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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 267-268
Pulmonary cryptosporidiosis in HIV negative, immunocompromised host


Department of Microbiology, Government Medical College, Nagpur, Maharashtra, India

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   Abstract 

Cryptosporidia are intestinal spore forming protozoa, which cause intracellular infections, predominantly in the epithelial cells of the intestine. Extra-intestinal infections with Cryptosporidium parvum have been rarely reported. However, a few reports of pulmonary cryptosporidiosis in HIV/AIDS cases have been mentioned in literature. In immunocompromised individuals who do not have HIV-related disease, Cryptosporidiosis has been rarely reported. We present a case of respiratory infection caused by C. parvum . The patient was a 10-year-old child with nephrotic syndrome and was receiving corticosteroids for 6 months. The child had history of low-grade fever, breathlessness and cough with expectoration of 3 months duration. The patient was nonreactive for HIV, and there was no evidence of primary immunodeficiency. Major serum immunoglobulins (IgG, IgA, and IgM) were in normal range. Simultaneous gastrointestinal involvement with C. parvum was observed.

Keywords: Acquired immune deficiency syndrome, cryptosporidiosis, Human immunodeficiency virus, immunocompromised host

How to cite this article:
Shrikhande S N, Chande C A, Shegokar V R, Powar R M. Pulmonary cryptosporidiosis in HIV negative, immunocompromised host. Indian J Pathol Microbiol 2009;52:267-8

How to cite this URL:
Shrikhande S N, Chande C A, Shegokar V R, Powar R M. Pulmonary cryptosporidiosis in HIV negative, immunocompromised host. Indian J Pathol Microbiol [serial online] 2009 [cited 2017 May 23];52:267-8. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/267/48942



   Introduction Top


Cryptosporidia are intestinal spore forming protozoa that cause intracellular infections, predominantly in the epithelial cells of intestine. They are transmitted through contaminated water or food by oocysts or spores. Mild to moderate self-limited diarrhea is common in healthy persons, but patients with immune dysfunction can have prolonged diarrhea due to severe intestinal injury. [1] Extra-intestinal involvement with cryptosporidium has been reported in AIDS. [2],[3],[4],[5],[6] There are fewer case reports of cryptosporidiosis in immunosuppressed individuals other than HIV-related disease. Here we report a case of pulmonary cryptosporidiosis of a child receiving corticosteroids.


   Case Report Top


A 10-year-old male child was admitted with history of low-grade fever and cough with expectoration for 3 months along with breathlessness. Patient was a known case of nephrotic syndrome and at the time of admission was receiving corticosteroids since 6 months. Examination of respiratory tract revealed decreased air entry on right side with crepitations in right lower region. X-ray chest revealed right-sided, lower zone consolidation.

Pathological findings

Patient had mild lucocytosis with differential counts within normal range. Mantoux skin test was negative and serum sample was nonreactive for HIV. Serum immunoglobulins (IgG, IgA and IgM) were within normal range. Sputum sample collected with prior oral wash was subjected to microscopic examination. Three smears stained with Gram's stain, Ziehl Neelsen (ZN) stain, and modified acid-fast stains were examined for the presence of bacteria, fungus, mycobacteria and nocardia. Sputum sample was inoculated on sheep blood agar, chocolate agar, Sabouraud's dextrose agar and Lowenstein Jenson medium.

Microscopic examination revealed presence of 4 to 6, circular, acid-fast structures in the smear stained with modified acid-fast staining technique [Figure 1]. Acid-fast organisms were not seen in ZN-stained smears. A repeat sputum sample and stool samples [Figure 2] collected after two days also confirmed presence of acid-fast structures in modified acid-fast stain morphologically consistent with cysts of cryptosporidium species. No pathogenic bacteria were grown on chocolate or blood agar. Mycobacterium tuberculosis was also not grown. Microscopic examination of sputum and culture were negative for fungal elements.


   Discussion Top


Cryptosporidium species is known to cause an intractable diarrhea in patients with acquired immunodeficiency syndrome. [7] Compared to intestinal infection, infections at other sites due to cryptosporidium are rarely reported in immunocompetent individuals. Chronic cough, dyspnea and fever are reported to be the major symptoms in pulmonary cryptosporidiosis. In most of the reported cases of respiratory cryptosporidiosis, diarrhea was an associated symptom.

The patient had received corticosteroids for 5 months for the management of nephrotic syndrome. Corticosteroids are known to depress the host response by suppression of inflammatory response. Normal serum levels of major serum immunoglobulins indicated adequate humoral immune response. Protracted cryptosporidiosis has been reported with selective IgA immunoglobulin deficiency. [8] Cellular immunity appears to be of paramount importance in clearing cryptosporidial infection as in individuals with defects in T-cell response, the most severe and prolonged disease is seen. [9]

Apart from the acid-fast oocysts of cryptosporidium, no other pathogenic organism was demonstrated by microscopic or culture examination. In the present case, in absence of any other established pulmonary pathogen, cryptosporidium was considered as an etiological agent for the pulmonary pathology. Thus pulmonary cryptosporidiosis should be considered as one of the differential diagnosis when an immunocompromised patient with respiratory symptoms is being investigated.

 
   References Top

1.Goodgame RW. Understanding intestinal spore-forming protozoa: Cryptosporidia, Microsporidia, Isospora and Cyclospora. Ann Intern Med 1996;124:429-41.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Clavel A, Arnal AC, Sanchez EC, Cuesta J, Letona S, Amiguet JA, et al . Respiratory cryptosporidiosis: Case series and review of the literature. Infection 1996;24:341-6.  Back to cited text no. 2    
3.Pellicelli AM, Palmieri F, Spinazzola F, D'Ambrosio C, Causo T, De Mori P, et al . Pulmonary cryptosporidiosis in patients with acquired immunodeficiency syndrome. Minerva Med 1998;89:173-5.  Back to cited text no. 3  [PUBMED]  
4.Stern JB, Antoine M, Roux P, Mayaud C, Cadranel J. Pulmonary cryptosporidium in a patient with AIDS. Rev Mal Respir 1998;15:549-53.  Back to cited text no. 4  [PUBMED]  
5.Palmieri F, Cicalini S, Froio N, Rizzi EB, Goletti D, Festa A, et al . Pulmonary cryptosporidiosis in an AIDS patient: Successful treatment with paromomycin plus azithromycin. Int J STD AIDS 2005;16:515-7.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Brea Hernando AJ, Bandres Franco E, Mosquera Lozano JD, Lantero Benedito M, Ezquerra Lezcano M. Pulmonary cryptosporidiosis and AIDS: Presentation of a case and review of the literature. Ann Med Intern 1993;10:232-6.  Back to cited text no. 6    
7.Mahdi NK, Ali NH. Cryptosporidiosis and other intestinal parasitic infections in patients with chronic diarrhea. Saudi Med J 2004;25:1204-7.  Back to cited text no. 7  [PUBMED]  
8.Jacyno MR, Parkin J, Goldin R, Baron JH. Protracted enteric cryptosporidial infection in selective immunoglobulin A and saccharomyces opsonin deficiencies. Gut 1990;31:714-6.  Back to cited text no. 8    
9.Molbak K, Lisse IM, Hojlyng N, Aaby P. Severe cryptosporidiosis in children with normal T-cell subsets. Parasite Immunol 1994;16:275-7.  Back to cited text no. 9    

Top
Correspondence Address:
S N Shrikhande
A 303, Amar Enclave, Nagpur - 440 015, Maharashatra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48942

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