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Indian Journal of Medical Sciences, Vol. 61, No. 7, July, 2007, pp. 419-421 Letter To Editor Cryptosporidiosis in a relapsed case of Hodgkin's disease Karanth NarayanV, Karanth PranjaliN, Gupta Sudeep, Nair Reena, Parikh PurvishM Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai Code Number: ms07070 Sir, Cryptosporidiosis is the leading cause of diarrhea due to protozoal infections worldwide. It constitutes 24% of patients of acquired immunodeficiency syndrome (AIDS) with diarrhea compared to only 6% of immunocompetent persons. [1] Association of Cryptosporidiosis with cancerous illnesses is not as robust as with AIDS. Here we report a case of Cryptosporidiosis in a relapsed Hodgkin′s disease (HD). This boy presented to our institution with subacute onset rapidly progressive paraparesis of 3 weeks. He was diagnosed with HD 8 years ago, for which he had received adequate therapy. He developed large-volume watery diarrhea with mild abdominal cramps on admission; 8-10 bowel movements/ 24 h, during night time. Stool contained mucus and few inflammatory cells but not blood. On day 12, oocysts of Cryptosporidium were identified in the stool by modified acid fast bacilli (AFB) stain [Figure - 1]. He received oral Azithromycin for 5 days as the most effective drug Paromomycin could not be procured. The frequency of stools reduced; and after a week, reexamination of stool was negative for Cryptosporidium. In a study done by Shreedharan et al., the incidence of cryptosporidiosis was 1.3% in 560 cancer patients evaluated, and none were positive for human immunodeficiency virus antibodies. [2] We suggest routine screening of stool for Cryptosporidium in all patients with malignant neoplasm with persistent diarrhea in view of low cell-mediated immunity. Cryptosporidiosis was thought to be a rare infection of little or no importance until 1982, when the AIDS epidemic began. The parasite is transmitted through waterborne sources. It has an incubation period of up to 2 weeks. Risk factors for a healthy person include international travel, contact with cattle, contact with persons >2 to 11 years of age with diarrhea, and freshwater swimming. Most (90%) patients have profuse watery diarrhea containing mucus but rarely blood or leucocytes, which usually lasts for 2 weeks. Other features include abdominal cramps in 80%, fever in 20-30%, weight loss in 75%, vomiting in more than 40%. The diagnosis can be made by detecting oocysts using modified acid fast staining on microscopical examination of stool. There is no antimicrobial chemotherapeutic agent that will reliably eradicate the organism. In patients with AIDS, the best treatment is improvement of immune function with highly active antiretroviral therapy, which also helps resolve Cryptosporidium infection. If highly active antiretroviral therapy is not possible or effective, combination therapy with an antimicrobial agent and an antidiarrheal agent will continue to be the standard treatment for cryptosporidial diarrhea. Paromomycin (250-500 mg q.i.d., 4 weeks), azithromycin and (most recently) nitazoxanide are commonly used. The absence of effective therapy highlights the need to ensure that infection is avoided. [3] Cryptosporidiosis can be effectively controlled by boiling water, filtering through one-micron filter, ozonization; and minimizing contact with sources of infection, young animals and water in lakes. References
Copyright 2007 - Indian Journal of Medical Sciences The following images related to this document are available:Photo images[ms07070f1.jpg] |
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