Diagnosis and treatment of digestive cryptosporidiosis in allogeneic haematopoietic stem cell transplant recipients: a prospective single centre study

Abstract

Digestive cryptosporidiosis (DC) can mimic GVHD after allogeneic haematopoietic stem cell transplantation (HSCT), thus requiring a reduction of immunosuppressive drugs and a specific therapy, whereas GVHD requires an intensification of immunosuppression. We systematically searched for cryptosporidiosis by light microscopy, immunochromatography and PCR in HSCT recipients who presented with at least one episode of diarrhoea. Of 115 consecutive patients allografted between July 2006 and November 2008, we analysed stools in 52 of 56 patients meeting these criteria. We identified Cryptosporidium parvum in 5 of the 52 patients (9.6%) at a median of 503 days (range 20-790) after HSCT. In those five patients, the median CD4 þ cell and B lymphocyte counts were 60/mm 3 (0-234) and 0/mm 3 (0-96), respectively. Two patients died of invasive fungal infections. In the other three patients, diarrhoea disappeared after a median of 5 weeks following onset of bitherapy with azithromycine and nitazoxanide; they were still alive 433, 380 and 1179 days after the DC diagnosis. DC is probably under diagnosed after HSCT because it is difficult to detect during the asymptomatic phase. Early bitherapy and reduction of immunosuppression seem efficacious. In our series, DC has a seasonal pattern and is promoted by profound T lymphopenia.

Cord Colitis Syndrome in Cord-Blood Stem-Cell Transplantation

“…[12][13][14][15] More common gastrointestinal viral pathogens, such as rotavirus and norovirus, are increasingly recognized as frequent causes of diarrhea in patients who have undergone HSCT. 14,19 Conditioning-related mucositis 20 and neutropenic enterocolitis 21 frequently cause diarrhea before engraftment; Clostridium difficile 22 infection and medication-related diarrhea 23,24 are common throughout the transplantation course. 18 Protozoal infections due to giardia and cryptosporidium are possible causes, but the risk of such infections is minimized by the strict hygiene practices used after transplantation.…”

Intestinal parasitic infections in leukemic patients with diarrhea

“…The importance of parasitic infections has been increased that create serious clinical conditions in immunocompromised patients [12][13][14][15].…”

Treatment of Cryptosporidium: What We Know, Gaps, and the Way Forward

“…Other groups have noted that transplant patients responded poorly to nitazoxanide alone. Still, there are anecdotes of better responses to combinations of nitazoxanide, azithromycin, and/or paromomycin [34-36]. …”

“…Azithromycin seemed to be better than two anthelminthic drugs for cryptosporidiosis in children [41]. It has also been used in combination with nitazoxanide and/or paromomycin in compromised hosts with decreased stool frequency and parasite clearance in some patients [34, 42]. …”