Treatment and prevention of cryptosporidiosis
- Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
- Section Editor — Travel Medicine
- Head of Infectious Diseases Unit
- Monash University, Australia
- Peter F Weller, MD, MACP
Peter F Weller, MD, MACP
- Editor-in-Chief — Infectious Diseases
- Section Editor — Tropical Medicine
- William Bosworth Castle Professor of Medicine
- Harvard Medical School
- Professor of Immunology and Infectious Diseases
- Harvard T. H. Chan School of Public Health
Cryptosporidium is an intracellular protozoan parasite that is associated with self-limited diarrhea in immunocompetent hosts and severe debilitating diarrhea with weight loss and malabsorption in immunocompromised patients (eg, patients with AIDS). The approach to treatment for patients with cryptosporidiosis depends upon the immune status of the host as well as the severity of symptoms.
This topic will address the treatment and prevention of cryptosporidiosis in immunocompetent and HIV-infected patients. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of cryptosporidiosis are found elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of cryptosporidiosis".)
Most patients with cryptosporidiosis have mild to moderate symptoms and are able to keep up with their fluid losses without the need for additional therapies. However, for patients with severe, prolonged symptoms, supportive care includes:
●Antidiarrheal agents — Loperamide is often used for control of diarrhea. However, tincture of opium may be more effective than loperamide .
●Enteral or parenteral nutrition — Repletion of electrolyte losses by either oral or intravenous routes is important in patients who experience significant volume loss associated with severe diarrhea. Volume loss of >10 liters per day has been reported in patients with "cholera-like" diarrhea, which can be life-threatening without aggressive repletion . In patients with chronic symptoms and weight loss, total parenteral nutrition should also be considered. Additional discussions of fluid management are found elsewhere. (See "Overview of cholera", section on 'Fluid management' and "Oral rehydration therapy".)
- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf (Accessed on September 21, 2016).
- Abubakar I, Aliyu SH, Arumugam C, et al. Prevention and treatment of cryptosporidiosis in immunocompromised patients. Cochrane Database Syst Rev 2007; :CD004932.
- Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 2005; 40:1173.
- Amadi B, Mwiya M, Musuku J, et al. Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial. Lancet 2002; 360:1375.
- Rossignol JF, Ayoub A, Ayers MS. Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. J Infect Dis 2001; 184:103.
- Smith HV, Corcoran GD. New drugs and treatment for cryptosporidiosis. Curr Opin Infect Dis 2004; 17:557.
- Rossignol JF, Kabil SM, el-Gohary Y, Younis AM. Effect of nitazoxanide in diarrhea and enteritis caused by Cryptosporidium species. Clin Gastroenterol Hepatol 2006; 4:320.
- Checkley W, White AC Jr, Jaganath D, et al. A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium. Lancet Infect Dis 2015; 15:85.
- White AC Jr, Chappell CL, Hayat CS, et al. Paromomycin for cryptosporidiosis in AIDS: a prospective, double-blind trial. J Infect Dis 1994; 170:419.
- Hewitt RG, Yiannoutsos CT, Higgs ES, et al. Paromomycin: no more effective than placebo for treatment of cryptosporidiosis in patients with advanced human immunodeficiency virus infection. AIDS Clinical Trial Group. Clin Infect Dis 2000; 31:1084.
- Hussien SM, Abdella OH, Abu-Hashim AH, et al. Comparative study between the effect of nitazoxanide and paromomycine in treatment of cryptosporidiosis in hospitalized children. J Egypt Soc Parasitol 2013; 43:463.
- Sparks H, Nair G, Castellanos-Gonzalez A, White AC Jr. Treatment of Cryptosporidium: What We Know, Gaps, and the Way Forward. Curr Trop Med Rep 2015; 2:181.
- Carr A, Marriott D, Field A, et al. Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet 1998; 351:256.
- Miao YM, Awad-El-Kariem FM, Franzen C, et al. Eradication of cryptosporidia and microsporidia following successful antiretroviral therapy. J Acquir Immune Defic Syndr 2000; 25:124.
- Maggi P, Larocca AM, Quarto M, et al. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur J Clin Microbiol Infect Dis 2000; 19:213.
- Smith NH, Cron S, Valdez LM, et al. Combination drug therapy for cryptosporidiosis in AIDS. J Infect Dis 1998; 178:900.
- Legrand F, Grenouillet F, Larosa F, et al. Diagnosis and treatment of digestive cryptosporidiosis in allogeneic haematopoietic stem cell transplant recipients: a prospective single centre study. Bone Marrow Transplant 2011; 46:858.
- Hong DK, Wong CJ, Gutierrez K. Severe cryptosporidiosis in a seven-year-old renal transplant recipient: case report and review of the literature. Pediatr Transplant 2007; 11:94.
- Priyamvadaa, PS, Parameswaranb,S, Morkhandikarc,S et al. Successful eradication of cryptosporidium in kidney transplant recipients – Two case reports. Indian J Transplantation 2014; 8:22
- Palmieri F, Cicalini S, Froio N, et al. Pulmonary cryptosporidiosis in an AIDS patient: successful treatment with paromomycin plus azithromycin. Int J STD AIDS 2005; 16:515.
