Eradication of cryptosporidium from a defunctionalized colon limb by refeeding stoma effluent.
Over the last 40 years, cryptosporidium has increasingly been recognized as a cause of acute self-limiting diarrhea in normal hosts. In the immunocompromised patient, cryptosporidium may cause severe illness with prolonged diarrhea and malabsorption. Pharmacologic therapy of cryptosporidium relies on adequate delivery of drug metabolites to the colon. Here we describe a patient who developed toxic megacolon during induction therapy for leukemia, requiring ileostomy formation to proceed with leukemia treatment. Although the megacolon resolved promptly, the resulting isolation of the colon from the fecal stream prevented luminal delivery of active metabolites of anti-protozoal drugs, resulting in persistent cryptosporidiosis. Refeeding of the ileostomy output into the colon effectively eradicated cryptosporidium from the colon and permitted closure of the ileostomy.
Sidebotham
Emma L
EL
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Sepkowitz
Kent
K
Price
Anita P
AP
Steinherz
Peter G
PG
La Quaglia
Michael P
MP
Kayton
Mark L
ML
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002404:Catheterization; D002675:Child, Preschool; D003106:Colon / Q000469:parasitology*; D003108:Colonic Diseases / Q000188:drug therapy* / Q000469:parasitology; D003457:Cryptosporidiosis / Q000188:drug therapy* / Q000601:surgery; D003458:Cryptosporidium / Q000187:drug effects / Q000302:isolation & purification; D003967:Diarrhea / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D008531:Megacolon / Q000139:chemically induced; D016896:Treatment Outcome; D014258:Trichuris / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents