title: Ruling out nosocomial transmission of Cryptosporidium in a renal transplantation unit: case report.
abstract: BACKGROUND
  Cryptosporidium spp. is a ubiquitous parasite affecting humans as well as domestic and wild vertebrates, causing diarrhea in both immunocompetent and immunocompromised hosts worldwide. Its transmission occurs primarily by the fecal-oral route. In humans, C. parvum and C. hominis are the most prevalent species, whereas immunocompetent and immunocompromised individuals can also be infected by other zoonotic species. Renal transplant patients are prone to develop cryptosporidiosis, which can induce severe and life-threatening diarrhea.
  
  
  METHODS
  We report here a series of nearly concomitant cases of acute symptomatic cryptosporidiosis in three renal transplant patients attending the Strasbourg University Hospital Nephrology Unit. The clinical presentation was persistent diarrhea and acute renal failure. The diagnosis was confirmed by microscopic stool examination using a modified Ziehl-Neelsen staining method and species identification by molecular tools. All patients were treated with nitazoxanide and recovered from diarrhea after 14 days of therapy.
  
  
  CONCLUSIONS
  Genotypic species identification was not consistent with an epidemic context, thus underlining the need for genotyping to monitor at risk patients.
authors.affiliation: Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France. jbrunet@unistra.fr.|Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France. jbrunet@unistra.fr.
authors.forename: J
authors.initials: J
authors.lastname: Brunet
authors.affiliation: Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Lemoine
authors.affiliation: Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Pesson
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Valot
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.|UMR 1347, Université de Bourgogne, 17 rue de Sully, F-21000, Dijon, France.
authors.forename: M
authors.initials: M
authors.lastname: Sautour
authors.affiliation: Laboratoire de Parasitologie et de Mycologie, Plateau Technique de Biologie du CHU Dijon, 2 rue Angélique Ducoudray, BP 37013, F-21070, Dijon cedex, France.|UMR 1347, Université de Bourgogne, 17 rue de Sully, F-21000, Dijon, France.
authors.forename: F
authors.initials: F
authors.lastname: Dalle
authors.affiliation: Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Muller
authors.affiliation: Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Borni-Duval
authors.affiliation: Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Caillard
authors.affiliation: Département de Néphrologie et Transplantation, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Moulin
authors.affiliation: Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.|Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France.
authors.forename: A W
authors.initials: AW
authors.lastname: Pfaff
authors.affiliation: Laboratoire de Parasitologie-Mycologie, EA 3800, Centre Hospitalier Universitaire, Université de Rouen, 1, rue de Germont, F-76031, Rouen, France.
authors.forename: R
authors.initials: R
authors.lastname: Razakandrainibe
authors.affiliation: Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Abou-Bacar
authors.affiliation: Laboratoire de Parasitologie-Mycologie, EA 3800, Centre Hospitalier Universitaire, Université de Rouen, 1, rue de Germont, F-76031, Rouen, France.
authors.forename: L
authors.initials: L
authors.lastname: Favennec
authors.affiliation: Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, F-67091, Strasbourg cedex, France.|Institut de Parasitologie et Pathologie Tropicale, EA 7292, Fédération de Médecine Translationnelle, Université de Strasbourg, 3 rue Koeberlé, F-67000, Strasbourg, France.
authors.forename: E
authors.initials: E
authors.lastname: Candolfi
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000469:parasitology; D000328:Adult; D000818:Animals; D003049:Coccidiostats / Q000627:therapeutic use; D003428:Cross Infection / Q000469:parasitology*; D003457:Cryptosporidiosis / Q000150:complications / Q000188:drug therapy / Q000635:transmission*; D003458:Cryptosporidium / Q000235:genetics / Q000472:pathogenicity*; D003967:Diarrhea / Q000209:etiology / Q000469:parasitology; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009574:Nitro Compounds; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D003049:Coccidiostats; D009574:Nitro Compounds; D013844:Thiazoles; C041747:nitazoxanide
keywords: Case report; Cryptosporidium; Genotypic species identification; Renal transplant; Zoonotic species