Introduction:
Cryptosporidium is a common cause of diarrhea in post-renal transplant patients, though data on its impact in solid organ transplant recipients are limited. This study aimed to assess the prevalence, risk factors, treatment strategies, and the role of food handlers in transmission and outcomes of Cryptosporidium infection in renal transplant recipients (RTRs).
Methods:
We conducted a retrospective review of RTRs with diarrhea that required evaluation and hospitalization, with Cryptosporidium detected via stool microscopy using acid-fast staining and confirmed with fluorescent microscopy, data were extracted from medical records using a standardized data collection form and results were analyzed.
Results:
Over a year, 60 renal transplant recipients (RTRs) developed diarrhea, with Cryptosporidium detected in 17 (28.3%). Among them, 11 patients (64.7%) had received rATG induction therapy, which increased the infection risk by 1.8 times. Most infections (53%) occurred within the first 6 months post-transplant, and 18% had a history of acute rejection treated with pulse steroids.Common extra-gastrointestinal manifestations included weight loss and leucopenia. Hospitalization was required for 15 patients (88%), with 2 having concurrent CMV infection and 1 with Parvovirus B19. Treatment varied: 24% required triple-drug therapy, 47% a two-drug regimen, and 29% a single drug. Treatment duration ranged from 2 to over 6 weeks. MMF was adjusted in 13 cases. Combination therapy showed better outcomes compared to nitazoxanide alone. Relapse occurred in 2 patients (12%), and 24% experienced new-onset graft dysfunction, with 3 cases involving hypotension, all of them recovered fully.Among food handlers, 10 of 17 (59%) tested positive for Cryptosporidium, despite showing no symptoms. Highlighting a significant concern of potential transmission.
Conclusions:
Cryptosporidium infection is frequently overlooked, particularly in post-transplant patients presenting with diarrhea. Routine screening for this infection is essential due to its prevalence in this population. Patients who have recently undergone induction therapy or have been treated for rejection are at a significantly higher risk of contracting Cryptosporidium. Treating cryptosporidiosis often necessitates prolonged nitazoxanide therapy, either alone or in combination, and may require adjustments in immunosuppressive medication. Asymptomatic carriers and food handlers pose a greater risk to renal transplant recipients (RTRs), so it is crucial for infected food handlers to receive effective treatment and for their stool to be re-examined.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.