarkets in Aparecida de Goiânia, Goiás, Brazil / Detecção de enteroparasitas em hortaliças comercializadas em feiras e supermercados em Aparecida de Goiânia, Goiás, Brasil

Foliar vegetables contaminated with fecal residues are an important route of transmission of intestinal parasites to humans. The aim of this study was to evaluate the presence of parasitic forms of protozoa and helminths on lettuces (Lactuca sativa) and collard greens (Brassica oleracea) sold in street- and supermarkets in the city of Aparecida de Goiânia, Goiás, Brazil. A total of 30 samples of each vegetable (15 samples from each supermarkets and street markets) was analyzed. All samples were processed by spontaneous sedimentation method and centrifugal flotation. In 45% of the samples, immature forms of intestinal parasites were identified with 66.7% helminths eggs and 33.3% protozoan cysts or oocysts. Significantly more lettuce samples were contaminated with eggs, cysts or oocyst of at least one parasite than collard green samples (U=216; Z=-3.45; P <0.001). The parasitic forms were identified morphologically up to the family level with eggs of Ancylostomatidae, Strongyloididae, Ascarididae and Taeniidae, or oocysts of Eimeriidae, to the genus with Cystoisospora sp. and Toxocara sp., and to the species level with Cystoisospora canis, Dipylidium caninum and Hymenolepis nana. The presence of these infective agents in lettuce and collard green from both street- and supermarkets highlights the high risk of spreading parasites by eating raw vegetables sold in Aparecida de Goiânia.

Hortaliças contaminadas com resíduos fecais são importantes vias de transmissão de parasitas intestinais ao homem. O objetivo deste estudo foi avaliar a presença de formas parasitárias de protozoários e helmintos em alface (Lactuca sativa) e couve (Brassica oleracea) vendidas em feiras e supermercados na cidade de Aparecida de Goiânia, Goiás, Brasil. Um total de 30 amostras de cada vegetal (15 amostras de supermercados e 15 de feiras livres) foi analisado. Todas as amostras foram processadas pelos métodos de sedimentação espontânea e centrífugo-flutuação. Em 45% das amostras foram identificadas formas imaturas de parasitas intestinais sendo 66,7% ovos de helmintos e 33,3% de cistos ou oocistos de protozoários. Significativamente, mais amostras de alface estavam contaminadas com ovos, cistos ou oocistos de pelo menos um parasita do que as amostras de couve (U = 216; Z = -3,45; P <0,001). As formas parasitárias foram identificadas morfologicamente ao nível de família com ovos de Ancylostomatidae, Strongyloididae, Ascarididae e Taeniidae ou oocistos de Eimeriidae, dos gêneros Cystoisospora sp. e Toxocara sp., e ao nível de espécies com Cystoisospora canis, Dipylidium caninum e Hymenolepis nana. A presença desses agentes infecciosos em alface e couve, provenientes tanto de feiras quanto de supermercados, ressalta o alto risco de veiculação de parasitas pela ingestão de hortaliças cruas comercializadas em Aparecida de Goiânia.

Case Report: Molecular Diagnosis of Cystoisospora belli in a Severely Immunocompromised Patient with HIV and Kaposi Sarcoma.

Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim-sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting trimethoprim-sulfamethoxazole, her diarrhea and eosinophilia improved, and she had undetectable Cystoisospora belli DNA on repeat stool quantitative polymerase chain reaction. This case highlights the importance of a thorough workup for diarrhea, including parasites, especially for immunocompromised patients. Antibiotic prophylaxis is recommended in patients with Cystoisospora belli and HIV/AIDS.

Prevalence and genetic characteristics of Blastocystis hominis and Cystoisospora belli in HIV/AIDS patients in Guangxi Zhuang Autonomous Region, China.

Blastocystis hominis and Cystoisospora belli are considered to be common opportunistic intestinal protozoa in HIV/AIDS patients. In order to investigate the prevalence and genetic characteristics of B. hominis and C. belli in HIV/AIDS patients, a total of 285 faecal samples were individually collected from HIV/AIDS patients in Guangxi, China. B. hominis and C. belli were investigated by amplifying the barcode region of the SSU rRNA gene and the internal transcribed spacer 1 (ITS-1) region of the rRNA gene, respectively. Chi-square test or Fisher's exact test were conducted to assess the risk factors related to B. hominis and C. belli infection. The prevalence of B. hominis and C. belli was 6.0% (17/285) and 1.1% (3/285) respectively. Four genotypes of B. hominis were detected, with ST3 (n = 8) and ST1 (n = 6) being predominant, followed by ST6 (n = 2) and ST7 (n = 1). Females had a statistically higher prevalence of B. hominis (11.6%) than males (4.2%). The statistical analysis also showed that the prevalence of B. hominis was significantly associated with age group and educational level. Our study provides convincing evidence for the genetic diversity of B. hominis, which indicates its potential zoonotic transmission and is the first report on the molecular characteristics of C. belli in HIV/AIDS patients in China.

Progression of asexual to sexual stages of Cystoisospora suis in a host cell-free environment as a model for Coccidia.