- Rossignol JF. Nitazoxanide in the treatment of acquired immune deficiency syndrome-related cryptosporidiosis: results of the United States compassionate use program in 365 patients. Aliment Pharmacol Ther 2006; 24:887.
- Rossignol JF, Hidalgo H, Feregrino M, et al. A double-'blind' placebo-controlled study of nitazoxanide in the treatment of cryptosporidial diarrhoea in AIDS patients in Mexico. Trans R Soc Trop Med Hyg 1998; 92:663.
- Amadi B, Mwiya M, Sianongo S, et al. High dose prolonged treatment with nitazoxanide is not effective for cryptosporidiosis in HIV positive Zambian children: a randomised controlled trial. BMC Infect Dis 2009; 9:195.
- Holmberg SD, Moorman AC, Von Bargen JC, et al. Possible effectiveness of clarithromycin and rifabutin for cryptosporidiosis chemoprophylaxis in HIV disease. HIV Outpatient Study (HOPS) Investigators. JAMA 1998; 279:384.
- Cabada MM, White AC Jr. Treatment of cryptosporidiosis: do we know what we think we know? Curr Opin Infect Dis 2010; 23:494.
- Fichtenbaum CJ, Zackin R, Feinberg J, et al. Rifabutin but not clarithromycin prevents cryptosporidiosis in persons with advanced HIV infection. AIDS 2000; 14:2889.
- Giacometti A, Cirioni O, Barchiesi F, et al. Activity of nitazoxanide alone and in combination with azithromycin and rifabutin against Cryptosporidium parvum in cell culture. J Antimicrob Chemother 2000; 45:453.
- Gathe JC Jr, Mayberry C, Clemmons J, Nemecek J. Resolution of severe cryptosporidial diarrhea with rifaximin in patients with AIDS. J Acquir Immune Defic Syndr 2008; 48:363.
- Amenta M, Dalle Nogare ER, Colomba C, et al. Intestinal protozoa in HIV-infected patients: effect of rifaximin in Cryptosporidium parvum and Blastocystis hominis infections. J Chemother 1999; 11:391.
- Hicks P, Zwiener RJ, Squires J, Savell V. Azithromycin therapy for Cryptosporidium parvum infection in four children infected with human immunodeficiency virus. J Pediatr 1996; 129:297.
- Blanshard C, Shanson DC, Gazzard BG. Pilot studies of azithromycin, letrazuril and paromomycin in the treatment of cryptosporidiosis. Int J STD AIDS 1997; 8:124.
- Hoepelman AI. Current therapeutic approaches to cryptosporidiosis in immunocompromised patients. J Antimicrob Chemother 1996; 37:871.
- Griffiths JK. Treatment for AIDS-associated cryptosporidiosis. J Infect Dis 1998; 178:915.
- Zardi EM, Picardi A, Afeltra A. Treatment of cryptosporidiosis in immunocompromised hosts. Chemotherapy 2005; 51:193.
- Bhadauria D, Goel A, Kaul A, et al. Cryptosporidium infection after renal transplantation in an endemic area. Transpl Infect Dis 2015; 17:48.
- Krause I, Amir J, Cleper R, et al. Cryptosporidiosis in children following solid organ transplantation. Pediatr Infect Dis J 2012; 31:1135.
- Blanshard C, Jackson AM, Shanson DC, et al. Cryptosporidiosis in HIV-seropositive patients. Q J Med 1992; 85:813.
- Manabe YC, Clark DP, Moore RD, et al. Cryptosporidiosis in patients with AIDS: correlates of disease and survival. Clin Infect Dis 1998; 27:536.
- McGowan I, Hawkins AS, Weller IV. The natural history of cryptosporidial diarrhoea in HIV-infected patients. AIDS 1993; 7:349.
- Connolly GM, Dryden MS, Shanson DC, Gazzard BG. Cryptosporidial diarrhoea in AIDS and its treatment. Gut 1988; 29:593.
- Hunter PR, Hughes S, Woodhouse S, et al. Health sequelae of human cryptosporidiosis in immunocompetent patients. Clin Infect Dis 2004; 39:504.
- Rehn M, Wallensten A, Widerström M, et al. Post-infection symptoms following two large waterborne outbreaks of Cryptosporidium hominis in Northern Sweden, 2010-2011. BMC Public Health 2015; 15:529.
- Kelly P. Treatment and prevention of cryptosporidiosis: what options are there for a country like Zambia? Parasitology 2011; 138:1488.
- Davies AP, Chalmers RM. Cryptosporidiosis. BMJ 2009; 339:b4168.
- Goodgame RW. Understanding intestinal spore-forming protozoa: cryptosporidia, microsporidia, isospora, and cyclospora. Ann Intern Med 1996; 124:429.
- Mead JR. Prospects for immunotherapy and vaccines against Cryptosporidium. Hum Vaccin Immunother 2014; 10:1505.