Acute cryptosporidiosis as a cause of sudden recurrence of digestive symptoms in patients with Crohn's disease

Cryptosporidiosis in individuals with inflammatory bowel disease: a scoping review protocol

INTRODUCTION

Cryptosporidiosis is a leading cause of moderate-to-severe diarrhoea globally, and, while it is often self-limited, in immunocompromised individuals, the infection can be associated with significant morbidity and mortality. Diagnosis might be missed or delayed in patients with inflammatory bowel disease (IBD) due to similar presentation, and these patients may also be on immunosuppressive therapies, increasing their risk of infection. Additionally, gastrointestinal infection and dysbiosis may be a risk factor for IBD. Diagnosis, presentation and treatment of cryptosporidiosis in individuals with IBD, as well as any epidemiologic correlations between the two diseases, will be investigated.

METHODS AND ANALYSIS

MEDLINE, Embase, Cochrane Library, CINAHL, Dissertations and Theses Global and grey literature will be searched. Joanna Briggs Institute (JBI) methodology for scoping reviews was used for the protocol and will be for the review. Two reviewers will independently screen studies and extract data. The evidence and presentation of the results will be analysed with input from the review team. Studies of cryptosporidiosis in patients with IBD will be included. Paediatric, adolescent and adult studies in all patient environments will be included. Cases in which Crohn's disease does not affect the intestine and cases in which cryptosporidial infection is not in the intestine will be excluded.

ETHICS AND DISSEMINATION

Published clinical literature will be systematically reviewed, and this work does not directly involve patients. Consequently, ethical review by an institutional review board is not required. Data will be presented at academic conferences, and a culminating report will be published in a peer-reviewed journal. OPEN SCIENCE FRAMEWORK REGISTRATION: https://osf.io/j47mb.

Horse-Specific Cryptosporidium Genotype in Human with Crohn's Disease and Arthritis

We identified an unusual subtype of a Cryptosporidium sp. horse genotype as the cause of cryptosporidiosis in a 13-year-old girl in Poland who was undergoing immunosuppressive treatment for juvenile rheumatoid arthritis and Crohn’s disease. The same subtype was identified in a horse the girl had ridden.

Postinfectious Inflammatory Syndrome following Cryptosporidium Infection

A 38-year-old woman with a history of Crohn's disease, multiple bowel resections, and ileostomy placement presented to the hospital with symptoms of increased ileostomy output for 1 week. She reported that she was emptying her bag fifteen times a day as opposed to her normal 3–4 times a day. Upon workup, she was found to have an acute kidney injury (AKI), and stool studies were positive for Cryptosporidium. She was treated with nitazoxanide 500 mg p.o. BID for 3 days along with continued rehydration. The patient was discharged after creatinine (Cr) and electrolytes returned to baseline. She continued to have elevated ileostomy output, and 1 week later, she was readmitted for another AKI and worsening of symptoms. At this hospitalization, stool studies were negative for Cryptosporidium, and the gastroenterologist consult recommended evaluation for active Crohn's and Lomotil for possible short bowel syndrome. Eventually, her laboratory results improved, and she was discharged again before the full workup was completed. The patient's ileostomy output continued to remain high following the second hospital discharge, and she eventually returned with another AKI, her third visit in a month. The workup for active Crohn's was completed, with fecal calprotectin, serum cortisol, and small bowel follow-through all returning to normal. At this time, postinfectious inflammatory syndrome was suspected, and she was started on 60 mg of prednisone for 2 weeks. Steroid therapy elicited a significant response with normalization of her ileostomy output and return of laboratory results to baseline. The patient was discharged without return of symptoms at follow-up.

Long-term health effects after resolution of acute Cryptosporidium parvum infection: a 1-year follow-up of outbreak-associated cases

We describe a longitudinal study carried out in an adult outbreak-associated cohort to investigate health effects, including post-infectious irritable bowel syndrome, occurring after resolution of acute Cryptosporidium parvum infection. New symptoms self-reported up to 12 months included: weight loss (31 %), abdominal pain (38 %), diarrhoea (33 %), eye pain (9 %), joint pain (33 %), fatigue (22 %) and symptoms consistent with irritable bowel syndrome (IBS) (28 %). Two people were medically diagnosed with IBS. This study describes for the first time sequelae reported by patients up to 12 months after infection with C. parvum, which appear to be similar to those described with C. hominis.

Cryptosporidium-contaminated water disinfection by a novel Fenton process

Three novel modified advanced oxidation process systems including ascorbic acid-, pro-oxidants- and ascorbic acid-pro-oxidants-modified Fenton system were utilized to study the disinfection efficiency on Cryptosporidium-contaminated drinking water samples. Different concentrations of divalent and trivalent iron ions, hydrogen peroxide, ascorbic acid and pro-oxidants at different exposure times were investigated. These novel systems were also compared to the classic Fenton system and to the control system which comprised of only hydrogen peroxide. The complete in vitro mechanism of the mentioned modified Fenton systems are also provided. The results pointed out that by considering the optimal parameter limitations, the ascorbic acid-modified Fenton system decreased the Cryptosporidium oocytes viability to 3.91%, while the pro-oxidant-modified and ascorbic acid-pro-oxidant-modified Fenton system achieved an oocytes viability equal to 1.66% and 0%, respectively. The efficiency of the classic Fenton at optimal condition was observed to be 20.12% of oocytes viability. The control system achieved 86.14% of oocytes viability. The optimum values of the operational parameters during this study are found to be 80mgL^-1 for the divalent iron, 30mgL^-1 for ascorbic acid, 30mmol for hydrogen peroxide, 25mgL^-1 for pro-oxidants and an exposure time equal to 5min. The ascorbic acid-pro-oxidants-modified Fenton system achieved a promising complete water disinfection (0% viability) at the optimal conditions, leaving this method a feasible process for water disinfection or decontamination, even at industrial scales.

