International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 10(4), February, 2018

Pages: 09-11

Date of Publication: 17-Feb-2018


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Cryptosporidiosis in a Child with Acquired Immunodeficiency Syndrome: A Case Report

Author: Nanthini Devi P., Gomathi S.

Category: Healthcare

Abstract:Cryptosporidiosis is caused by the coccidian parasite Cryptosporidium and has a tendency to cause diarrhoea with dehydration in immunocompetent and immunocompromised individuals. Here we describe the clinical course of a 4 year old male child who was HIV(Human immunodeficiency virus) reactive and improvement was seen after a course of Nitazoxanide.

Keywords: Cryptosporidium, Diarrhoea, Acquired immunodeficiency syndrome

DOI: 10.7324/IJCRR.2018.1042

Full Text:

Introduction

Cryptosporidiosis is an infection  with the coccidian parasite Cryptosporidium and is a significant opportunistic disease among HIV-infected individuals and  [1].   In developing countries like India, 2-19% of diarrheal diseases can be attributed to Cryptosporidium.   It is spread through the fecal-oral route, often through contaminated water [2].  The age group most commonly affected is children from 1 to 9 years old [3].  Cryptosporidium causes prolonged diarrhoea in HIV patients regardless of the age group [4].  Here we present a case of chronic diarrhoea in a four year old male child with Acquired Immune Deficiency Syndrome (AIDS) and mile stone delay.

Case history:

A 4 year old known HIV positive boy  with milestone delay had diarrhoea and vomiting for one week.  He experienced ten episodes of watery, non-bloody diarrhoea per day.  He had similar illness in the past but stool examination was not done.  His parents were also HIV positive. The child was on Anti-retroviral therapy (ART) but on irregular treatment.

His vital signs showed blood pressure to be 86/54 mm Hg, pulse rate of 120 beats per minute and respiratory rate of 16 per minute.  The laboratory investigations revealed Serum sodium-130 mmol/L), Serum potassium-4.5mEq/L,Chloride-111mEq/L,Bicarbonate-13 mmol/L, Serum calcium-8.4 mg/dl, Blood glucose-98 mg/dl.  The total count was 20800 cells/mm3(56% neutrophils, 36% lymphocytes, 7%monocytes, 1% eosinophil, 1% basophil).  The hemoglobin level was 8.2 g/dL, platelets 468,000/mm3 and red blood cell count-4.1 million /mm3.  The urine routine examination  showed no albumin, no sugar and 1-2 pus cells per high power field.  There was no growth in blood and urine culture.

The stool wet mount examination showed numerous spherical and refractile oocysts about 5 micrometer diameter.  Modified Acid fast bacilli staining showed pink coloured oocysts of Cryptosporidium  with distinct oocyst walls.  Giemsa staining revealed the presence of purple coloured oocysts.  Hot safranin staining showed pink coloured oocysts.

The child was treated with intravenous fluids, zinc supplements and a course of Nitazoxanide.  The stool episodes reduced after treatment.  The parents were advised to continue ART to the child for immune reconstitution.  Health education was provided to the parents regarding hygienic practices and importance of regular ART.

Discussion:

Cryptosporidiosis is  caused by the enteric pathogen Cryptosporidium, a genus of  protozoan parasites in the phylum Apicomplexa [5].  There are more than 26 known Cryptosporidium species which can be differentiated by  morphology, host specificity and molecular biology studies [6].  The  majority of human cryptosporidiosis worldwide are mainly caused by two species C. parvum and C. hominis.[7].Cryptosporidium spp. is increasingly being recognized as an important pathogen causing diarrhea in children nowadays, with the highest morbidity and mortality reported in  children less than 5 years in developing countries [8].It  can affect both immunocompetent  and immunocompromised  individuals, resulting in watery diarrhea and extreme dehydration [9]. Cryptosporidiosis is a potential threat to HIV-infected individuals with a risk of infection of around 10% in developed countries. Patients can have chronic watery diarrhea lasting for more than two months and shed oocysts in stool during the entire period [10,11].  Early childhood infection with Cryptosporidium can result in delayed growth and cognitive decline[12]. Cryptosporidium was  first recognized as a human parasite in 1976, in a three year-old child with  enterocolitis. But  it  became recognized as an important human pathogen after the HIV pandemic in the 1980s [13].  The first case of cryptosporidiosis  in a homosexual man with AIDS was reported back in 1982 [14].  Since then, there have been many reports  of Cryptosporidium as an important pathogen in AIDS. Currently, Cryptosporidios is listed as an AIDS-defining illness (Clinical Category C) by the Centers for Disease Control and Prevention [15].  The infection in  HIV infected individuals is  life- threatening and involves infections of the  gastrointestinal tract in addition to hepatobiliary and respiratory tract infections [16,17].

