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• W2029681918 abstract "Cryptosporidium, an intracellular parasite, has evolved as an important pathogen in an immunosuppressed population. Literature on cryptosporidium infestation in transplant recipients is scarce. We conducted a preliminary study at our center to get an idea about prevalence, disease manifestation, and management of cryptosporidial infection. A total of 180 stool samples were collected from 60 patients in formalin containers over a period of one month. Modified acid fast staining was used for stool routine examination. The median duration posttransplant when the samples were collected was four months. Out of 60 patients, 12 patients (20%) had cryptosporidium oocysts (Table 1). Two patients were symptomatic; one presented with acute diarrhea, and the other with chronic diarrhea. The diagnosis in the second patient was delayed because the stool sample was sent initially without a special request for cryptosporidia; because of this, he underwent unnecessary investigations like colonoscopy and barium meal examination. However, cryptosporidium was later documented with special stains. Both the patients responded well to spiramycin (2 g/day for 10 days).Table 1: Cryptosporidium infestation in transplant patientsCryptosporidial infestation was first reported in a renal transplant patient by Weisburger et al. (1) in 1979. Since then, there have been only few studies about cryptosporidium in transplant population. Ok et al. (2) reported only two symptomatic cases out of 13 transplant recipients with cryptosporidial infestation, one with diarrhea and the other with abdominal pain and distention; both became asymptomatic after treatment with spiramycin. The prevalence in their population was 18.8%. In our series, two patients had symptoms in the form of diarrhea, both of which responded to spiramycin. Extraintestinal manifestations like biliary, pulmonary, and middle ear involvement as described in AIDS patients (3) were not seen in our patients. The diagnosis in one case was delayed, as special stains were not used initially in stool routine examination and the patient was further investigated causing delay in the treatment. Hence, clinicians should realize that stool routine and microscopic examination do not include tests for cryptosporidium, and therefore need to be specifically requested. This holds especially true in transplant patients with diarrhea. There is no standard drug therapy for cryptosporidium infestation. Some studies suggested that spiramycin might be effective (4) but in a controlled trial of 54 patients with AIDS, no significant effect was demonstrated (5). Ok et al. (2) have shown good results with spiramycin in transplant population. Two symptomatic cases in our series responded well to spiramycin with complete eradication of oocyst excretion in the stool. These data suggest that Cryptosporidium is an important cause of diarrhea in transplant recipients. A high index of suspicion is required and special stains need to be requested for demonstration of this parasite in the stool samples. Spiramycin may be an effective drug for this condition. Since most of the studies have been carried out in patients with AIDS, further evaluation with larger transplant population is required to study the efficacy and safety of these drugs." @default.
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• W2029681918 date "2004-06-01" @default.
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• W2029681918 title "CRYPTOSPORIDIASIS IN LIVE RELATED RENAL TRANSPLANT RECIPIENTS: A SINGLE CENTER EXPERIENCE" @default.
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• W2029681918 doi "https://doi.org/10.1097/01.tp.0000132341.99938.c1" @default.
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