Coccidia display a characteristic life cycle, where the parasites switch between asexual and sexual development, resulting in an environmental stage, the oocyst. The entero-pathogenic Cystoisospora suis, a coccidian parasite of swine and close relative to Toxoplasma gondii, undergoes development in one host-cycle. Despite the well-described intracellular development of Coccidia, the C. suis life cycle can progress in an in vitro, host cell-free system after initial intracellular development of merozoites. A novel host cell-free cultivation method was developed by transferring purified merozoites from cell culture supernatant (dpi 6) to culture medium and incubating them for 5 days to induce their progression to sexually differentiated stages. The development of sexual stages in the absence of host cells was verified by morphological studies, flow cytometry and the transcription analysis of three genes linked to sexual stages (HAP2, OWP and TyRP). The host cell-free culture permits the sexual development (and with this, the complete life cycle progression from sporozoites to oocysts) of C. suis in vitro and provides a new tool for detailed research on the development of C. suis and possibly other Coccidia. This will also be useful for the evaluation of novel drug or vaccine targets in these parasites.

Cystoisospora belli infection in a renal transplant recipient: a case report and review of literature.

Cystoisospora belli is a coccidian parasite that causes prolonged watery diarrhea especially among immunocompromised patients. Herein, we report a renal transplant patient who complaints of alternating diarrhea and review of literature related to cystoisosporiasis amongst the transplant recipients.

Pitfalls in Morphologic Diagnosis of Pathogens: Lessons Learned From the Pseudo-Cystoisospora Epidemic.

Multiple groups have recently reported involvement of the gallbladder mucosa of immunocompetent patients by cystoisospora organisms. However, this has recently been disproved with the support of molecular and ultrastructural studies. Here we present a summary of these events, recounting how this pseudo-Cystoisospora epidemic began and ended. This review also highlights the important role played by ancillary techniques in supplementing the morphologic diagnosis of pathogens.

Occurrence of gastrointestinal parasites in dogs and cats domiciliated in Santos, SP, Brazil / Ocorrência de parasitos gastrintestinais em cães e gatos domiciliados em Santos, SP, Brasil

Abstract Helminths and protozoa are major causes of diseases in domestic animals, and many can also cause infections in humans. Knowledge of intestinal parasitoses affecting domestic animals is important for the implementation of appropriate preventive measures. The objective of this study was to evaluate the occurrence of gastrointestinal parasites in fecal samples of dogs and cats attended at the Veterinary Hospital of the Metropolitan University of Santos, SP, Brazil. We also attempted to determine whether such infection was associated with sex, age, or the presence of diarrhea. We analyzed 100 fecal samples: 85 from dogs and 15 from cats. Among the dogs, 31.8% of the samples were positive, and to 40.0% among the cats. Infection was not associated with sex or age. However, among the dogs, parasitism showed a significant association with the presence of diarrhea (P = 0.013). The helminths Ancylostoma spp. and the protozoa Giardia duodenalis were the most frequent parasites in this research. Although they present unknown species and assemblages, they are parasites with a zoonotic potential of great importance in public health. Therefore, it is essential that pets are properly diagnosed and treated against gastrointestinal parasitic infection to prevent the spread of diseases.

Resumo As enfermidades causadas por helmintos e protozoários representam uma das principais causas de doenças em animais domésticos, e muitos desses parasitos podem causar infecções em seres humanos. O conhecimento das enteroparasitoses que acometem os animais domésticos é de suma importância para que medidas preventivas adequadas sejam implementadas. O objetivo do presente trabalho foi avaliar a frequência de ocorrência de parasitos gastrointestinais em amostras de fezes de cães e gatos atendidos no Hospital Veterinário da Universidade Metropolitana de Santos, bem como sua associação com o sexo, a idade e a presença de diarreia. Do total das amostras de cães analisadas, 31,8% estavam positivas, em relação aos gatos, e 40% apresentaram positividade. Não houve associação entre o sexo e a idade, porém, foi observada associação significativa entre a presença da parasitose e da diarreia (p=0,013) entre os cães. O helminto Ancylostoma spp. e o protozoário Giardia duodenalis foram os mais frequentes na pesquisa. Embora apresentem espécies e "assemblages" desconhecidas, são parasitos de potencial zoonóticos de grande importância em saúde pública. Assim, é essencial que os animais de companhia sejam corretamente diagnosticados e tratados contra infecções parasitárias gastrintestinais para evitar a propagação de doenças.

