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Ulusan Bagci O, Goksel O, Gumusburun R, Mert U, Bogatekin G, Toz S, Caner A. Molecular prevalence of Pneumocystis jirovecii and Cryptosporidium in patients with asthma. Diagn Microbiol Infect Dis 2024; 108:116124. [PMID: 37913698 DOI: 10.1016/j.diagmicrobio.2023.116124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
Asthma is characterized by chronic airway inflammation. In addition to allergens, microorganisms can affect the clinical course of asthma. It has been shown that some fungi play an important role in the progression of asthma. However, the effects of Pneumocystis jirovecii and Cryptosporidium spp., on the disease are little known. We investigated P. jirovecii and Cryptosporidium spp. in the sputum and stool sample of patients with asthma (n = 40) by microscopy and PCR compared to the healthy group (n = 40). P. jirovecii (12.5 %), and Cryptosporidium spp. (12.5 %) were detected in the sputum samples of only asthmatic patients (p = 0.029 and 0.029 respectively). However, Crpytosporidium spp. was detected equally in stool samples of both groups (p = 0.682). Our results indicate that P. jirovecii and Cryptosporidium spp. should be considered in patients with asthma and molecular screening of these neglected eukaryotes in respiratory tract samples may be beneficial in the clinical management of the disease.
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Affiliation(s)
- Ozlem Ulusan Bagci
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey; Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey
| | - Ozlem Goksel
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma, Faculty of Medicine, Ege University, Izmir, Turkey; Ege University Translational Pulmonary Research Group (EGESAM), Izmir, Turkey
| | - Reyhan Gumusburun
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ufuk Mert
- Ege University Translational Pulmonary Research Group (EGESAM), Izmir, Turkey; Ataturk Health Care Vocational School, Ege University, Izmir, Turkey
| | - Gulhan Bogatekin
- Department of Pulmonary Medicine, Division of Immunology, Allergy and Asthma, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Seray Toz
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ayse Caner
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey; Department of Basic Oncology, Institute of Health Sciences, Ege University, Izmir, Turkey; Ege University Translational Pulmonary Research Group (EGESAM), Izmir, Turkey.
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Prasad N, Bansal S, Akhtar S. Cryptosporidium infection in solid organ transplant recipients in South Asia - Expert group opinion for diagnosis and management. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Iroh Tam PY, Chisala M, Nyangulu W, Thole H, Nyirenda J. Respiratory cryptosporidiosis in Malawian children with diarrheal disease. PLoS Negl Trop Dis 2021; 15:e0009643. [PMID: 34329296 PMCID: PMC8357119 DOI: 10.1371/journal.pntd.0009643] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/11/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Respiratory cryptosporidiosis has been documented in children with diarrhea. We sought to describe the dynamics of respiratory involvement in children hospitalized with gastrointestinal (GI) diarrheal disease. Methods We conducted a prospective, observational longitudinal study of Malawian children 2–24 months hospitalized with diarrhea. Nasopharyngeal (NP) swabs, induced sputum and stool specimens were collected. Participants that were positive by Cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Results Of the 162 children recruited, participants had mild-moderate malnutrition (mean HAZ -1.6 (SD 2.1)), 37 (21%) were PCR-positive for Cryptosporidium at enrollment (37 stool, 11 sputum, and 4 NP) and 27 completed the majority of follow-up visits (73%). Cryptosporidium was detected in all compartments over the 4 post-enrollment visits, most commonly in stool (100% at enrollment with mean cycle thresholds (Ct) of 28.8±4.3 to 44% at 8 weeks with Ct 29.9±4.1), followed by sputum (31% at enrollment with mean Ct 31.1±4.4 to 20% at 8 weeks with Ct 35.7±2.6), then NP (11% with mean Ct 33.5±1.0 to 8% with Ct 36.6±0.7). Participants with Cryptosporidium detection in both the respiratory and GI tract over the study period reported respiratory and GI symptoms in 81% and 62% of study visits, respectively, compared to 68% and 27%, respectively, for those with only GI detection, and had longer GI shedding (17.5±6.6 v. 15.9±2.9 days). Conclusion Cryptosporidium was detected in both respiratory and GI tracts throughout the 8 weeks post-enrollment. The development of therapeutics for Cryptosporidium in children should target the respiratory as well as GI tract. We conducted a prospective, observational longitudinal study of Malawian children 2–24 months hospitalized with diarrhea. NP swabs, induced sputum and stool specimens were collected. Participants that were positive by Cryptosporidium PCR in any of the three compartments were followed up with fortnightly visits up to 8 weeks post-enrollment. Cryptosporidium was detected by PCR in 21%, 7% and 3% in stool, sputum and nasopharynx of children hospitalized with diarrhea. Of those positive at enrollment, detection was noted in 44%, 20%, and 8%, respectively, by 8 weeks post-enrollment.
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Affiliation(s)
- Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Paediatrics, University of Malawi College of Medicine, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Mphatso Chisala
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Wongani Nyangulu
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Herbert Thole
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - James Nyirenda
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Mor SM, Ascolillo LR, Nakato R, Ndeezi G, Tumwine JK, Okwera A, Sponseller JK, Tzipori S, Griffiths JK. Expectoration of Cryptosporidium Parasites in Sputum of Human Immunodeficiency Virus-Positive and -Negative Adults. Am J Trop Med Hyg 2018; 98:1086-1090. [PMID: 29405104 PMCID: PMC5928827 DOI: 10.4269/ajtmh.17-0741] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Respiratory cryptosporidiosis is thought to be a rare, end-stage complication of HIV. Few studies have systematically examined the frequency of such infection in adults. Sputum specimens submitted for tuberculosis (TB) testing at Mulago Hospital, Uganda, were anonymously retested for Cryptosporidium using real-time polymerase chain reaction (PCR). Visual confirmation using immunofluorescence confocal microscopy was performed for a subset of PCR-positive samples. Of 824 sputum samples tested, 24 (2.9%) were Cryptosporidium positive. Prevalence in sputum ranged between 0% and 10% in each month of the study and exceeded TB prevalence in some months. In this referral population, respiratory Cryptosporidium prevalence was lower in people with HIV (1.3% versus 4.4% without HIV, P = 0.028) and higher in those with TB (6.8% versus 2.6% without TB, P = 0.086). The weak association between respiratory Cryptosporidium infection and TB persisted after controlling for HIV (odds ratio = 3.2, 95% confidence interval: 0.9, 11.8; P = 0.080). This is the first study to document adult respiratory tract cryptosporidiosis in a referral population with presumed TB. These findings 1) confirm that Cryptosporidium respiratory infection occurs in HIV-negative and -positive adults; 2) suggest there is potential for Cryptosporidium to be disseminated or transmitted by coughing or expectoration; and 3) identify possible synergy between Cryptosporidium and TB in the respiratory tract.
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Affiliation(s)
- Siobhan M Mor
- University of Sydney School of Veterinary Science, Sydney, Australia.,Tufts University School of Medicine, Boston, Massachusetts
| | | | - Ritah Nakato
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Makerere University College of Health Sciences, Kampala, Uganda
| | - James K Tumwine
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Alphonse Okwera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Jerlyn K Sponseller
- Tufts University Cummings School of Veterinary Medicine, Grafton, Massachusetts
| | - Saul Tzipori
- Tufts University Cummings School of Veterinary Medicine, Grafton, Massachusetts
| | - Jeffrey K Griffiths
- Tufts University School of Medicine, Boston, Massachusetts.,Tufts University Cummings School of Veterinary Medicine, Grafton, Massachusetts
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Reina FTR, Ribeiro CA, Araújo RSD, Matté MH, Castanho REP, Tanaka II, Viggiani AMFS, Martins LPA. INTESTINAL AND PULMONARY INFECTION BY Cryptosporidium parvum IN TWO PATIENTS WITH HIV/AIDS. Rev Inst Med Trop Sao Paulo 2016; 58:21. [PMID: 27007564 PMCID: PMC4804558 DOI: 10.1590/s1678-9946201658021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/11/2015] [Indexed: 11/29/2022] Open
Abstract
We describe two patients with HIV/AIDS who presented pulmonary and intestinal
infection caused by Cryptosporidium parvum, with a fatal outcome.
The lack of available description of changes in clinical signs and radiographic
characteristics of this disease when it is located in the extra-intestinal region
causes low prevalence of early diagnosis and a subsequent lack of treatment.
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Affiliation(s)
| | | | - Ronalda Silva de Araújo
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil, ,
| | - Maria Helena Matté
- Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil, ,
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Kumar H, Singh VB, Meena BL, Agrawal J, Beniwal S, Swami T. Pulmonary cryptosporidiosis in an immunocompetent host treated successfully with nitazoxanide. Lung India 2016; 33:69-71. [PMID: 26933311 PMCID: PMC4748669 DOI: 10.4103/0970-2113.173085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Cryptosporidium parvum is an intracellular spore-forming protozoa which predominantly causes intestinal diseases. It causes severe and life-threatening diarrheal diseases in immunocompromised hosts and usually self-limiting disease in immunocompetent hosts. Extra-intestinal manifestations of cryptosporidium infection are very rare. Herein, we report a case of pulmonary cryptosporidiosis in a 35-yrs-old immunocompetent host, who presented with fever, cough and breathlessness which was soon followed by diarrhea and vomiting, had lung consolidation, and treated successfully with nitazoxanide.
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Affiliation(s)
- Harish Kumar
- Department of Medicine, Sardar Patel (SP) Medical College, Bikaner, Rajasthan, India
| | - Veer Bahadur Singh
- Department of Medicine, Sardar Patel (SP) Medical College, Bikaner, Rajasthan, India
| | - Babu Lal Meena
- Department of Medicine, Sardar Patel (SP) Medical College, Bikaner, Rajasthan, India
| | - Jatin Agrawal
- Department of Medicine, Sardar Patel (SP) Medical College, Bikaner, Rajasthan, India
| | - Sanjay Beniwal
- Department of Medicine, Sardar Patel (SP) Medical College, Bikaner, Rajasthan, India
| | - Taruna Swami
- Department of Microbiology, Sardar Patel (SP) Medical College, Bikaner, Rajasthan, India
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The evolution of respiratory Cryptosporidiosis: evidence for transmission by inhalation. Clin Microbiol Rev 2015; 27:575-86. [PMID: 24982322 DOI: 10.1128/cmr.00115-13] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The protozoan parasite Cryptosporidium infects all major vertebrate groups and causes significant diarrhea in humans, with a spectrum of diseases ranging from asymptomatic to life-threatening. Children and immunodeficient individuals are disproportionately affected, especially in developing countries, where cryptosporidiosis contributes substantially to morbidity and mortality in preschool-age children. Despite the enormous disease burden from cryptosporidiosis, no antiprotozoal agent or vaccine exists for effective treatment or prevention. Cryptosporidiosis involving the respiratory tract has been described for avian species and mammals, including immunocompromised humans. Recent evidence indicates that respiratory cryptosporidiosis may occur commonly in immunocompetent children with cryptosporidial diarrhea and unexplained cough. Findings from animal models, human case reports, and a few epidemiological studies suggest that Cryptosporidium may be transmitted via respiratory secretions, in addition to the more recognized fecal-oral route. It is postulated that transmission of Cryptosporidium oocysts may occur by inhalation of aerosolized droplets or by contact with fomites contaminated by coughing. Delineating the role of the respiratory tract in disease transmission may provide necessary evidence to establish further guidelines for prevention of cryptosporidiosis.
