Cryptosporidiosis in paediatric renal transplantation

Abstract

Diarrhoea in transplantation may be secondary to infectious agents and immunosuppressive drugs. The use of combined immunosuppressive drugs increases the incidence of infectious diarrhoea. We retrospectively collected all diarrhoea episodes during a 3-year period in 199 pediatric renal transplant recipients, including 47 patients receiving a kidney transplant during this period. We diagnosed 64 diarrhoea episodes (32% of the patients, 10.7% per year). Fourteen diarrhoea episodes could be attributed to the immunosuppressive treatment, and 12 remained without diagnosis. Nineteen patients (<10%) receiving mycophenolic acid (MPA) developed diarrhoea, 14 of whom had episodes attributable to the immunosuppressive treatment. Reducing the MPA dose or switching to another immunosuppressant did not induce graft rejection, if at all, for at least 6 months. Thirty-eight diarrhoea episodes were caused by infectious agents: viruses in 16 patients, bacterial agents in ten patients, Candida albicans in four cases and parasitic agents in eight cases (Giardia lambdia in one patient and Cryptosporidium in seven patients). In our cohort, Cryptosporidium was responsible for 18% of the infectious diarrhoea and 11% of all causes of diarrhoea, and it affected 3.5% of the newly transplanted patients during the 3-year study period. The clinical presentation of the disease was profuse and persistent diarrhoea with acute renal failure in all patients. We propose that oocysts be screened for in the stool during the early stages of tests for determining the origin of infectious diarrhoea. Disease treatment requires early specific treatment (nitazoxanide) for extended periods of time in conjunction with supportive rehydration.

Microbiological Diagnosis of Severe Diarrhea in Kidney Transplant Recipients by Use of Multiplex PCR Assays

“…In practice, negative microbiological diagnosis leads nephrologists to perform invasive complementary tests like colonoscopy and often to modify immunosuppressive treatment considered to be the cause of diarrhea, with a risk of acute or chronic transplant rejection (9)(10)(11). Yet in various studies, it has been reported that, in 38 to 64% of cases, diarrhea was of infectious origin (1,(12)(13)(14). The implicated microorganisms corresponded mainly to enteric bacteria (Campylobacter spp., enterovirulent Escherichia coli, Salmonella spp., Clostridium difficile), parasites (Giardia intestinalis), and viruses (Norovirus and Rotavirus) that are already responsible for gastroenteritis in the general population (1,2,6,(12)(13)(14)(15)(16).…”

“…Yet in various studies, it has been reported that, in 38 to 64% of cases, diarrhea was of infectious origin (1,(12)(13)(14). The implicated microorganisms corresponded mainly to enteric bacteria (Campylobacter spp., enterovirulent Escherichia coli, Salmonella spp., Clostridium difficile), parasites (Giardia intestinalis), and viruses (Norovirus and Rotavirus) that are already responsible for gastroenteritis in the general population (1,2,6,(12)(13)(14)(15)(16). However, some pathogens, like human cytomegalovirus (CMV), microsporidia, and cryptosporidia, were specifically found in immunocompromised patients (1,12,13,(17)(18)(19)(20)34).…”

“…Microbiological diagnosis of diarrhea episodes in transplant recipients is currently based on using classical techniques involving stool culture for bacteriology, parasitological examination of stool, and virus detection using rapid antigen detection tests (RADT) (1,6,12,13). These methods have in general a poor ability to detect fragile microorganisms that are present at low levels in the stool of immunocompromised patients or microorganisms that demonstrate significant antigenic variations.…”

Human Cryptosporidiosis and Drinking Water: Looking Beyond HIV

“…Most of the data on cryptosporidiosis is from HIV-positive patients (Tali et al 2011;Erhabor et al 2011;Del Chierico et al 2011;Ojurongbe et al 2011;Lim et al 2011;Nel et al 2011;Le et al 2008;Lucca et al 2009;Singla et al 2010;Kaushik et al 2008Kaushik et al , 2009aRao Ajjampur et al 2007a;Muthusamy et al 2006;Agarwal et al 1998a). There are scanty data on patients with other immunocompromised status like renal transplant recipients (Bandin et al 2009a;Ok et al 1997) and on patients with hematological malignancies (Nahrevanian and Assmar 2008; Botero et al 2003;Udgiri et al 2004). So, data from this subgroup of patients are urgently required.…”

Association between Toll-Like Receptor 4 (Thr399Ile and Asp299Gly), Toll-Like Receptor 2 196-174 Deletion Polymorphisms with cryptosporidiosis

“…is a Coccidian enteric parasite causing severe diarrhea in immuno-compromised patients, such as human immunodeficiency virus (HIV) infected patients and organ transplant recipients [1]- [5]. This obligate intracellular parasite infects the small intestine.…”