Cryptosporidium infection in solid organ transplantation.
Diarrhea is a common complication in solid organ transplant (SOT) recipients and may be attributed to immunosuppressive drugs or infectious organisms such as bacteria, viruses or parasites. Cryptosporidium usually causes self-limited diarrhea in immunocompetent hosts. Although it is estimated that cryptosporidium is involved in about 12% of cases of infectious diarrhea in developing countries and causes approximately 748000 cases each year in the United States, it is still an under recognized and important cause of infectious diarrhea in SOT recipients. It may run a protracted course with severe diarrhea, fluid and electrolyte depletion and potential for organ failure. Although diagnostic methodologies have improved significantly, allowing for fast and accurate identification of the parasite, treatment of the disease is difficult because antiparasitic drugs have modest activity at best. Current management includes fluid and electrolyte replacement, reduction of immunosuppression and single therapy with Nitazoxanide or combination therapy with Nitazoxanide and other drugs. Future drug and vaccine development may add to the currently poor armamentarium to manage the disease. The current review highlights key epidemiological, diagnostic and management issues in the SOT population.
Diana F Florescu, Uriel Sandkovsky, Transplant Infectious Diseases Program, Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, United States.
Diana F
DF
Florescu
Diana F Florescu, Uriel Sandkovsky, Transplant Infectious Diseases Program, Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, United States.
Uriel
U
Sandkovsky
Antiparasitic drugs; Cryptosporidium; Diarrhea; Nitazoxanide; Solid organ transplantation
Scand J Infect Dis. 2005;37(5):354-60
16051572
J Antimicrob Chemother. 2000 Jul;46(1):57-60
10882689
BMC Infect Dis. 2009 Dec 02;9:195
19954529
J Hepatol. 2003 May;38(5):688-91
12713884
J Med Microbiol. 2015 Jul;64(7):688-93
25976007
Pediatr Transplant. 2000 Feb;4(1):50-5
10731059
J Clin Microbiol. 2003 Feb;41(2):623-6
12574257
Pediatr Infect Dis J. 2009 Sep;28(9):838-40
19684527
Rev Soc Bras Med Trop. 1998 Jul-Aug;31(4):333-7
9662959
N Engl J Med. 1989 May 25;320(21):1372-6
2716783
J Infect Dis. 2012 May 1;205(9):1464-71
22454464
J Microbiol Methods. 2012 Apr;89(1):38-40
22366300
Am J Trop Med Hyg. 2010 Apr;82(4):600-7
20348507
Epidemiol Infect. 2012 Apr;140(4):673-83
21733255
MMWR Morb Mortal Wkly Rep. 1984 Oct 26;33(42):599-601
6434936
Transpl Infect Dis. 2012 Dec;14(6):635-48
22340660
J Infect Dis. 1989 Sep;160(3):559
2668434
BMC Microbiol. 2010 Aug 09;10:213
20696051
Lancet. 1990 Jun 16;335(8703):1455-6
1972222
J Clin Microbiol. 2000 Nov;38(11):3984-90
11060056
Trans R Soc Trop Med Hyg. 1998 Nov-Dec;92 (6):663-6
10326116
J Water Health. 2007 Mar;5(1):1-38
17402277
J Clin Microbiol. 1997 Jun;35(6):1526-9
9163474
Transpl Infect Dis. 2015 Feb;17(1):48-55
25620388
Arch Pathol Lab Med. 1991 Nov;115(11):1160-2
1747035
J Egypt Soc Parasitol. 2002 Dec;32(3):969-78
12512828
Clin Microbiol Infect. 2006 Jul;12(7):656-9
16774562
Pediatr Infect Dis J. 1989 Mar;8(3):136-40
2652084
J Infect Dis. 2001 Jul 1;184(1):103-6
11398117
Curr Opin Infect Dis. 2002 Oct;15(5):523-7
12686887
Lancet. 1986 May 24;1(8491):1207
2871438
Pediatr Infect Dis J. 2012 Jan;31(1):10-5
22094626
Lancet. 2013 Jul 20;382(9888):209-22
23680352
J Infect Dis. 1998 Sep;178(3):900-3
9728569
Emerg Infect Dis. 2011 Jan;17(1):7-15
21192848
Curr Opin Gastroenterol. 2011 Mar;27(2):125-31
21248635
Clin Microbiol Rev. 2014 Jul;27(3):575-86
24982322
Parasitology. 2010 Jan;137(1):27-36
19765343
J Med Microbiol. 2011 Nov;60(Pt 11):1598-604
21757501
Am J Transplant. 2013 Mar;13 Suppl 4:318-26
23465024
Parasitol Res. 1991;77(1):44-7
1825238
Exp Parasitol. 2010 Jan;124(1):138-46
19545516
Nefrologia. 2010;30(4):476-7
