31/64. Experimental fecal transmission of human cryptosporidia to pigs, and attempted treatment with an ornithine decarboxylase inhibitor. Fecal material collected from an immunologically deficient man with persistent cryptosporidia infection was stored in potassium dichromate for two weeks and then fed (inoculated) to newborn pigs. The six inoculated newborn pigs shed the organism in their feces starting four to five days afer inoculation and continuing for as long as 22 days after inoculation. Pigs which were killed and necropsied while shedding had cryptosporidia infection of ileum, cecum, and colon. Infected pigs had atrophied ileal villi and flattened irregular cecal and colonic epithelium. Uninoculated littermate controls remained free to the infection and had histologically normal intestinal tracts at necropsy. Treatment of three of the six inoculated pigs with the ornithine decarboxylase inhibitor, DL-alpha-difluoromethylornithine, orally for ten days had no apparent effect on the infection. ( info) |
32/64. Human cryptosporidiosis in immunocompetent and immunodeficient persons. Studies of an outbreak and experimental transmission. infection with cryptosporidium occurred in 12 immunocompetent persons who had direct contact with the feces of infected calves during three unrelated outbreaks of calf cryptosporidiosis. Nine of the twelve subjects had diarrhea and abdominal cramps that lasted 1 to 10 days. Infections were diagnosed and monitored by detection of oocysts in feces, with a modified Sheather's flotation technique and phase-contrast microscopy. oocysts of cryptosporidium were isolated from calves but not from other animals with which these subjects had been in contact. oocysts of cryptosporidium were also detected during repeated examinations of feces from two immunodeficient patients with persistent cryptosporidiosis. An apparently identical infection was transmitted to calves and mice, using oocysts from infected calves and human beings. oocysts from an immunodeficient person also produced infections in kittens, puppies, and goats. This study shows that cryptosporidium may produce a moderate self-limited illness in immunocompetent persons, which contrasts sharply with the prolonged severe diarrhea in immunocompromised patients who contract cryptosporidiosis. Calves with diarrhea should be considered a potential source of human infection, and immunocompromised persons should avoid contact with such animals. ( info) |
| Because of their distinctive morphology the cysts of giardia lamblia usually are not mistaken for cysts or eggs of other intestinal parasites. At a hospital laboratory in kentucky a case of giardiasis was encountered in which the initial fecal examination revealed only degenerated cysts of Giardia which were mistaken for the oocysts of isospora at the one-sporoblast stage. ( info) |
| Two patients with coccidioidal meningitis experienced transient neurologic deficits shortly after receiving intrathecal injections of amphotericin b. Continuation of treatment eventually led to a severe flaccid paraparesis with a thoracic sensory level in one patient, and a partial Brown-Sequard's syndrome in the other. myelography was normal in both, with no evidence of arachnoiditis. autopsy findings in the first patient showed a focal area of necrosis in the left half of the spinal cord consistent with the patient's clinical findings during life. The distribution of the lesion corresponded to the area supplied by a central sulcal artery. amphotericin b may exert a direct toxic effect on the spinal cord or its vascular supply when given intrathecally. ( info) |
35/64. cryptosporidiosis. Report of a fatal case complicated by disseminated toxoplasmosis. A middle-aged woman suffered from chronic diarrhea and malnutrition as a result of a small intestinal infection with a coccidial protozoan--cryptosporidium. This parasite has been found among a wide range of reptilian, avian and mammalian hosts, but rarely in human beings. This woman ultimately died as a result of disseminated toxoplasmosis of the type usually encountered in an adult whose immune responses were compromised. There was clinical evidence of both humoral and cellular immunologic incompetence, such as depressed levels of complement and immunoglobulins, and decreased T cell reactivity, respectively. The former could be accounted for on the basis of malnutrition causing deficient protein synthesis, and the latter may have been a manifestation of altered function of transformed T cells. ( info) |
