Cryptosporidium spp. Infection in Solid Organ Transplantation: The Nationwide "TRANSCRYPTO" Study.
Diarrhea is a frequent complication of solid organ transplantation. Cryptosporidiosis is classically reported in patients with acquired immunodeficiency syndrome and emerged as a cause of persistent diarrhea in solid organ transplant patients.



Through the ANOFEL Cryptosporidium National Network and the French Transplantation Society, we collected all cryptosporidiosis cases identified in solid organ transplanted patients between 2006 and 2010 in France.



We reported 47 solid organ transplant recipients (41 kidneys) with cryptosporidiosis, mostly men (68%), with a median age of 52 (6-70) years old. Five patients had additional immunodepression favoring cryptosporidiosis (CD40 ligand deficiency [n = 1], human immunodeficiency virus infection [n = 4]). Cryptosporidiosis occurred at a median time of 3.4 (0-19.8) years posttransplant. Exposure to environmental risk factors was found before infection onset in 18 patients. Time between first symptoms and diagnosis was 10 (2-110) days. Four patients had associated extraintestinal location (biliary tract [n = 3] and lung [n = 1]). Thirty-five patients received specific therapy against cryptosporidiosis ie nitozoxanide, 25 in monotherapy, and 10 in association with azithromycin, 13 in association with immunosuppression (IS) reduction. Four patients were cured with IS treatment tapering only. The others patients had neither IS reduction nor specific therapy against cryptosporidiosis. Cryptosporidiosis was complicated by renal failure in 15 patients. Symptoms resolved after a median of 10 days of treatment. Six patients relapsed and 3 died, 1 with evolutive infection.



Cryptosporidiosis is a late posttransplant infection that disseminated to biliar duct or lung in 9% of patients. When limited to digestive tract, infection may resolve without IS reduction.
1 Université Paris Descartes, Service de maladies infectieuses et tropicales, Hôpital Necker-Enfants malades, Assistance Publique des Hôpitaux de Paris (AP-HP), Imagine Institute, Paris, France. 2 Unité de parasitology-Mycologie, Hôpital Universitaire de Rouen, Rouen, France. 3 Service de Transplantation rénale, Hôpital Necker Enfants malades, AP-HP, Paris, France. 4 Unité de Recherche Clinique/Centre d'Investigation Clinique, Hôpital Universitaire Necker Enfants malades, AP-HP, Paris, France. 5 Département d'Urologie, Néphrologie et Transplantation, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, APHP, Univ. Pierre et Marie Curie, Paris, France. 6 Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Médecine Interne, Néphrologie Pédiatrique, Hôpital des enfants, Centre de Référence des maladies rénales rares du Sud Ouest. (SORARE), Toulouse, France. 7 Université Paris Descartes, Unité de Parasitologie-Mycologie, Service de Microbiologie Clinique, Hôpital Necker Enfants Malades, APHP, Paris, France.
Fanny
F
Lanternier
Karima
K
Amazzough
Loic
L
Favennec
Marie-France
MF
Mamzer-Bruneel
Hendy
H
Abdoul
Jérome
J
Tourret
Stéphane
S
Decramer
Julien
J
Zuber
Anne
A
Scemla
Christophe
C
Legendre
Olivier
O
Lortholary
Marie-Elisabeth
ME
Bougnoux
D000293:Adolescent; D000328:Adult; D000368:Aged; D000930:Antidiarrheals / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D003457:Cryptosporidiosis / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D003458:Cryptosporidium / Q000145:classification / Q000302:isolation & purification*; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000930:Antidiarrheals; D000981:Antiprotozoal Agents; D007166:Immunosuppressive Agents
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