20651893
Clin Infect Dis. 2010 May 15;50(10):1366-72
20377408
Clin Gastroenterol Hepatol. 2006 Mar;4(3):320-4
16527695
Clin Microbiol Rev. 2013 Jan;26(1):115-34
23297262
Parasite Immunol. 2000 Dec;22(12):597-604
11123751
Am J Transplant. 2013 Mar;13 Suppl 4:304-10
23465022
J Antimicrob Chemother. 2006 Feb;57(2):353-5
16361328
Emerg Infect Dis. 2014 Apr;20(4):581-9
24655474
Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004932
17253532
Curr Opin Infect Dis. 2012 Oct;25(5):555-63
22907279
Clin Infect Dis. 1998 Jun;26(6):1324-9
9636857
Lancet Infect Dis. 2015 Jan;15(1):85-94
25278220
J Pediatr Gastroenterol Nutr. 1984;3(1):149-57
6694044
Clin Microbiol Rev. 2002 Jan;15(1):145-54
11781272
Contrib Microbiol. 2000;6:75-91
10943508
APMIS. 2004 Apr-May;112(4-5):309-13
15233648
J Clin Microbiol. 2014 Oct;52(10):3667-73
25100818
AIDS. 2000 Dec 22;14(18):2889-93
11153670
J Pediatr Gastroenterol Nutr. 1991 Jan;12(1):139
2061770
Pediatr Infect Dis J. 1994 Apr;13(4):310-7
8036049
Emerg Infect Dis. 2011 Jan;17(1):151-2
21192888
Pediatr Transplant. 2012 Jun;16(4):E115-9
21320246
Trop Parasitol. 2012 Jan;2(1):20-3
23508690
Microbes Infect. 2002 Aug;4(10):1059-66
12191656
Transplantation. 2005 Mar 27;79(6):702-9
15785377
AIDS. 1994 Apr;8(4):555-6
8011262
Parasitol Res. 2014 Jan;113(1):211-6
24221885
Transpl Infect Dis. 2011 Aug;13(4):416-8
21615846
Enferm Infecc Microbiol Clin. 2013 Mar;31(3):193-4
22763114
Transplant Proc. 2004 Sep;36(7):2128-9
15518772
Future Microbiol. 2010 Mar;5(3):335-7
20210541
Parasite Immunol. 2013 Feb;35(2):55-64
23173616
Eur J Clin Microbiol Infect Dis. 2011 Dec;30(12):1461-72
21484252
Adv Parasitol. 1988;27:63-129
3289331
Clin Nephrol. 2005 Apr;63(4):305-9
15847259
Transplant Proc. 2002 May;34(3):951-2
12034256
Pediatr Infect Dis J. 2012 Nov;31(11):1135-8
22810017
Nefrologia. 2006;26(6):753-4
17227259
Infect Immun. 2008 Jan;76(1):23-9
17967863
Clin Res Hepatol Gastroenterol. 2012 Apr;36(2):130-8
22306050
Int J STD AIDS. 1997 Feb;8(2):124-9
9061412
Clin Lab Med. 1991 Dec;11(4):873-97
1802526
Water Res. 2011 Dec 15;45(20):6603-14
22048017
Trends Parasitol. 2013 May;29(5):237-51
23566713
Infect Immun. 1998 Feb;66(2):441-3
9453592
Euro Surveill. 2012 Feb 02;17(5):null
22321139
Epidemiol Infect. 2014 Oct;142(10):2105-13
24308502
J Clin Microbiol. 2011 Mar;49(3):918-24
21177904
Minerva Med. 1998 May;89(5):173-5
9676183
Pediatr Transplant. 2007 Feb;11(1):94-100
17239130
J Environ Health. 2012 Nov;75(4):14-9
23210393
MMWR Suppl. 2015 May 1;64(3):1-14
25928581
JAMA. 1998 Feb 4;279(5):384-6
9459473
N Engl J Med. 1994 Jul 21;331(3):161-7
7818640
Curr Opin Infect Dis. 2004 Dec;17(6):557-64
15640710
J Clin Microbiol. 1996 Jan;34(1):227-9
8748314
J Infect Dis. 1989 Jan;159(1):131-2
2642518
J Infect Dis. 1994 Aug;170(2):419-24
8035029
Transpl Infect Dis. 2007 Dec;9(4):270-5
17511817
Euro Surveill. 2013 Jan 10;18(2):null
23324424
Pediatr Transplant. 2005 Jun;9(3):315-23
15910387
Nephron. 1997;75(2):171-4
9041537
Appl Environ Microbiol. 1990 May;56(5):1423-8
2339894
MMWR Morb Mortal Wkly Rep. 2014 Jan 10;63(1):6-10
24402466
Am J Transplant. 2013 Mar;13 Suppl 4:280-303
23465021
Curr Opin Infect Dis. 2010 Oct;23 (5):494-9
20689422
Bone Marrow Transplant. 1997 Jun;19(12):1261-3
9208124
Exp Parasitol. 2010 Jan;124(1):80-9
19358845
Int J Parasitol. 2002 May;32(5):517-25
11943224
Front Microbiol. 2015 Nov 19;6:1208
26635732
Eur J Pediatr. 2000 Jan-Feb;159(1-2):113-5
10653343
Ann Intern Med. 1992 May 15;116(10):840-2
1348918
Pediatr Nephrol. 2009 Nov;24(11):2245-55
19714369
Ann Intern Med. 1985 Dec;103(6 ( Pt 1)):886-8
4062089
BMJ. 2009 Oct 19;339:b4168
19841008
J Immunol. 1997 Jan 15;158(2):977-83
8993019
Contrib Microbiol. 2000;6:50-74
10943507
J Antimicrob Chemother. 2000 Apr;45(4):453-6
10747821
Clin Infect Dis. 2001 May 15;32(10):1516-7
11317257
J Pediatr. 1996 Aug;129(2):297-300
8765631