The Brief Case: Cryptosporidiosis in a Severely Immunocompromised HIV Patient

Abstract

A 52-year-old male with AIDS was admitted to the University of Utah Hospital with chronic (Ͼ3-month duration) watery diarrhea. The patient had been diagnosed with HIV infection 3 years prior to admission but had been noncompliant with antiviral therapy since primary diagnosis. Three months prior to admission (at the time of the diarrhea onset), his CD4 ϩ cell count was critically low (6 cells/l), he had an elevated viral load (ϳ54,000 copies/ml), and he was displaying rapid deterioration of overall health. The patient also suffered from multiple other known viral complications attributable to his severe immunosuppression, including chronic cytomegalovirus (CMV) retinitis and recurrent anogenital lesions caused by herpes simplex virus 2 (HSV-2).The patient was severely malnourished and hypokalemic at admission (potassium level, Ͻ1.6 mmol/liter). The stools (Ͼ20 per day) were nonbloody and devoid of mucus, and inflammation was indicated by the presence of lactoferrin in the stool. Routine stool cultures were negative for Shigella, Salmonella, Campylobacter, Yersinia, Aeromonas, Plesiomonas, and Vibrio. Shiga-like-toxin-producing Escherichia coli was not detected by antigen detection, and Clostridium difficile was not detected by real-time PCR. CMV colitis was excluded on the basis of negative results for immunohistochemical staining of colonoscopy-obtained biopsy samples. A single microscopic examination of stool for ova and protozoal parasites (O&P detection), consisting of a concentrated wet-mount preparation, a trichrome stain, a modified trichrome stain, and a modified acid-fast (MAF) stain, gave negative results for gastrointestinal parasites and microsporidia. The result for fecal antigen detection for Cryptosporidium was also negative. Additional testing with a multiplex real-time PCR panel for Entamoeba histolytica, Giardia, Cryptosporidium parvum/Cryptosporidium hominis, Dientamoeba fragilis, and Cyclospora cayetanensis gave a positive result for the presence of Cryptosporidium DNA. This result was discrepant with those for both antigen detection and microscopy but was repeatedly confirmed and eventually verified by sequencing of the amplicon.To investigate this discrepancy and attempt to provide a clinical clarification of the test results, the MAF-stained slide was reexamined for the presence of Cryptosporidium oocysts. No oocysts were seen upon review. Two additional slide preparations from the original specimen were stained and examined and revealed rare oocysts with characteristic fuchsia staining, size (5-m diameter), and morphology consistent with this protozoan (Fig. 1). Several "ghost cells" were also seen on the slides. The antigen test was repeated, and the results were negative in duplicate. The report for the MAF stain was corrected, and the physicians were consulted such that the management of cryptosporidiosis was incorporated into the long-term care of the patient. DISCUSSIONCryptosporidium is an apicomplexan protozoan infecting the gastrointestinal tract of animals and humans, whose phylo...

Cryptosporidiosis in HIV-seronegative patients: A case series

“…These oocysts are the infective form of the parasite and can also be transmitted via autoinfection (thin oocysts). 14 In the first case that we have reported, the patient failed to clear oocysts from his GIT on account of his immunodeficiency which may be due to organ transplant, diabetes or consumption of immunosuppressive drugs. Appropriate anti-cryptosporidial therapy for the immunocompromised patients still remains a challenging task.…”

Neoplastic patients’ knowledge about intestinal parasitoses in southern Brazil

“…Therefore, individuals who have undergone immunosuppressive therapy are likely to contract infectious agents. Besides, the disease is usually more severe in these patients, mainly when it is caused by opportunistic parasites (Albuquerque et al, 2012;Rossi and Couturier, 2016).…”