36/64. Malabsorption syndrome, coccidiosis, combined immune deficiency, and fulminant lymphoproliferative disease. coccidia were found in a patient suffering from malabsorption syndrome. In addition, immunologic investigation showed combined humoral and cellular immunodeficiency. Treatment with metronidazole induced the disappearance of coccidia from the stool and clinical remission. Six months later, the patient was seen with acute lymphoproliferative disease and died thereafter. The possible relationship between malabsorption, immunodeficiency, coccidiosis, metronidazole, and malignancy is reviewed. ( info) |
37/64. cryptosporidiosis of man and calf: a case report and results of experimental infections in mice and rats. cryptosporidiosis is reported in a healthy 25-year-old male. Clinical symptoms include 1 day of nausea and low-grade fever and 9 days of diarrhea, followed by 3 days of constipation. oocysts of cryptosporidium sp. were present in sugar flotations of the first fecal sample collected 56 hours after onset of the symptoms and in daily fecal samples collected through day 12 of the illness. oocysts of the human isolate of cryptosporidium sp. were morphologically indistinguishable from those obtained from naturally and experimentally infected calves. After 1 week of sporulation at room temperature, oocysts from the human and from calves contained four sporozoites and a spherical residuum. When inoculated orally, sporulated cryptosporidium sp. oocysts of human and of calf origin produced indistinguishable infections in suckling mice and rats and in adult mice. ( info) |
38/64. Intractable diarrhea of infancy due to intestinal coccidiosis. Intestinal coccidiosis in a 6-mo-old infant terminated fatally after 30 wk of continuous total parenteral nutrition, and proved refractory to treatment with antibiotics, hydrocortisone, and antimetabolic agents. Intestinal biopsies obtained at laparotomy revealed flattened mucosa infiltrated with coccidia at various stages of the parasites' life cycle. The course was characterized by severe diarrhea due to a cholera-like hypersecretion of intraluminal fluid. This case suggests that intestinal coccidiosis may be included among the small number of conditions responsible for authentic "intractable diarrhea of infancy." ( info) |
39/64. cyclospora species as a gastrointestinal pathogen in immunocompetent hosts. Previous reports of diarrhea resulting from cyclospora species have been linked to travelers and immunocompromised patients. We conducted a prospective study of 1,042 formalin-ethyl acetate fecal concentrates collected from patients with diarrhea. Between May and November 1993, we identified three patients for whom studies were positive for nonrefractile spherical organisms measuring 10 microns in diameter and containing a cluster of refractile membrane-bound globules. The cysts exhibited variable acid fastness consistent with cyclospora species. These three patients had no history of recent travel and presented with relapsing, watery, nonbloody diarrhea that lasted from 12 days to 8 weeks. No other parasitic or bacterial pathogens were identified in their stools. All three instances of diarrhea occurred in May or June. No common source of food or water was identified. None of these patients were immunosuppressed, and their diarrhea resolved spontaneously. We suggest that cyclospora species should be considered in community-acquired diarrhea. ( info) |
40/64. Overwhelming watery diarrhea associated with a cryptosporidium in an immunosuppressed patient. A 39-year-old man with severe bullous pemphigoid developed overwhelming diarrhea after 5 weeks' treatment with 150 mg of cyclophosphamide and 60 mg of prednisolone daily. Jejunal and ileal biopsies showed severe mucosal injury and tiny 2- to 4-mu organisms on the epithelial surfaces. Similar organisms were seen in smears of jejunal fluid. Electron microscopic examination of jejunal biopsies showed these spherical bodies to be trophozoites, schizonts, microgametocytes, and macrogametocytes typical of the genus cryptosporidium. diarrhea resolved 2 weeks after discontinuation of cyclophosphamide and coincided with disappearance of Cryptosporidia from the jejunal biopsies. immunosuppression may have predisposed this patient to cryptosporidial diarrhea. cryptosporidiosis is another infection which can be diagnosed by small bowel biopsy. When immunosuppressed patients develop severe diarrhea, opportunistic infection with this and other organisms should be considered as the possible cause. ( info) |