1516. Nitazoxanide Treatment of Intestinal Cryptosporidiosis Following Hematopoietic Stem Cell Transplantation
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • cryptosporidium poster IDSA.pdf (717.2 kB)
  • Background:

    Diarrhea caused by the protozoa Cryptosporidium has been well documented and studied in patients with human immunodeficiency virus infection (HIV).  Cryptosporidium has recently been reported as the causative agent of diarrheal illness in immunosuppressed patients without HIV infection.  In this study, we reported two cases of cryptosporidiosis in hematopoietic stem cell transplanted patients and reviewed the literature on previously reported cases.

    Methods:

    We compared four studies of cryptosporidiosis in the immunosuppressed, non-HIV patients.  Our study including two case series from Moffitt Cancer Center in Tampa, Florida was compared with three previously published studies in the literature including an observational study from India, a prospective single study from France, and a retrospective study from Israel.

    Results:

    Twenty patients were included in our comparative analysis. The ages of patients ranged from pediatric to geriatric. All patients were immunocompromised from either malignancy or organ transplantation. Six patients had solid organ transplant, 6 with acute myelogenous leukemia, 4 with acute lymphocytic leukemia, 1 with chronic myelogenous leukemia, 1 with coexisting chronic myelogenous leukemia and small cell lymphocytic lymphoma, 1 patient with carcinoma of the cervix, and 1 patient with sarcoma of the uterus. Only eight of the twenty patients received treatment with nitazoxanide.  Patients who received therapy experienced less complication and remained cured from infection.

    Conclusion:

    Patient undergoing HSCT and chemotherapy most likely encounter episodes of chronic infectious diarrhea. Cryptosporidiosis should be considered in the differential diagnosis of chronic diarrhea in this patient population and must be differentiated from chronic graft versus host disease, as the treatment of both is profoundly different. Nitazoxinide is recommended for treatment of cryptosporidiosis in this population.  A long course of therapy (as long as 12 weeks) may sometimes be necessary to prevent disease relapse.

    Lily Jones, DO1, Abraham Yacoub, MD2, Domenico Coppola, MD3, Kevin Smith, MD1, Ramon Sandin, MD4 and John Greene, M.D., F.A.C.P.5, (1)Infectious Diseases and International Medicine, University of South Florida, Tampa, FL, (2)H. Lee Moffitt Cancer Center and Research Institute, TAMPA, FL, (3)Department of Anatomic Pathology, H Lee Moffitt Cancer Center and Research Institute, TAMPA, FL, (4)Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL, (5)Moffitt Cancer Center, Tampa, FL

    Disclosures:

    L. Jones, None

    A. Yacoub, None

    D. Coppola, None

    K. Smith, None

    R. Sandin, None

    J. Greene, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.