Ruling out nosocomial transmission of Cryptosporidium in a renal transplantation unit: case report

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.

Case presentation

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.

Conclusion

Genotypic species identification was not consistent with an epidemic context, thus underlining the need for genotyping to monitor at risk patients.

Acute, Severe Cryptosporidiosis in an Immunocompetent Pediatric Patient

Severe diarrheal illness in children can be attributed to a number of different microbiological agents. Without appropriate microbiological testing of stool samples, patients who present with multiple days of severe diarrhea might have a delay in proper diagnosis and treatment. Here, we report a case of an immunocompetent pediatric patient presenting with acute cryptosporidiosis. Humans and bovine species are known hosts of cryptosporidium and several studies have evaluated the zoonotic transmission of cryptosporidium from cattle to humans. Adding diagnostic tests for cryptosporidium like Ziehl-Neelsen staining of stool or fecal rapid antigen detection techniques should be considered in the workup of patients presenting with undifferentiated, severe diarrheal illness, especially in those who have close contact with livestock.

Cryptosporidial infection in children with inflammatory bowel disease

BACKGROUND AND AIMS

Cryptosporidiosis is usually a self-limiting illness in healthy patients. However, it can cause severe life threatening complications in immunocompromised patients. The effect of cryptosporidial infection on inflammatory bowel disease (IBD) has not been well studied and available literature is largely restricted to adult case reports. The purpose of this study is to describe the clinical characteristics of cryptosporidial infection in children with IBD.

METHODS

Stool studies from children with IBD presenting with presumed relapse during the period 2005-2011 were reviewed retrospectively. Cryptosporidial infection was diagnosed by stool enzyme immunoassay. An age matched control group of IBD patients without cryptosporidial infection was used for comparison.

RESULTS

Medical records of 170 IBD patients were reviewed and a total of 149 presumed relapses were identified. Cryptosporidial infection was found in seven of the 39 patients with positive stool studies (four ulcerative colitis/three Crohn's disease) presenting with relapse. The median age was 13 years (range: 3-17) and five patients were female. The median duration of the IBD was 18 months (range 2-48 months). All but one patient had stable disease prior to acquiring infection. Five patients required hospitalization due to significant dehydration. Three of the five patients treated with nitazoxanide had significant clinical improvement in 3 days. All patients had complete resolution of symptoms by three weeks and no infection related complications were noted. In comparison to patients with cryptosporidial infection, the control group required an increased need for escalation of therapy (71% vs. 0.0%, p=001) and higher re-hospitalization rates (24% Vs.0.0%, p=0.54) within 6 months following indexed relapse.

CONCLUSION

In IBD patients, cryptosporidiosis can cause significant illness leading to increased need for hospitalization. In the absence of appropriate stool studies, cryptosporidiosis can be misdiagnosed as disease relapse and lead to inappropriate therapy. Nitazoxanide appears to be effective along with supportive therapy.

Looking for Cryptosporidium: the application of advances in detection and diagnosis

The protozoan Cryptosporidium is a major public and animal health concern. Young children, immunocompromised people, and pre-weaning animals are especially vulnerable, but treatment options are limited and there is no vaccine. A laboratory diagnosis is required to confirm cases of cryptosporidiosis, and species and genotype determination is essential in distinguishing human from non-human sources, understanding transmission, and strengthening the epidemiological evidence for causative links in outbreaks. However, testing is not consistent, as demonstrated by investigation of a significant increase in cases in some European countries during 2012. Many methods employed are laborious and time-consuming; recent advances, translated into diagnostic assays, can improve testing and facilitate typing to support clinical and environmental investigations.

Prevalence and clinical significance of Cryptosporidium infection in patients with hepatitis B virus-associated acute-on-chronic liver failure

BACKGROUND

Patients with acute-on-chronic liver failure (ACLF) are often highly susceptible to microbial infection due to a depressed immune system. This study was carried out to investigate the prevalence and clinical significance of Cryptosporidium infection in patients with hepatitis B virus (HBV)-associated ACLF in Hunan Province, China.

METHODS

Fecal samples from 218 patients with HBV-associated ACLF, 122 patients with chronic hepatitis B (CHB), and 140 children with diarrhea were collected; Cryptosporidium infection was detected by auramine-phenol staining, modified acid-fast staining, and the polymerase chain reaction. The clinical characteristics of this parasitic infection in Cryptosporidium-positive ACLF patients were further evaluated.

RESULTS

The prevalence of Cryptosporidium infection in the HBV-associated ACLF patients was 6.0% (13/218), which was markedly higher than that found in CHB patients (0.8%, 1/122) and in children with diarrhea (1.4%, 2/140). Although watery diarrhea was not seen in the 13 Cryptosporidium-positive ACLF patients, eight (61.5%) of them had diarrhea. Moreover, our investigation showed that Cryptosporidium infection was not associated with the severity of the disease in ACLF patients.

CONCLUSIONS

The prevalence of Cryptosporidium infection is high among patients with HBV-associated ACLF and might be a significant cause of diarrhea in this population.