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Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan.

Raja K, Abbas Z, Hassan SM, Luck NH, Aziz T, Mubarak M - J Nephropathol (2014)

Bottom Line: 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.Stool examination is usually negative for pus cells.

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Affiliation: Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.

ABSTRACT

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.

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

Patients and 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.

No MeSH data available.


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Mentions: The main demographic, clinical and laboratory parameters of the study patients are shown in Table 1. Out of 644 renal transplant patients who presented with acute diarrhea in the posttransplant OPD during the study period, oocysts of cryptosporidia were identified in 343 (53%) patients, in fairly large numbers in all cases (Figure 1). This constituted the cryptosporidium positive group. Of these, 213 (62%) were males and 130 (38%) females. Among cryptosporidium negative group, 169 (56%) were males and 132 (44%) were females. There was no significant difference in the gender distribution in the two groups. The mean age was 32.1±11 years in cryptosporidium positive group and 36±13 years in cryptosporidium negative group, with no statistically significant difference among the two groups. In addition to the presence of cryptosporidia, numerous pus cells (≥10 cells/HPF) were reported in the stool examination in 27 (7.8%) patients, co-infection with giardia intestinalis cysts in 15 (4.4%) and entamoeba histolytica cysts in 10 (2.6%) patients of the cryptosporidium positive group. The same parameters in the cryptosporidium negative group were found in 35 (11.6%), 9 (2.9%), and 14 (4.63%) respectively with no significant difference in the two groups. Overall, 43 (12.5%) patients of the cryptosporidium positive group were deemed to be suffering from co-infection as suggested by the presence of cysts of other organisms or superadded bacterial infection resulting in numerous pus cells in the stools. So these patients were treated with ciprofloxacin and metronidazole in addition to nitazoxanide for mixed infection and all responded favorably to the combined therapy.


Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan.

Raja K, Abbas Z, Hassan SM, Luck NH, Aziz T, Mubarak M - J Nephropathol (2014)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219614&req=5

Mentions: The main demographic, clinical and laboratory parameters of the study patients are shown in Table 1. Out of 644 renal transplant patients who presented with acute diarrhea in the posttransplant OPD during the study period, oocysts of cryptosporidia were identified in 343 (53%) patients, in fairly large numbers in all cases (Figure 1). This constituted the cryptosporidium positive group. Of these, 213 (62%) were males and 130 (38%) females. Among cryptosporidium negative group, 169 (56%) were males and 132 (44%) were females. There was no significant difference in the gender distribution in the two groups. The mean age was 32.1±11 years in cryptosporidium positive group and 36±13 years in cryptosporidium negative group, with no statistically significant difference among the two groups. In addition to the presence of cryptosporidia, numerous pus cells (≥10 cells/HPF) were reported in the stool examination in 27 (7.8%) patients, co-infection with giardia intestinalis cysts in 15 (4.4%) and entamoeba histolytica cysts in 10 (2.6%) patients of the cryptosporidium positive group. The same parameters in the cryptosporidium negative group were found in 35 (11.6%), 9 (2.9%), and 14 (4.63%) respectively with no significant difference in the two groups. Overall, 43 (12.5%) patients of the cryptosporidium positive group were deemed to be suffering from co-infection as suggested by the presence of cysts of other organisms or superadded bacterial infection resulting in numerous pus cells in the stools. So these patients were treated with ciprofloxacin and metronidazole in addition to nitazoxanide for mixed infection and all responded favorably to the combined therapy.

Bottom Line: 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.Stool examination is usually negative for pus cells.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.

ABSTRACT

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.

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

Patients and 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.

No MeSH data available.


Related in: MedlinePlus