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Cryptosporidium enteritis in solid organ transplant recipients: multicenter retrospective evaluation of 10 cases reveals an association with elevated tacrolimus concentrations
Author(s) -
Bonatti H.,
Barroso II L.F.,
Sawyer R.G.,
Kotton C.N.,
Sifri C.D.
Publication year - 2012
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/j.1399-3062.2012.00719.x
Subject(s) - medicine , interquartile range , cryptosporidium , tacrolimus , gastroenterology , diarrhea , creatinine , enteritis , retrospective cohort study , transplantation , feces , biology , paleontology
Background Cryptosporidial enteritis, a diarrheal infection of the small intestine caused by the apicomplexan protozoa C ryptosporidium , is infrequently recognized in transplant recipients from developed countries. Methods A retrospective review of all cases of cryptosporidiosis in solid organ transplant ( SOT ) recipients at 2 centers from J anuary 2001 to O ctober 2010 was performed and compared with transplant recipients with community‐onset C lostridium difficile infection ( CDI ). A literature search was performed with regard to reported cases of cryptosporidiosis in SOT recipients. Results Eight renal, 1 liver, and 1 lung transplant recipient were diagnosed with cryptosporidiosis at median 46.0 months (interquartile range [ IQR ] 25.2–62.8) following SOT . Symptoms existed for a median 14 days ( IQR 10.5–14.8) before diagnosis. For the 9 patients receiving tacrolimus ( TAC ), mean TAC levels increased from 6.3 ± 1.1 to 21.3 ± 9.2 ng/mL ( P = 0.0007) and median serum creatinine increased temporarily from 1.3 ( IQR 1.1–1.7) to 2.4 ( IQR 2.0–4.6) mg/dL ( P = 0.008). By comparison, 8 SOT recipients (6 kidney, 2 liver) hospitalized with community‐onset CDI had a mean TAC level of 10.8 ± 2.8 ng/dL during disease compared with 9.2 ± 2.3 ng/mL at baseline ( P = 0.07) and had no change in median creatinine. All patients recovered from C ryptosporidium enteritis after receiving various chemotherapeutic regimens. Conclusions Cryptosporidiosis should be recognized as an important cause of diarrhea after SOT and is associated with elevated TAC levels and acute kidney injury. Increased TAC levels may reflect altered drug metabolism in the small intestine.