Cryptosporidium Infection in Solid Organ Transplant Recipients in South Asia ‑ Expert Group Opinion for Diagnosis and Management

Abstract

Cryptosporidium is a protozoan ubiquitous in natural water sources worldwide. It is a common intestinal pathogen that frequently causes gastroenteritis syndrome. It is mainly transmitted from person to person via the fecal-oral route, sexual transmission, and possibly through respiratory secretions. After an incubation period of a few days to 2 weeks, it presents as an asymptomatic oocyst passer to clinically evident profuse and prolonged diarrhea, associated with nausea, vomiting, abdominal pain, and fever. The extraintestinal manifestations may occur in the form of respiratory tract disease, pancreatitis, cholangitis, rarely sclerosing cholangitis, and urinary tract infection. Stool microscopy examination for identifying oocysts is the mainstay diagnostic tool. The association with cancer is new evolving paradigm with cryptosporidium infection. Nitazoxanide is the treatment of choice. However, paromomycin in combination with other antiparasitic agents, such as macrolides (azithromycin, spiramycin), and nitazoxanide may be a more effective option in case of no response.