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Cryptosporidiosis in children following solid organ transplantation

Irit Krause1, Jacob Amir, Roxana Cleper

  • 1Institute of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petah-Tiqva, Israel. ikrause@post.tau.ac.il

The Pediatric Infectious Disease Journal
|July 20, 2012
PubMed

Insights

Cryptosporidium infection in pediatric solid organ transplant recipients can cause severe diarrhea and complications. Early diagnosis and prolonged nitazoxanide treatment (at least 14 days) are crucial for recovery.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Transplantation Medicine

Background:

  • Cryptosporidium parvum is a common cause of diarrhea, typically self-limiting in healthy individuals.
  • It can cause severe disease in immunocompromised patients, with limited data in pediatric solid organ transplant recipients.
  • This study reports on 6 pediatric solid organ transplant recipients experiencing Cryptosporidium-induced gastroenteritis.

Purpose of the Study:

  • To describe the clinical presentation and outcomes of Cryptosporidium infection in pediatric solid organ transplant recipients.
  • To highlight the importance of timely diagnosis and appropriate treatment in this vulnerable population.

Main Methods:

  • Retrospective review of gastroenteritis episodes in solid organ transplant recipients from January 2008 to August 2011.
  • Identification of cases with positive Cryptosporidium antigen stool staining.
  • Analysis of patient demographics, clinical symptoms, laboratory findings, treatment, and outcomes.

Main Results:

  • Cryptosporidium was detected in 6 out of 57 (11%) gastroenteritis episodes in pediatric solid organ transplant recipients.
  • Affected patients experienced prolonged diarrhea, fever, abdominal pain, and weight loss, with a mean symptom duration of 10.5 days before diagnosis.
  • Complications included kidney function deterioration (5 patients), increased tacrolimus levels (5 patients), and abnormal liver enzymes (4 patients).
  • All patients were hospitalized, received fluid replacement, and were treated with nitazoxanide; two experienced symptom recurrence after short therapy courses.
  • All patients eventually recovered.

Conclusions:

  • Routine testing for Cryptosporidium is recommended in solid organ transplant recipients presenting with diarrhea.
  • Delayed treatment initiation can lead to serious complications, including acute renal failure.
  • Extended therapy with nitazoxanide (minimum 14 days) may improve patient recovery outcomes.
Abstract

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