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Perez-Cordon G, Yang G, Zhou B, Nie W, Li S, Shi L, Tzipori S, Feng H. Interaction of Cryptosporidium parvum with mouse dendritic cells leads to their activation and parasite transportation to mesenteric lymph nodes. Pathog Dis 2013; 70:17-27. [PMID: 23913680 DOI: 10.1111/2049-632x.12078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/04/2013] [Accepted: 07/29/2013] [Indexed: 12/23/2022] Open
Abstract
Dendritic cells (DCs) are the antigen-presenting cells capable of activating naïve T cells. Although CD4+ T cells are crucial for Cryptosporidium parvum clearance, little is known about the role of DCs in the immune response to this parasite. In this study, the interaction between mouse DCs and C. parvum was investigated both in vitro and in vivo. For in vitro experiments, mouse bone marrow-derived dendritic cells (BMDCs) derived from wild-type C57B1/6 or MyD88-/- or C3H/HeJ mice and DC cell line DC2.4 were pulsed with C. parvum. Active invasion of parasites was demonstrated by parasite colocalization with host cell membranes and actin-plaque formation at the site of attachment. DC activation induced by the parasite invasion was demonstrated by upregulation of costimulatory molecules CD40, CD80, and CD86, as well as inflammatory cytokines IL-12, TNF-α, and IL-6. BMDCs derived from MyD88-/- and C3H/HeJ mice failed to produce IL-12 in response to C. parvum, suggesting the importance of TLR-dependent signaling pathway specially presence of a functional TLR4 pathway, for C. parvum-induced cytokine production. In vivo experiments showed that both parasite antigens and live parasites were transported to mice mesenteric lymph nodes. All together, these data suggest that DCs play a key role in host immune responses to C. parvum and pathogenesis of the disease.
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Affiliation(s)
- Gregorio Perez-Cordon
- Division of Infectious Diseases, Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA, USA
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9
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Albuquerque YMMD, Silva MCF, Lima ALMDA, Magalhães V. Pulmonary cryptosporidiosis in AIDS patients, an underdiagnosed disease. J Bras Pneumol 2013; 38:530-2. [PMID: 22964939 DOI: 10.1590/s1806-37132012000400017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Abstract
The incidence, mortality, and epidemiology of human immunodeficiency virus (HIV)-associated pulmonary infections have changed as a result of effective antiretroviral and prophylaxis antimicrobial therapy. The clinical presentation, radiographic abnormalities, and treatment of pneumonia from various uncommon pathogens in patients with AIDS can be different from those in immunocompetent patients. Advances in invasive and noninvasive testing and molecular biological techniques have improved the diagnosis and prognosis of pulmonary infections in patients infected with HIV. This review focuses on pulmonary infections from nontuberculosis mycobacteria, cytomegalovirus, fungi (aspergillosis, cryptococcosis, endemic fungi), and parasites (toxoplasmosis), and uncommon bacterial pneumonia (nocardiosis, rhodococcosis) in these patients.
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Affiliation(s)
- Jakrapun Pupaibool
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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11
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Mor SM, Tumwine JK, Ndeezi G, Srinivasan MG, Kaddu-Mulindwa DH, Tzipori S, Griffiths JK. Respiratory cryptosporidiosis in HIV-seronegative children in Uganda: potential for respiratory transmission. Clin Infect Dis 2010; 50:1366-72. [PMID: 20377408 DOI: 10.1086/652140] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Respiratory cryptosporidiosis is recognized as a late-stage complication in persons with human immunodeficiency virus (HIV) infection and AIDS. However, respiratory signs and symptoms are common in otherwise healthy children with intestinal cryptosporidiosis, which suggests that respiratory infection may occur in immunocompetent hosts. METHODS We recruited children 9-36 months of age who presented with diarrhea to Mulago Hospital in Kampala, Uganda, from November 2007 through January 2009. Children with stool samples positive or negative for Cryptosporidium species were selected for further evaluation, including sputum induction in those with cough or unexplained respiratory signs and collection of saliva and blood specimens. Sputum samples were subjected to comprehensive bacteriologic testing, and both sputum and saliva specimens were tested for Cryptosporidium species by nested polymerase chain reaction. RESULTS Of 926 fecal samples screened, 116 (12.5%) were positive for Cryptosporidium. Seventeen (35.4%) of 48 sputum samples tested from children with positive stool samples were positive for Cryptosporidium. Sixteen (94.1%) of the 17 children with confirmed respiratory cryptosporidiosis were HIV seronegative, and 10 (58.8%) of 17 children were not malnourished. None of the 12 sputum specimens from children with negative stool samples tested positive for Cryptosporidium (P = .013, compared with children who tested positive for Cryptosporidium in the stool). Parasite DNA was detected in only 2 (1.9%) of 103 saliva samples (P < .001, compared with sputum samples). CONCLUSIONS Respiratory cryptosporidiosis was documented in one-third of HIV-seronegative children who were tested. These novel findings suggest the potential for respiratory transmission of cryptosporidiosis. Trial registration. ClinicalTrials.gov identifier: NCT00507871.