Parásitos gastrointestinales en mamíferos silvestres cautivos en el Centro de Fauna de San Emigdio, Palmira (Colombia) / Gastrointestinal parasites in captive wild mammals at the fauna center from San Emigdio, Palmira (Colombia)

RESUMEN La parasitosis intestinal en mamíferos silvestres es una de las principales complicaciones debido a las condiciones exógenas del cautiverio; predisponen al animal a complicaciones fisiológicas o infecciones secundarias que impiden su rehabilitación y reintroducción. El objetivo de esta investigación fue determinar la presencia de parásitos gastrointestinales en mamíferos silvestres del Centro de Atención y Valoración de Fauna silvestre del Centro de Educación Ambiental San Emigdio, San Emigdio, Palmira (Colombia). Se tomaron muestras fecales de 25 animales cautivos en el Centro de Atención y Valoración y fueron analizadas mediante dos técnicas: a) montaje con solución salina al 0,85 % y solución de lugol al 1% y b) técnica de flotación por solución saturada (Sheather) con densidad de 1.28g/ml, encontrando un 36% de positividad. Se encontró Enterobius vermicularis, Fasciola sp., Entamoeba sp. y Ancylostoma sp. El grupo de primates no humanos presentó cargas parasitarias más altas con respecto a felinos, caninos y demás mamíferos del estudio. Los microorganismos identificados son reconocidos como parásitos causantes de complicaciones en animales cautivos y en libertad; al igual, son catalogados como posibles riesgos zoonóticos.

ABSTRACT Intestinal parasitosis in wild mammals is one of the main complications due to the exogenous conditions of captivity. They predispose the animal to physiological complications or secondary infections that prevent its rehabilitation and reintroduction. The objective is to determine the presence of gastrointestinal parasites in wild mammals from the Wildlife Care and Valuation Center of the San Emigdio Environmental Education Center, San Emigdio, Palmira (Colombia). Fecal samples were taken from 25 captive animals in Care and Valuation Center being analyzed using two techniques: a) assembly with 0.85% saline solution and 1% lugol solution and b) saturated solution flotation technique (Sheather) with a density of 1.28g/ml, with a 36% of positivity. Enterobius vermicularis, Fasciola sp., Entamoeba sp. and Ancylostoma sp. were found. The group of non-human primates had higher parasitic intensity compared to felines, canines and other mammals in the study. The identified microorganisms are recognized as parasites causing complications in captive animals and in free life; likewise, they are classified as possible zoonotic risks.

Diversity of enteric coccidia in pigs from the Paraíba Semiarid Region of Northeastern Brazil.

There is great diversity in swine coccidia, which are responsible for causing intestinal disorders ranging from sporadic diarrhea to severe cases of hemorrhagic enteritis. Thus, determining the species of coccidia that affect the animals of a region and associating them with the characteristics of the farms become extremely important. The objective of this study was to determine the prevalence of coccidia parasites in pigs reared in a family farming production system in the Semiarid Region of the State of Paraíba, Northeast Brazil. Fecal samples for analysis were collected from 187 pigs on 51 farms. For morphological analysis, 1,590 sporulated oocysts were used. The prevalence of oocysts in fecal samples was 56.6% (106/187). The most prevalent species were Eimeria suis (21.9%), followed by Eimeria neodebliecki (16.6%), Eimeria perminuta (14.9%), Eimeria polita (12.8%), Eimeria debliecki (10.6%), Eimeria porci (10.1%), Cystoisospora suis (3.7%), Eimeria scabra (1.6%) and Eimeria cerdonis (0.5%). It can be concluded that pigs from the Semiarid Region of the State of Paraíba were parasitized by a diversity of coccidia species, mainly of the genus Eimeria, and predominantly presented with mixed infections occurring in the subclinical form.

Morphological and molecular characterization of Cystoisospora laidlawi oocysts (Apicomplexa: Eimeriidae) in farmed American mink (Neovison vison) in Denmark.

From a longitudinal survey conducted on 30 Danish mink farms in 2016, 11.0% of faecal samples (456/4140) were positive for Cystoisospora laidlawi oocysts by microscopy, with 60% (189/315) of mink being positive at least once during the study period. Morphological analysis of sporulated oocysts identified Cystoisospora oocysts measuring 34.3 × 29.5 µm with an oocyst length/width (L/W) ratio of 1.2. The morphological features of the oocysts were identical to Isospora laidlawi previously morphological identified in farmed mink from Denmark and elsewhere. Phylogenetic analysis of 18S rDNA sequences (1221 bp) from three positive mink indicated that Cystoisospora from mink shared the highest genetic similarity to C. canis from a Canadian dog (99.6%). The phylogenetic analysis placed Cystoisospora from mink in a clade with other Cystoisospora isolates.

Ultrastructural Characteristics of Gallbladder Epithelial Inclusions Mimicking Cystoisospora.

OBJECTIVES: There is recently reported increased prevalence of Isospora organisms in cholecystectomy specimens from immunocompetent patients, especially in acalculous cholecystectomies. We performed an ultrastructural and molecular evaluation of these specimens. METHODS: From 28 gallbladders with intraepithelial inclusions, two specimens with diffuse involvement of the gallbladder epithelium were analyzed by electron microscopy. Polymerase chain reaction was performed on five samples for the ITS2 region of C belli and eukaryotic 18S region. The 18S products were sequenced by next-generation sequencing. RESULTS: Electron microscopic analysis showed cytoplasmic condensations leading to vacuole formation. In contrast with true C belli, there were no identifiable organelles or organization. None of these cases showed amplified products other than human on molecular analysis. CONCLUSIONS: Electron microscopic analysis demonstrates that the inclusions are condensed cytoplasmic material and not true organisms.