Spiramycin Is Not Effective in Treating Cryptosporidium Diarrhea in Infants: Results of A Double-Blind Randomized Trial

Wittenberg, Dankwart Friedrich; Miller, N. M.; Ende, Jan van den

doi:10.1093/infdis/159.1.131

Cited by 63 publications

(26 citation statements)

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“…Malnutrition may contribute to increased length of diarrheal illness, hospitalization, and perhaps to fatality associated with intestinal cryptosporidiosis (39,158,196,234,273,289,309,350,351). For example, one study (273) from a hospital in Jerusalem revealed that children with diarrhea and Cryptosporidiumpositive stools were significantly more malnourished than children with diarrhea and no Cryptosporidium oocysts in their stools.…”

Section: Immunocompetent Personsmentioning

confidence: 99%

“…Inconclusive results have been reported for oral treatment with spiramycin, a macrolide antibiotic related to erythromycin (64,97,120,248,253,272,350,354). An evaluation of 37 patients with cryptosporidial diarrhea who were treated with spiramycin prompted investigators to conclude that 28 had a favorable response in the reduction of the number of daily bowel movements to <50% of that prior to treatment and that 12 of the 28 stopped shedding oocysts (228a).…”

Section: Treatment Chemotherapymentioning

confidence: 99%

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Cryptosporidiosis

1991

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Before 1982, only eight case reports of human cryptosporidiosis and fewer than 30 papers on Cryptosporidium spp. appeared in the biomedical literature. At that time, cryptosporidiosis was thought to be an infrequent infection in animals and rarely an opportunistic infection in humans. The concept of Cryptosporidium spp. as pathogens has changed dramatically within the past 8 years because of improved diagnostic techniques, increased awareness within the biomedical community, and the development of basic research programs in numerous laboratories. Presently, greater than 1,000 publications including over 400 case reports in the biomedical literature address Cryptosporidium spp. and cryptosporidiosis. Cryptosporidium parvum is now thought to be one of the three most common enteropathogens causing diarrheal illness in humans worldwide, especially in developing countries. It is likely that cryptosporidiosis was previously included in the 25 to 35% of diarrheal illness with unknown etiology. Because of the severity and length of diarrheal illness and because no effective therapy has been identified, cryptosporidiosis is one of the most ominous infections associated with AIDS. The role of C. parvum as an enteropathogen is well established; documentation of its role as a cause of hepatobiliary and respiratory diseases is now appearing in the literature. Our present understanding of the natural history, epidemiology, biology, and immunology of Cryptosporidium spp. as well as the clinical features, pathogenicity, and treatment of cryptosporidiosis are reviewed here.

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Section: Immunocompetent Personsmentioning

confidence: 99%

Section: Treatment Chemotherapymentioning

confidence: 99%

Cryptosporidiosis

1991

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“…Nosocomial patient-to-patient transmission of C. parvum in hospitals has also been reported (7,32,65,106,117,126,128,140,148,152,176); the reports have varied with respect to the strength of the evidence that infection was hospital acquired. Patient-to-patient transmission of infection is beyond the scope of this article, and nosocomially acquired cases were not included in the case counts (Table 4).…”

Section: General Commentsmentioning

confidence: 99%

Laboratory-Acquired Parasitic Infections from Accidental Exposures

2001

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SUMMARY Parasitic diseases are receiving increasing attention in developed countries in part because of their importance in travelers, immigrants, and immunocompromised persons. The main purpose of this review is to educate laboratorians, the primary readership, and health care workers, the secondary readership, about the potential hazards of handling specimens that contain viable parasites and about the diseases that can result. This is accomplished partly through discussion of the occupationally acquired cases of parasitic infections that have been reported, focusing for each case on the type of accident that resulted in infection, the length of the incubation period, the clinical manifestations that developed, and the means by which infection was detected. The article focuses on the cases of infection with the protozoa that cause leishmaniasis, malaria, toxoplasmosis, Chagas' disease (American trypanosomiasis), and African trypanosomiasis. Data about 164 such cases are discussed, as are data about cases caused by intestinal protozoa and by helminths. Of the 105 case-patients infected with blood and tissue protozoa who either recalled an accident or for whom the likely route of transmission could be presumed, 47 (44.8%) had percutaneous exposure via a contaminated needle or other sharp object. Some accidents were directly linked to poor laboratory practices (e.g., recapping a needle or working barehanded). To decrease the likelihood of accidental exposures, persons who could be exposed to pathogenic parasites must be thoroughly instructed in safety precautions before they begin to work and through ongoing training programs. Protocols should be provided for handling specimens that could contain viable organisms, using protective clothing and equipment, dealing with spills of infectious organisms, and responding to accidents. Special care should be exercised when using needles and other sharp objects.

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“…Although close to eighty chemotherapeutic, biologic and other anti-diarrheal agents have now been evaluated, only anecdotal success has been reported. In at least three trials, spiramycin, previously the most promising agent, has now been shown to have little predictable efficacy (3,11,12). Bovine-derived products, especially colostrum hyperimmune to Cryptosporidium, have been tried recently in both animals and humans, and may be protective and/or therapeutic (13,14,15,16).…”

Section: ' L0andimentioning

confidence: 99%

“…Of particular relevance are several groups now thought to be at increased risk for Cryptosporidium infection: Nosocomial spread of Cryptosporidium to hospitalized patients has been noted (12,19), and immunologically healthy family members and health care workers are frequently infected after contact with a patient with cryptosporidiosis (20,21,22,23). Travellers or temporary workers in areas of high endemicity are also at increased risk (24,25,26,27,28).…”

Section: ' L0andimentioning

confidence: 99%

Diagnosis of AIDS-Related Intestinal Parasites

Ungar¹

1989

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Spiramycin Is Not Effective in Treating Cryptosporidium Diarrhea in Infants: Results of A Double-Blind Randomized Trial

Cited by 63 publications

References 0 publications

Cryptosporidiosis

Cryptosporidiosis

Laboratory-Acquired Parasitic Infections from Accidental Exposures

Diagnosis of AIDS-Related Intestinal Parasites

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