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Affiliation(s)
- Siobhan M Mor
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
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12
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Abbassi H, Coudert F, Dambrine G, Chérel Y, Naciri M. Effect of Cryptosporidium baileyi in specific pathogen free chickens vaccinated (CVI988/Rispens) and challenged with HPRS-16 strain of Marek's. Avian Pathol 2010; 29:623-34. [DOI: 10.1080/03079450020016887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shankar EM, Vignesh R, Murugavel KG, Balakrishnan P, Ponmalar E, Rao UA, Velu V, Solomon S. Common protozoans as an uncommon cause of respiratory ailments in HIV-associated immunodeficiency. ACTA ACUST UNITED AC 2009; 57:93-103. [DOI: 10.1111/j.1574-695x.2009.00588.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rani H, Gupta V, Gulati N, Chander J. Cryptosporidial oocysts in gastric aspirate of an infant. Indian J Med Microbiol 2009; 27:172-4. [PMID: 19384051 DOI: 10.4103/0255-0857.49441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
In the present study we investigated whether the pathological changes induced by Cryptosporidium in the lungs are mediated through the activation of COX-2, and whether the pathway employed for this activation involves NF-kB. 70 albino rats were submitted for this work. They were categorized into 3 groups: 30 immunocompetent (IC) rats infected with Cryptosporidium oocysts, 30 immunosuppressed (IS) rats infected with Cryptosporidium oocysts, and 10 IC, non-infected rats. Immunohistochemical expression of COX2 and NF-kB in lung tissues of the rats was examined. 43.3% of IC rats showed chronic pneumonia and fibrosis, 40% COX2 positivity, and 36.67% NF-kB positivity. 96.7% of IS rats showed chronic pneumonia and fibrosis, 56.7% non-caseating granuloma with Cryptosporidium oocysts, and 66.7% positivity for both COX2 and NF-kB. Density of inflammatory infiltration was statistically correlated with quickscore of both COX2 and NF-kB in both IC and IS groups. An association between quickscores of COX2 and NF-kB was found in our studied material. These data could demonstrate that Cryptosporidium infection induces upregulation of COX2 possibly through the NF-kB pathway, which suggests the events that contribute to the pathogenesis of Cryptosporidium. These findings could indicate potential therapeutic pharmacological target-mediating treatment of lesions caused by Cryptosporidium.
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Affiliation(s)
- Nancy Y Asaad
- Department of Pathology, Faculty of Medicine, Menoufiya University, Shebin El-kom, Egypt.
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Meamar AR, Rezaian M, Rezaie S, Mohraz M, Kia EB, Houpt ER, Solaymani-Mohammadi S. Cryptosporidium parvum bovine genotype oocysts in the respiratory samples of an AIDS patient: efficacy of treatment with a combination of azithromycin and paromomycin. Parasitol Res 2006; 98:593-5. [PMID: 16416289 DOI: 10.1007/s00436-005-0097-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Accepted: 11/18/2005] [Indexed: 11/28/2022]
Abstract
Cryptosporidium has been recognized as an emerging zoonotic agent of intestinal cryptosporidiosis leading to diarrhea, malabsorption syndrome, and weight loss in AIDS patients. In the present case, oocysts of zoonotic Cryptosporidium parvum were detected in the sputum and stool samples of an AIDS patient with a 3-month history of intestinal cryptosporidiosis. The oocysts were detected by modified Ziehl-Neelsen staining; confirmation was achieved by nested polymerase chain reaction (PCR), targeting the most polymorphic region of the 18S rRNA gene. Genotyping was done by restriction endonuclease digestion of the PCR product. The zoonotic C. parvum bovine genotype was identified in both intestinal and respiratory samples. Treatment with both azithromycin and paromomycin resulted in improvement of both intestinal and respiratory symptoms, as well as the elimination of the parasite. This is the first report of the identification of Cryptosporidium sp. oocysts in the respiratory samples obtained from an AIDS patient in Iran. Pulmonary cryptosporidiosis should be considered whenever an AIDS patient with intestinal cryptosporidiosis develops respiratory symptoms.