Conclusion:

This case is important because it highlights the mother to child transmission of HIV.  In pediatric populations, prevalence data are still underestimated, due to the absence of advanced laboratory diagnostic tools.  In the poorest areas, Cyptosporidiosis, enhanced by malnutrition, causes growth failure and further immune derangement, leading to wasting and enhancing children mortality.

With the widespread use of ART, Cryptosporidiosis is no longer the dangerous condition it once was in AIDS patients, it continues to be a dangerous threat to AIDS patients in developing countries where ART is not  available. The case report shows that health education should be provided to HIV positive parents regarding antenatal screening, regular ART, hygienic practices to cut down the prevalence of HIV and HIV related diseases.

Abbreviations:

HIV-Human Immunodeficiency virus

AIDS-Acquired immunodeficiency Syndrome

ART-Anti retroviral therapy

Acknowledgement: Authors acknowledge the immense help from the scholars whose articles are cited and included in the references of this manuscript. The authors are also grateful to authors/editors /publishers of all those articles/journals and books from where the literature for this article has been reviewed and discussed.

Source of funding: none

Conflict of interest: none

References:

1. Fayer R. Cryptosporidium: a water-borne zoonotic parasite. Vet Parasitol. 2004 Dec 9, 126(1-2):37-56.

2. Desai NT, Sarkar R, Kang G. Cryptosporidiosis: An under-recognized public health problem. Trop Parasitol 2012, 2:91-8

3. Snelling WJ, Xiao L, Ortega-Pierres G, Lowery CJ, Moore JE, Rao JR, et al. Cryptosporidiosis in developing countries. J Infect Dev Ctries 2007 Dec 1,1(3):242–56. pmid:19734601

4. Wanyiri JW, Kanyi H, Maina S, et al. Cryptosporidiosis in HIV/AIDS Patients in Kenya: Clinical Features, Epidemiology, Molecular Characterization and Antibody Responses. The American Journal of Tropical Medicine and Hygiene. 2014, 91(2):319-328. doi:10.4269/ajtmh.13-0254.

5. White AC Jr. Cryptosporidiosis (Cryptosporidium species). Bennett JE, Dolin R, Blaser MK, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2015. Chapter 284, pages 3173-83.

6. Ryan U, Fayer R, Xiao L. Cryptosporidium species in humans and animals: current understanding and research needs. Parasitology. 2014 Nov, 141(13):1667-85. 

7. Xiao L,  Fayer R, Ryan U, Upton SJ. Cryptosporidium taxonomy: recent advances and implications for public health. Clin. Microbiol. Rev. January 2004 ,17(1): 72-97

8. Bhattacharya, MK,  Teka T,  Faruque AS,  Fuchs GJ. .Cryptosporidium infection in children in urban Bangladesh. J. Trop. Pediatr.1997, 43:282-286.

9. Hunter PR, Nichols G. Epidemiology and Clinical Features of Cryptosporidium Infection in Immunocompromised Patients. Clinical Microbiology Reviews. 2002, 15(1):145-154.

10. Bouzid M,  Hunter PR, Chalmers RM , Tyler KM. Clin. Microbiol. Rev. 2013 , 26(1): 115-134

11. Ghazy AA,  Abdel- ShafyS ,  Shaapan RM. Cryptosporidiosis in Animals and Man: 1. Taxonomic Classification, Life Cycle, Epidemiology and Zoonotic Importance. Asian Journal of Epidemiology.2015, 8: 48-63.

12. Leitch GJ, He Q. Cryptosporidiosis-an overview. Journal of Biomedical Research. 2011, 25(1):1-16.

13.Iqbal A, Lim YAL, Mahdy MAK, Dixon BR, Surin J. Epidemiology of Cryptosporidiosis in HIV-Infected Individuals: A Global Perspective. 2012,1:431.

14.Tzipori S, Widmer G. A hundred-year retrospective on cryptosporidiosis. Trends in parasitology. 2008, 24(4):184-189.

15. Centers for Disease Control and Prevention (1992) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992 Dec 18;41(RR-17):1-19.

16. Tali A, Addebbous A, Asmama S, Chabaa L, Zougaghi L. Respiratory cryptosporidiosis in two patients with HIV infection in a tertiary care hospital in Morocco. Ann Biol Clin 2011, 69(5): 605-8.

17. Chen X-M, LaRusso NF. Human intestinal and biliary cryptosporidiosis. World Journal of Gastroenterology. 1999,5(5):424-429.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A study by Shafaque M. et al. entitled \"A Case-Control Study Performed in Karachi on Inflammatory Markers by Ciprofloxacin and CoAmoxicillin in Patients with Chronic Suppurative Otitis Media\" is awarded Best Article of Vol 14 issue 17
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A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
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A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
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A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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