Pediatr Transplant 2000 Feb;4(1):50-5

Cryptosporidial infections after solid organ transplantation in children

Gerber DA, Green M, Jaffe R, Greenberg D, Mazariegos G, Reyes J

Abstract
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