title: Cryptosporidial infection in children with inflammatory bowel disease.
abstract: OBJECTIVE
  Cryptosporidiosis is usually a self-limiting illness in healthy patients. However, it can cause severe life threatening complications in immunocompromised patients. The effect of cryptosporidial infection on inflammatory bowel disease (IBD) has not been well studied and available literature is largely restricted to adult case reports. The purpose of this study is to describe the clinical characteristics of cryptosporidial infection in children with IBD.
  
  
  METHODS
  Stool studies from children with IBD presenting with presumed relapse during the period 2005-2011 were reviewed retrospectively. Cryptosporidial infection was diagnosed by stool enzyme immunoassay. An age matched control group of IBD patients without cryptosporidial infection was used for comparison.
  
  
  RESULTS
  Medical records of 170 IBD patients were reviewed and a total of 149 presumed relapses were identified. Cryptosporidial infection was found in seven of the 39 patients with positive stool studies (four ulcerative colitis/three Crohn's disease) presenting with relapse. The median age was 13 years (range: 3-17) and five patients were female. The median duration of the IBD was 18 months (range 2-48 months). All but one patient had stable disease prior to acquiring infection. Five patients required hospitalization due to significant dehydration. Three of the five patients treated with nitazoxanide had significant clinical improvement in 3 days. All patients had complete resolution of symptoms by three weeks and no infection related complications were noted. In comparison to patients with cryptosporidial infection, the control group required an increased need for escalation of therapy (71% vs. 0.0%, p=001) and higher re-hospitalization rates (24% Vs.0.0%, p=0.54) within 6 months following indexed relapse.
  
  
  CONCLUSIONS
  In IBD patients, cryptosporidiosis can cause significant illness leading to increased need for hospitalization. In the absence of appropriate stool studies, cryptosporidiosis can be misdiagnosed as disease relapse and lead to inappropriate therapy. Nitazoxanide appears to be effective along with supportive therapy.
authors: Division of Pediatric Gastroenterology and Nutrition, Children's of Alabama, Birmingham, AL, USA. nvadlamudi@peds.uab.edu
authors: Narendra
authors: N
authors: Vadlamudi
authors: Jeanine
authors: J
authors: Maclin
authors: Reed A
authors: RA
authors: Dimmitt
authors: Kirk A
authors: KA
authors: Thame
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000977:Antiparasitic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D003457:Cryptosporidiosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003458:Cryptosporidium / Q000302:isolation & purification; D003967:Diarrhea / Q000209:etiology* / Q000469:parasitology; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D009574:Nitro Compounds; D010359:Patient Readmission; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000977:Antiparasitic Agents; D007166:Immunosuppressive Agents; D009574:Nitro Compounds; D013844:Thiazoles; C041747:nitazoxanide
keywords: 5-ASA; 5-Amino-salicylic acid; Anti-tumor necrosis factor alpha; CD; Crohn's disease; Cryptosporidium; Gastroenteritis; IBD; Inflammatory bowel disease; Nitazoxanide; UC; Ulcerative colitis; aTNFα