Cryptosporidial diarrhoea in HIV infected patients

Cryptosporidial infection may be chronic and life threatening in the immunosuppressed, particularly HIV patients.

Level of immunosupression will determine the clinical presentation which may range from no symptoms or transient disease to relapsing/chronic diarrhoea or cholera-like diarrhoea, which can lead to life-threatening wasting and malabsorption.

• in immunocompromised children, chronic severe diarrhoea can result in malnutrition, failure to thrive, and substantial intestinal fluid losses, resulting in severe dehydration and even death
• biliary tract disease is associated with CD4 counts ≤50/mm (1)

The incidence of cryptosporidiosis in HIV-infected patients has declined dramatically since the introduction of combination antiretroviral therapy (cART) (1).

Persistent isolation of Cryptosporidia from stool samples for longer than a month is diagnostic of AIDS.

Course:

• 10-20% of cases recover symptomatically and have negative stool samples
• most survive for 1 year or more providing sufficient supportive and fluid therapy is administered
• 10% develop a diarrhoea of greater than 2 litres per day and die rapidly

Treatment:

• consult expert advice
• nitazoxanide and spiramycin have been used in this condition

Reference:

• (1) Siberry GK et al. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J. 2013;32 Suppl 2:i-KK4
• (2) White AC. Nitazoxanide: an important advance in anti-parasitic therapy. Am J Trop Med Hyg. 2003;68:382-3.
• (3) Abubakar I, Aliyu SH, Arumugam C, Usman NK, Hunter PR. Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta-analysis. Br J Clin Pharmacol. 2007;63:387-93