1/44. 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 = 1keywords = immunodeficiency (Clic here for more details about this article) |
2/44. 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 = immunodeficiency (Clic here for more details about this article) |
3/44. Gastric cryptosporidiosis as a clue for the diagnosis of the acquired immunodeficiency syndrome.cryptosporidium parvum has been detected with increasing frequency in the gastrointestinal tract, but involvement of the stomach is rarely reported. Whenever found in the histologic examination of the gastrointestinal mucosa, it should raise the suspicion of an immunocompromised host. We report a case of Cryptosporidium-associated erosive gastritis in a 64-year-old woman, who was found later to have the acquired immunodeficiency syndrome. Gastroduodenoendoscopy and biopsy of the gastric mucosa played an invaluable role in the diagnosis of cryptosporidiosis and to disclose the underlying immunodeficiency state.- - - - - - - - - - ranking = 50.620009322766keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
4/44. 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 = 1keywords = immunodeficiency (Clic here for more details about this article) |
5/44. Reversible sclerosing cholangitis secondary to cryptosporidiosis in a renal transplant patient.cryptosporidium parvum is a well-known cause of chronic diarrhea. In human immunodeficiency virus (hiv)-infected patients as well as in other immunocompromised patients it has also been shown to cause sclerosing cholangitis. We report a case of reversible C. parvum-induced sclerosing cholangitis in a renal transplant patient. This 40-year-old female received a renal transplant 9 years prior to presentation. She had no history of liver disease and was doing well on tacrolimus, prednisone, and azathioprine. She developed diarrhea and was found to have C. parvum present in the stool. Shortly after, she developed clinical, biochemical, radiologic, and histologic features of SC. After accidental reduction in her immunesuppression secondary to starting her on rifampin to treat her itching, she cleared C. parvum from her stool and had a marked improvement in her diarrhea, jaundice, and general health. Her liver enzymes normalized and magnetic resonance cholangiography showed complete resolution of biliary abnormalities. To our knowledge, this is the first case of C. parvum-induced sclerosing cholangitis in a renal transplant patient and one of a few in non-hiv patients. It is also the first to document resolution of sclerosing cholangitis after eradication of C. parvum in a non-hiv patient.- - - - - - - - - - ranking = 1keywords = immunodeficiency (Clic here for more details about this article) |
6/44. Isolated antral narrowing associated with gastrointestinal cryptosporidiosis in acquired immunodeficiency syndrome.A 33-year-old man with human immunodeficiency virus infection had severe protracted diarrhea. Radiologic assessment disclosed narrowing of the gastric antrum. biopsy specimens revealed diffuse Cryptosporidium infection of the antral mucosa. Isolated antral narrowing due to Cryptosporidium gastritis should be added to the list of gastrointestinal complications associated with acquired immunodeficiency syndrome (AIDS).- - - - - - - - - - ranking = 50.620009322766keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
7/44. Treatment of cryptosporidiosis with paromomycin. A report of five cases.cryptosporidiosis continues to be one of the most devastating complications of the acquired immunodeficiency syndrome, causing severe, chronic diarrhea that is largely refractory to treatment. More than 60 drugs have been tried in the treatment of cryptosporidiosis, none of which have been consistently successful. We describe the successful treatment of cryptosporidiosis in five patients with acquired immunodeficiency syndrome with oral paromomycin at a dose of 1500 to 2000 mg/d. All five patients had resolution of symptoms and normalization of bowel movements, although one patient later relapsed while receiving paromomycin. Three of five patients cleared Cryptosporidium from the stool. paromomycin is a promising therapy for cryptosporidiosis in acquired immunodeficiency syndrome and further prospective clinical trials are warranted.- - - - - - - - - - ranking = 29.772005593659keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/44. coinfection of Cryptosporidium and geotrichum in a case of AIDS.A 32 year old male, positive for human immunodeficiency virus (mY) antibodies, was found to be positive for multiple opportunistic infections by a parasite and a fungi, which is a very rare occurrence. Cryptosporidium and geotrichum were simultaneously detected from his stool and sputum respectively.- - - - - - - - - - ranking = 1keywords = immunodeficiency (Clic here for more details about this article) |
9/44. Whipple's disease can mimic chronic AIDS enteropathy.Previous case reports have demonstrated that the intestinal pathology of mycobacterium avium-intracellulare (MAI) infection in the acquired immune deficiency syndrome (AIDS) has a light microscopic appearance similar to Whipple's disease. This case report describes a 52-yr-old male patient with a clinical picture suggestive of AIDS, including diarrhea, weight loss, oral thrush, and intestinal cryptosporidiosis. The intestinal biopsy showed light microscopic features compatible with either MAI or Whipple's disease, but electron microscopy confirmed the presence of the Whipple bacillus. Markers of human immunodeficiency virus (hiv) infection were absent. Although immune abnormalities have been reported in Whipple's disease, this is the first report of opportunistic infections complicating this condition. A useful clinical pearl emerges from this and other cases: AIDS can mimic Whipple's disease; Whipple's disease can mimic AIDS.- - - - - - - - - - ranking = 1keywords = immunodeficiency (Clic here for more details about this article) |
10/44. Respiratory and enteric cryptosporidiosis in humans.A 24-year-old homosexual man with acquired immunodeficiency syndrome presented with intractable diarrhea and fever. Examination of a rectal biopsy specimen and stool revealed Cryptosporidium. Approximately 4 months after admission he developed respiratory failure and died. Postmortem examination revealed cryptosporidiosis involving the entire gastrointestinal tract as well as the tracheobronchial tree. To our knowledge, this is one of the rare presented cases of tracheobronchial cryptosporidiosis documented histologically.- - - - - - - - - - ranking = 9.9240018645531keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
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