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Affiliation(s)
- Ahmad-Reza Meamar
- Department of Medical Parasitology and Mycology, Division of Intestinal and Genital Protozoal Diseases, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, P.O. Box 14155, Tehran, 6446, Iran
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de Souza LDR, Rodrigues MAM, Morceli J, Kemp R, Mendes RP. Cryptosporidiosis of the biliary tract mimicking pancreatic cancer in an AIDS patient. Rev Soc Bras Med Trop 2004; 37:182-5. [PMID: 15094908 DOI: 10.1590/s0037-86822004000200015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diarrhea caused by Cryptosporidium sp is frequent in patients with AIDS, but involvement of other organs of the digestive tract is uncommon. We report a case of Cryptosporidium-associated obstruction of the biliary tract mimicking cancer of the head of the pancreas in a 43-year-old woman with AIDS.
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Affiliation(s)
- Lenice do Rosário de Souza
- Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, Universidade do Estado de São Paulo, Botucatu, SP.
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Harrington BJ, Kassa H. A Comparison of an Immunoassay with Acid-Fast Staining to Detect Cryptosporidium. Lab Med 2002. [DOI: 10.1309/ybul-j39n-jb59-m10h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Hailu Kassa
- Department of Public and Allied Health, Bowling Green State University, Bowling Green, OH
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Abstract
In addition to erythromycin, macrolides now available in the United States include azithromycin and clarithromycin. These two new macrolides are more chemically stable and better tolerated than erythromycin, and they have a broader antimicrobial spectrum than erythromycin against Mycobacterium avium complex (MAC), Haemophilus influenzae, nontuberculous mycobacteria, and Chlamydia trachomatis. All three macrolides have excellent activity against the atypical respiratory pathogens (C. pneumoniae and Mycoplasma species) and the Legionella species. Azithromycin and clarithromycin have pharmacokinetics that allow shorter dosing schedules because of prolonged tissue levels. Both azithromycin and clarithromycin are active agents for MAC prophylaxis in patients with late-stage acquired immunodeficiency syndrome (AIDS), although azithromycin may be the preferable agent because of fewer drug-drug interactions. Clarithromycin is the most active MAC antimicrobial agent and should be part of any drug regimen for treating active MAC disease in patients with or without AIDS. Although both azithromycin and clarithromycin are well tolerated by children, azithromycin has the advantage of shorter treatment regimens and improved tolerance, potentially improving compliance in the treatment of respiratory tract and skin or soft tissue infections. Intravenously administered azithromycin has been approved for treatment of adults with mild to moderate community-acquired pneumonia or pelvic inflammatory diseases. An area of concern is the increasing macrolide resistance that is being reported with some of the common pathogens, particularly Streptococcus pneumoniae, group A streptococci, and H. influenzae. The emergence of macrolide resistance with these common pathogens may limit the clinical usefulness of this class of antimicrobial agents in the future.
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Affiliation(s)
- S Alvarez-Elcoro
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic Jacksonville, Florida, USA
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Georges E, Rabaud C, Amiel C, Kurès L, Guedenet JC, Allamagny E, May T, Canton P. Enterocytozoon bieneusi multiorgan microsporidiosis in a HIV-infected patient. J Infect 1998; 36:223-5. [PMID: 9570660 DOI: 10.1016/s0163-4453(98)80019-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multiorgan microsporidiosis due to Enterocytozoon bieneusi was diagnosed in an HIV-infected patient. The parasite was found and identified as E. bieneusi by transmission electron microscopy in stools, duodenal biopsy, nasal discharge and sputum. No clinical improvement or parasite eradication was obtained after albendazole therapy, but the patient remained alive 9 months after diagnosis.
