Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan.
BACKGROUND
Cryptosporidium is an intracellular protozoan organism which causes diarrhea, both in immunocompetent and immunocompromised hosts. Renal transplant recipients are prone to develop a variety of infections including protozoal infections.


OBJECTIVE
The aim of this study was to determine the prevalence of cryptosporidiosis in our renal transplant recipients presenting with acute diarrhea.


METHODS
During six months of the study, 644 renal transplant recipients presented with acute diarrhea. Single stool sample was obtained for detailed analysis including gross and microscopic examination for red blood cells, pus cells, ova, cysts, and protozoa. The modified Ziehl-Neelsen (ZN) staining was done to identify the oocysts of cryptosporidia.


RESULTS
Out of 644 renal transplant patients, oocysts of cryptosporidia were identified in 343 patients (53%). Detailed stool analysis of these patients showed the presence of numerous pus cells in 27 (7.9%) patients, co-infection with giardia intestinalis cysts in 15 (4.3%), and entamoeba histolytica cysts in 10 (2.9%). In all, out of 343 patients, 43 (12.5%) had dual infection with bacteria and protozoa in addition to cryptosporidiosis.


CONCLUSIONS
Cryptosporidium is an important pathogen causing acute diarrhea in renal transplant recipients in our set up. Stool examination is usually negative for pus cells. It is recommended that in all transplant recipients presenting with acute diarrhea modified ZN staining should be done to rule out cryptosporidiosis in highly endemic areas like Pakistan.
Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Kapeel
K
Raja
Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Zaigham
Z
Abbas
Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Syed Mujahid
SM
Hassan
Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Nasir Hassan
NH
Luck
Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Tahir
T
Aziz
Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Muhammed
M
Mubarak
Cryptosporidium; Diarrhea; Immunocompromised; Renal transplant patients; Stool analysis