IJCRR - 10(4), February, 2018

Pages: 09-11

Date of Publication: 17-Feb-2018

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

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

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