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Eradication of Cryptosporidium in four children with acute lymphoblastic leukemia
Omar Trad1, Pauline Jumaa, Sayenna Uduman
1Department of Pediatrics, Tawam Hospital, AlAin, Abu Dhabi, United Arab Emirates. oatrad@emirates.net.ae
Insights
Cryptosporidium infection causes severe diarrhea in children undergoing chemotherapy for acute lymphoblastic leukemia. Paromomycin or azithromycin can effectively treat this opportunistic infection in immunocompromised patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Gastroenterology
Background:
- Acute lymphoblastic leukemia (ALL) treatment often involves chemotherapy, leading to immunocompromise.
- Immunocompromised patients are susceptible to opportunistic infections, including parasitic infections.
- Severe diarrhea in these patients can be a sign of Cryptosporidium infection.
Purpose of the Study:
- To investigate the occurrence of Cryptosporidium infection in children with ALL presenting with severe diarrhea.
- To evaluate the efficacy of paromomycin and azithromycin in treating Cryptosporidium diarrhea in this population.
- To highlight the importance of specific diagnostic methods for Cryptosporidium.
Main Methods:
- Case series of four children with ALL and severe diarrhea.
- Stool samples analyzed using modified Ziehl-Neelsen stain for Cryptosporidium detection.
- Treatment regimens included paromomycin and azithromycin, with clinical and laboratory monitoring.
Main Results:
- Cryptosporidium was identified in all four patients.
- Two patients treated with paromomycin showed good response.
- One patient initially treated with paromomycin but later switched to azithromycin showed a complete response.
- One patient treated with azithromycin from the start responded well.
Conclusions:
- Cryptosporidium should be suspected in immunocompromised children with severe or prolonged diarrhea.
- Modified Ziehl-Neelsen stain is crucial for diagnosis, as routine ova and parasite exams may be negative.
- Paromomycin and azithromycin are potential therapeutic options for Cryptosporidium diarrhea in immunocompromised children.
Abstract:
Four children on chemotherapy for acute lymphoblastic leukemia presented with severe diarrhea and dehydration. Cryptosporidium was identified in the stools using modified Ziehl-Neelsen stain. Two of them received paromomycin and responded well. One was started on paromomycin for 10 days and although there was clinical improvement, his stools examination continued to be positive for Cryptosporidium. He then received azithromycin for 10 days. He responded well and his stools became negative for Cryptosporidium. The fourth patient received azithromycin from the start and responded well. Cryptosporidium should be considered in all immunocompromised children with severe or prolonged diarrhea, and since it is not seen in a routine ova and parasite examination, the laboratory should be notified for diagnostic confirmation using modified Ziehl-Neelsen stain. Immunocompromised children with Cryptosporidium diarrhea may benefit from paromomycin or azithromycin therapy.