1/81. Sclerosing cholangitis associated to cryptosporidiosis in liver-transplanted children.Three children of a series of 461 pediatric liver transplant recipients developed diffuse cholangitis associated with intestinal cryptosporidium carriage. All three received immunosuppression consisting of tacrolimus and prednisone. Cryprosporidium carriage was treated with paramomycin, while immunosuppression was decreased according to graft tolerance. No other infectious pathogens were found, and no vascular problems were detected. Bile duct anastomosis was reoperated in all three, but biliary cirrhosis developed in one patient, requiring retransplantation. All three patients are alive and well, and free of intestinal parasites on follow-up. CONCLUSION: Cryptosporidium intestinal infection may play a role in some cases of otherwise unexplained cholangiopathies in pediatric liver transplant recipients. This may lead to significant morbidity, including need for retransplantation.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/81. Cryptosporidial infections after solid organ transplantation in children.The diagnosis and treatment of moderate-to-severe diarrhea in solid organ transplant recipients is often a challenge because of the variety of infectious and non-infectious causes. The morbidity associated with this clinical condition is of particular significance in the pediatric population where malnutrition may lead to poor growth and development. Rarely, Cryptosporidium has been identified as the cause of clinically significant diarrhea in pediatric solid organ transplant patients. A retrospective review identified cases of cryptosporidiosis among the 1160 non-renal, abdominal organ transplant recipients cared for at the Children's Hospital of Pittsburgh between 1981 and June 1998. Four cases of clinically significant diarrhea were identified in three liver transplant recipients and one small bowel transplant recipient. endoscopy and biopsy with histologic confirmation diagnosed three cases; ova and parasitic examination of stool specimens identified the fourth case. Therapy varied among the patients depending on when they had been diagnosed as, over the years, different and newer agents have been indicated for the treatment of cryptosporidiosis. All four patients resolved their infections. Hence, endoscopy and biopsy is recommended for pediatric transplant patients who present with chronic diarrhea of unknown etiology. The patients who may be at a higher risk for cryptosporidial infections include those with an increased immunosuppressive state (i.e. pre-existing immunodeficiency, malignancy, re-transplantation, and those receiving higher doses of immunosuppressive therapy). While cryptosporidiosis is a non-lethal complication, it allows the clinician to gain further insight into the degree of immunosuppression of their patient.- - - - - - - - - - ranking = 6keywords = infection (Clic here for more details about this article) |
3/81. cytomegalovirus and Cryptosporidium infections in AIDS: a necropsy study.A case of coinfection of cytomegalovirus (CMV) and Cryptosporidium in an AIDS patient is reported. Chronic diarrhea was the presenting symptom. Etiologic agents were diagnosed only at postmortem evaluation. CMV intranuclear inclusions were seen in the terminal ileum, colon and vermiform appendix. Cryptosporidium oocysts were also present in the intestinal brush border of the colon. Improvement of diagnostic procedures such as colonic biopsy and the use of appropriate staining procedure for AIDS patients with diarrhea can help identify the cause of illness.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
4/81. Rapid increase of mucosal CD4 T cells followed by clearance of intestinal cryptosporidiosis in an AIDS patient receiving highly active antiretroviral therapy.Highly active antiretroviral therapy (HAART) suppresses the replication of human immunodeficiency virus (HIV) and leads to an increase in circulating CD4 T lymphocytes, but its effects on other immune compartments such as the intestinal mucosa are not well understood. We describe a severely immunodeficient HIV-infected patient with intractable watery diarrhea and weight loss caused by infection with cryptosporidium parvum in whom we studied virologic and immunologic changes in both peripheral blood and the intestinal mucosa after initiating HAART. Mucosal biopsies were performed by rectoscopy before and at several time points after HAART was begun. nucleic acids were extracted from rectal biopsy specimens and blood samples, and HIV rna was measured by reverse-transcription polymerase chain reaction. lymphocytes were isolated from rectal biopsy specimens after mechanical disaggregation, and circulating and mucosal CD4 T cells were determined by flow cytometry. HAART led to clinical recovery and eradication of cryptosporidiosis. In both blood and mucosa, HIV rna decreased below the limit of detection and CD4 T cells increased. Mucosal CD4 T cells increased much faster and to much higher levels than circulating CD4 T cells. Our findings show a rapid repopulation of the intestinal mucosa with CD4 T cells after initiation of HAART that can effectively restore mucosal immunity, leading to eradication of opportunistic pathogens.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
