[Cryptosporidiosis in a toddler]

BACKGROUND

Usually, a virus is the cause of gastroenteritis in children. If the diarrhoea persists for a long time or the course is atypical, another causative agent may be the cause.

CASE DESCRIPTION

We present the case history of a 15-month-old boy with atypical gastroenteritis in which he had prolonged diarrhoea and vomiting. We found a cryptosporidium as the causative agent.

CONCLUSION

Especially young children, the elderly, patients with IgA deficiency or other immune disorders are at risk of severe and prolonged diarrhoea with dehydration caused by cryptosporidium. The disease is self-limiting but can sometimes become chronic. In the Netherlands no medical treatments are available. Farm animals and surface water are the main reservoirs of cryptospores. Because the sporozoites are resistant to chlorine and alcohol, elimination is difficult.

Eculizumab in Pediatric Dense Deposit Disease

BACKGROUND AND OBJECTIVES

Dense deposit disease (DDD), a subtype of C3 glomerulopathy, is a rare disease affecting mostly children. Treatment options are limited. Debate exists whether eculizumab, a monoclonal antibody against complement factor C5, is effective in DDD. Reported data are scarce, especially in children.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The authors analyzed clinical and histologic data of five pediatric patients with a native kidney biopsy diagnosis of DDD. Patients received eculizumab as therapy of last resort for severe nephritic or nephrotic syndrome with alternative pathway complement activation; this therapy was given only when the patients had not or only marginally responded to immunosuppressive therapy. Outcome measures were kidney function, proteinuria, and urine analysis.

RESULTS

In all, seven disease episodes were treated with eculizumab (six episodes of severe nephritic syndrome [two of which required dialysis] and one nephrotic syndrome episode). Median age at treatment start was 8.4 (range, 5.9-13) years. For three treatment episodes, eculizumab was the sole immunosuppressive treatment. In all patients, both proteinuria and renal function improved significantly within 12 weeks of treatment (median urinary protein-to-creatinine ratio of 8.5 [range, 2.2-17] versus 1.1 [range, 0.2-2.0] g/g, P<0.005, and eGFR of 58 [range, 17-114] versus 77 [range, 50-129] ml/min per 1.73 m(2), P<0.01). A striking finding was the disappearance of leukocyturia within 1 week after the first eculizumab dose in all five episodes with leukocyturia at treatment initiation.

CONCLUSIONS

In this case series of pediatric patients with DDD, eculizumab treatment was associated with reduction in proteinuria and increase in eGFR. Leukocyturia resolved within 1 week of initiation of eculizumab treatment. These results underscore the need for a randomized trial of eculizumab in DDD.