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Affiliation(s)
- E Georges
- Laboratoire de Parasitologie, Centre Hospitalier Universitaire de Nancy, France
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21
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Dionisio D, Orsi A, Sterrantino G, Meli M, Di Lollo S, Ibba Manneschi L, Trotta M, Pozzi M, Sani L, Leoncini F. Chronic cryptosporidiosis in patients with AIDS: stable remission and possible eradication after long-term, low dose azithromycin. J Clin Pathol 1998; 51:138-42. [PMID: 9602688 PMCID: PMC500509 DOI: 10.1136/jcp.51.2.138] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the effectiveness of long term, low dose azithromycin treatment for chronic cryptosporidiosis in patients with AIDS. METHODS Azithromycin was administered as initial daily treatment to 13 patients with AIDS: 6 patients received 500 mg for 30 to 40 days (mean 35); 3 patients received 1000 mg for 21 to 50 days (mean 37); and 4 patients received 1500 mg for 20 days. Nine of the 13 patients were also given low dose maintenance treatment with different schedules of azithromycin for 30 to 360 days (mean 129). Patients were monitored, during and after treatment, for parasite shedding in stool and for daily stool frequency and body weight. All but one patient had severe immunodeficiency. RESULTS Long term, low dose maintenance treatment was associated with major clinical and parasitological benefits: there was probable eradication of infection in 2 patients, and 7 patients showed a complete response with persistent high decrease (5 patients) or clearance (2 patients) of parasite in stool. The drug was well tolerated, and there was no relapse either during treatment or during follow up (up to 21 months). These results were more impressive than those observed after the short term initial course of azithromycin, which was unable at any tested dose to achieve parasite clearance in stool (except in the patient with less advanced immunodeficiency) or to prevent relapse in 3 patients who discontinued treatment. Reversible side effects occurred with the 1500 mg daily dose. CONCLUSIONS Long term, low dose azithromycin is well tolerated and may induce stable remission of chronic cryptosporidiosis in patients with AIDS. It may lead to probable eradication of the infection in some patients, even those with severe immunodeficiency.
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Affiliation(s)
- D Dionisio
- Infectious Diseases Unit, Careggi Hospital, Florence, Italy
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22
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23
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Poirot JL, Deluol AM, Antoine M, Heyer F, Cadranel J, Meynard JL, Meyohas MC, Girard PM, Roux P. Broncho-pulmonary cryptosporidiosis in four HIV-infected patients. J Eukaryot Microbiol 1996; 43:78S-79S. [PMID: 8822872 DOI: 10.1111/j.1550-7408.1996.tb05007.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J L Poirot
- Dept. of Parasitol, Saint-Antoine hospital
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24
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Clavel A, Arnal AC, Sánchez EC, Cuesta J, Letona S, Amiguet JA, Castillo FJ, Varea M, Gómez-Lus R. Respiratory cryptosporidiosis: case series and review of the literature. Infection 1996; 24:341-6. [PMID: 8923043 DOI: 10.1007/bf01716076] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Five case of intestinal cryptosporidiosis with pulmonary involvement in patients with AIDS are reported. The diagnosis was based on the recognition of acid-fast oocysts in sputum or aspirated bronchial material and stool specimens. Coughing and excess secretions were present in all cases. Four patients had other associated pulmonary pathogens: two Mycobacterium tuberculosis, one Mycobacterium fortuitum and one Cytomegalovirus + Pneumocystis carinii; all of them had a previous (three cases) or simultaneous (one case) diagnosis of intestinal cryptosporidiosis, presenting with diarrhoea and vomiting. In the fifth patient Cryptosporidium was the only pulmonary pathogen found in a bronchial aspirate, and the onset of diarrhoea was 1 month after respiratory detection. Fifty-seven cases of respiratory cryptosporidiosis have been reported since 1980. In 17 of them, no other pathogen was found. Diarrhoea was present in 77% of the patients, cough in 77%, dyspnea in 58%, expectoration in 54%, fever in 45%, thoracic pain in 33%.
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Affiliation(s)
- A Clavel
- Servicio de Microbiologia, Hospital Clínico Universitario, Zaragoza, Spain
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