Severe cryptosporidiosis in a seven‐year‐old renal transplant recipient – Case report and review of the literature

Hong, David K.; Wong, Cynthia; Gutierrez, Kathleen

doi:10.1111/j.1399-3046.2006.00593.x

Cited by 37 publications

(38 citation statements)

References 47 publications

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“…The prevalence of Cryptosporidium infection in Europe has been estimated to be 1-2%, which is less than that reported in emerging countries [8]. Cryptosporidiosis in renal transplant recipients can be more severe and associated with possible sclerosing cholangitis [1,2,6,8,10,12,13,[22][23][24][25][26][27][28][29]. In children, Cryptosporidial enteritis has been described after liver transplantation [1,10,14,20,30] and once after renal transplantation [13].…”

Section: Discussionmentioning

confidence: 99%

“…Oocysts are resistant to common disinfectants, including chlorine-based solutions used for chlorinated drinking water and for swimming pool water, and can survive up to 12 months in cold water [7,12,13,22]. They can be eliminated by filtering water through < 1-μm filters or by heating the water to 62°C for few seconds; boiling or freezing conditions kill the oocysts [7,10].…”

Section: Discussionmentioning

confidence: 99%

“…The delay in the disappearance of symptoms in graft recipients following antiparasitic treatment suggests that these infections are more pathogenic in transplant patients [6,13,14].…”

Section: Introductionmentioning

confidence: 99%

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Cryptosporidiosis in paediatric renal transplantation

Bandı́n¹,

Kwon

Linas

et al. 2009

Pediatr Nephrol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cryptosporidiosis in paediatric renal transplantation

Bandı́n¹,

Kwon

Linas

et al. 2009

Pediatr Nephrol

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“…Other IS groups at significant risk of severe cryptosporidiosis include those diagnosed with non-Hodgkin's lymphoma, leukemia, lymphoproliferative disease, or protein energy malnutrition (51,133,205,215). Patients receiving immunosuppressive drugs for organ transplants or cancers are also at risk of prolonged, potentially life-threatening persistent diarrhea (67,140,238), as are IS patients undergoing hemodialysis (244). Cryptosporidium infection with serious clinical symptoms has also been observed in IS patients with hyperIgM syndrome and primary CD4 lymphopenia (286).…”

Section: Cryptosporidiummentioning

confidence: 99%

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

et al. 2009

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SUMMARY Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4+ cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.

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“…Patients with secondary immunodeficiencies, i.e. those undergoing immunosuppressive treatment before or after transplantation or undergoing chemotherapy during cancer treatment, constitute another group at high risk of acute cryptosporidiosis (Campos et al 2000;Abdo et al 2003;Hong et al 2007). Among different PID, patients with CD40 ligand deficiency (CD40L) and patients with combined immunodeficiency syndromes or interferon gamma deficiency are particularly prone to Cryptosporidium infection (Kocoshis et al 1984;Levy et al 1997;Wolska-Kuśnierz et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Genotyping of Cryptosporidium isolates from human clinical cases in Poland

et al. 2008

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Cryptosporidium spp. infection is usually self-limited in immunocompetent hosts but can be severe and life threatening in children and in immunocompromised individuals including those with primary or acquired immunodeficiencies. One hundred and three faecal samples were collected from 35 hospitalised patients with different symptoms and tested for the presence of the parasite. Cryptosporidium oocysts were found in four of 35 patients (11.4%) using Ziehl-Neelsen staining of faecal smears and immunofluorescence assay, whereas 12 (34.3%) samples tested positive by nested polymerase chain reaction assay. Cryptosporidium DNA was detected in one bile sample but not in a liver tissue biopsy sample collected from a patient who suffered from sclerosing cholangitis. Sequence analysis of oocyst wall protein and beta-tubulin gene fragments revealed three different parasite species (Cryptosporidium hominis, Cryptosporidium meleagridis and Cryptosporidium parvum) in children with primary immunodeficiencies, whereas only C. parvum was found in immunocompetent individuals and in those with secondary immunodeficiencies. This study has revealed a high prevalence of Cryptosporidium infection in hospitalised patients in Poland and confirmed that molecular techniques enable a more sensitive detection of the parasite.

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Severe cryptosporidiosis in a seven‐year‐old renal transplant recipient – Case report and review of the literature

Cited by 37 publications

References 47 publications

Cryptosporidiosis in paediatric renal transplantation

Cryptosporidiosis in paediatric renal transplantation

Clinical Significance of Enteric Protozoa in the Immunosuppressed Human Population

Genotyping of Cryptosporidium isolates from human clinical cases in Poland

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