5/81. A report case of cyclospora and Cryptosporidium mixed infection in a HIV-negative child in thailand.The first case of cyclosporosis in a non HIV-infected child in thailand, co-infected with Cryptosporidium, was reported. The patient was a 3 year-old malnourished orphan who presented with fever, abdominal distension and relapsing diarrhea. There was no leukocyte in her stool, however, numerous cyclospora and Cryptosporidium oocysts were identified by modified acid-fast staining. The illness was cured by co-trimoxazole and fluid therapy. More coccidial infections in thailand may be detected if modified acid-fast staining is routinely performed.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
6/81. diarrhea and gallbladder hydrops in an immunocompetent child with Cryptosporidium infection.We report a case of an immunocompetent child who developed gallbladder hydrops during a concurrent diarrheal illness caused by cryptosporidium parvum. Hepatobiliary disease and chronic cryptosporidial diarrhea is an accepted association in adults with HIV infection but has only once previously been reported in a child, also with HIV.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
7/81. Human infection with Cryptosporidium felis: case report and literature review.An infection with Cryptosporidium felis in an HIV-positive man from italy was successfully treated with paromomycin, despite the patient's having a CD4 cell count of 31/mL. Fourteen cases of human infection with C. felis have been described, all in the past 3 years, emphasizing the public health importance of Cryptosporidium parasites other than C. parvum.- - - - - - - - - - ranking = 6keywords = infection (Clic here for more details about this article) |
8/81. X-linked hyper-IgM syndrome associated with cryptosporidium parvum and cryptococcus neoformans infections: the first case with molecular diagnosis in korea.X-linked hyper-IgM syndrome (XHIM) is a rare primary immunodeficiency disorder, caused by mutations of the gene encoding cd40 ligand (CD40L; CD154). We report the clinical manifestations and mutational analysis of the CD40L gene observed in a male patient from a XHIM family. Having hypogammaglobulinemia and elevated IgM, the 3-yr-old boy exhibited the characteristic clinical features of XHIM. The patient suffered from frequent respiratory infections, and chronic enteritis caused by cryptosporidium parvum. In addition, a lymph node biopsy and a culture from this sample revealed C. neoformans infection. Activated lymphocytes from the patient failed to express CD40L on their surface as assessed by flow cytometry and a missence mutation (W140R) was found at the XHIM hotspot in his CD40L cDNA to confirm the diagnosis. Genetic analysis of the mother and sister showed a heterozygote pattern, indicating carrier status. To our knowledge, this is the first report on the molecular diagnosis of an XHIM patient in korea.- - - - - - - - - - ranking = 6keywords = infection (Clic here for more details about this article) |
9/81. Identification of genotypes of cryptosporidium parvum isolates from a patient and a dog in japan.cryptosporidium parvum (C. parvum) is recognized as a significant pathogen in humans and animals, primarily as a cause of diarrheal illness. Recent genetic and biological studies indicate that C. parvum is not a single species but composed of genetically distinct multiple genotypes. Thus, it is valuable to distinguish between genotypes in the epidemiology of Cryptosporidium infection in humans and animals. Although C. parvum has been detected in humans and animals in japan, the genotype of isolates remains unclear because identification has been performed only by conventional microscopy. We report herein the genotypes of C. parvum isolates distinguished by the polymerase chain reaction (PCR)-based diagnostic method. C. parvum isolates, originally obtained from a patient and a pet dog, were found to have cattle and dog genotypes, respectively.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
10/81. Intestinal cryptosporidiosis as an initial manifestation in a previously healthy Japanese patient with AIDS.BACKGROUND: cryptosporidium parvum infection has been recognized as one of the pathogens causing severe and persistent diarrhea in immunodeficient patients, such as those with AIDS, worldwide. However, in japan, the frequency of this infection has been rare, except for environmental contamination through the water supply. In this communication, we describe a Japanese patient with AIDS presenting with intestinal cryptosporidiosis as an initial manifestation. methods: The oocysts of cryptosporidium parvum in his stool were detected by the Ziehl-Neelsen method and electron microscopy. The antigen-specificity was proved by immunostaining, using a fluorescein isothiocyanate (FITC)-labeled monoclonal antibody and enzyme-linked immunosorbent assay (ELISA), using Cryptosporidium-specific antibody. RESULTS: A 28-year-old Japanese homosexual man was admitted to our hospital because of severe watery diarrhea of 1-week duration. Numerous oocysts of cryptosporidium parvum were observed in his stool. cryptosporidium parvum antigen was detected in stool samples. Serological examinations revealed that anti-hiv-1 antibody was positive, and HIV rna was positive at a high level. He was diagnosed as having AIDS associated with intestinal cryptosporidiosis. The circulating CD4 T-cell count was 152/microl. His diarrhea was not alleviated by administration of loperamide and an ordinary antibiotic agent, but ultimately resolved by the administration of the macrolide antibiotic agent, clarithromycin. CONCLUSIONS: We emphasize that the presence of cryptosporidium parvum infection should be kept in mind in searching for pathogens causative of severe diarrhea in AIDS patients.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
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