Case Study: Cryptosporidium

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[. . .] (Medscape, 2011, p.1) Patients with acalculous cholecystitis are reported as generally being treated by cholecystectomy. (Medscape, 2011, p.1) Nitazoxanide is reported to shorten the duration of diarrhea significantly and to decrease the "risk of mortality in malnourished children." (Medscape, 2011, p.1) It is reported that research trials have demonstrated the efficacy of using Nitazoxanide in adults as well. (Medscape, 2011, p.1) The report states that in earlier studies with antiparasitic drugs in patients with AIDS and cryptosporidiosis, that the results were a disappointment. Reported as well is:

"Nitazoxanide, paromomycin, and azithromycin are partially active. Combination antiretroviral therapy that includes an HIV protease inhibitor is associated with dramatic improvement in many cases. Improvement is likely to result from immune reconstitution but may in part reflect the antiparasitic activity of the protease inhibitors. Nucleoside antiretroviral drugs are malabsorbed in chronic cryptosporidiosis. For that reason, the use of partially active antiparasitic drugs (eg, nitazoxanide or paromomycin combined with azithromycin) should be considered prior to initiating antiretroviral therapy." (Medscape, 2011, p.1)

It is reported that in patients with AIDS "cryptosporidiosis usually cannot be eradicated prior to restoration of the CD4 cell count in response to combination antiretroviral therapy. During early immune reconstitution, patients should generally continue antiparasitic therapy (such as nitazoxanide or paromomycin) and antimotility agents, as needed." (Medscape, 2011, p.1) Symptomatic therapy is reported to include fluid replacement, appropriate nutrition provision, and antimotility agent treatment. It is reported that Loperamide or diphenoxylate-atropine is helpful in some cases and that the more potent opiates including "anhydrous morphine (Paregoric)" are effective in cases that do not respond to milder agents.

Dietary lactose should be avoided by patients. Attention to the nutrition of the patient's care is critical since malnutrition can result in death. Stated is that enteral nutrition is generally found to be sufficient. Avoidance of infection involves purification of drinking water by filtration accomplished through use of a 1-um water filter when drinking tap water. AIDS patients should drink filtered water only and water in countries with a high transmission risk should boil all drinking water.

Avoidance of newborn animals including those which are domestic animals is important and in those with AIDS no animal younger than six months in age should be considered. Healthcare workers, childcare workers, food handlers and patients who are health compromised should wear gloves and wash their hands after potential contact with animal or human feces including changing of diapers.

In the event this infection is contracted the individual should consult the following specialists:

(1) Infectious disease specialist - For consideration of antiparasitic and antiretroviral therapy;

(2) Gastroenterologist - For ERCP and sphincterotomy; endoscopy sometimes required for diagnosis;

(3) General surgeon - For suspected acalculous cholecystitis; and (4) Studies of healthy hosts and malnourished children have demonstrated the importance of nitazoxanide treatment. (Medscape, 2011, p.1)

Since the advent of combination antiretroviral therapy, cryptosporidiosis is much less common in persons with AIDS. Patients not receiving combination antiretroviral therapy need to be stabilized with the drugs described below before starting HIV treatment. Antiparasitic drugs are geared toward treatment of diarrhea by "a direct anticryptosporidial effect, but maintenance treatment is often required. Antimotility agents are administered to relieve symptoms and to increase exposure to the antiparasitic and antiretroviral agents. Somatostatin analogues are partially beneficial for reducing secretory diarrhea in some refractory cases." (Medscape, 2011, p.1) Activity against Cryptosporidium is contained in "Nitazoxanide, paromomycin, and azithromycin." (Medscape, 2011, p.1)

VII. Medications

Specific information on the medications are listed as follows:

(1) Paromomvcin is an oral "nonabsorbed aminoglycoside that is partially active in cryptosporidiosis. It is an amebicidal and antibacterial aminoglycoside obtained from a strain of Streptomyces rimosus that is active in intestinal amebiasis. Paromomycin is recommended for treatment of Diphyllobothrium latum, Taenia saginata, Taenia solium, Dipylidium caninum, and Hymenolepis nana." (Medscape, 2011, p.1)

(2) Azithromvcin (Zithromax, Zmax): this is an "a macrolide antibiotic. In a clinical study, it provided good symptom control in combination with paromomycin." (Medscape, 2011, p.1)

(3) Nitazoxide (Alinia): This medication serves to "inhibit the growth of Cryptosporidium parvum sporozoites and oocysts and Giardia lamblia trophozoites. It elicits antiprotozoal activity by interfering with pyruvate-ferredoxin oxidoreductase (PFOR) enzyme -- dependent electron transfer reaction, which is essential to anaerobic energy metabolism." (Medscape, 2011, p.1)

VII. Alternatives to Tap Water

In the event the individual is advised not to drink tap water the stated alternatives includes the following:

(1) One option is to boil water prior to drinking or using for cooking. Water should be brought to a rolling boil for at least five minutes. (Illinois Department of Public Health, 2012, p.1)

(2) The second stated option is to use a "point-of-use (personal use, end-of-tap, under sink) filter. Only point-of-use filters that remove particles one micrometer or less in diameter should be considered." (Illinois Department of Public Health, 2012, p.1)

(3) The third option is to use bottled water however, it is not wise to assume that all bottled waters are 100% free of Cryptosporidium. While Cryptosprodius has been known to be acquired by drinking well water, however water treated by passing through a filter will nearly meet the same standards as distillation or reverse osmosis. (Illinois Department of Public Health, 2012, p.1)

Summary and Conclusion

In review Cryptosporidium is a coccidian protozoan parasite which attaches itself to the intestinal tissue of the host. This infection is not easily cured and there is no known specific effective treatment although there are medications that assist with the symptoms of infection and which deter the progression of the infection. It is important that human beings and animals alike, whether livestock or domestic animals, drink water that has gone through the proper distillation, reverse osmosis, or filtering to cleanse this parasite from the water.

Bibliography

Cabada, MM (2011) Cryptosporidiosis Medication. MedScape. Retrieved from: http://emedicine.medscape.com/article/215490-medication#2

Cabada, MM (2011) Crytosporidiosis Treatment and Management. MedScape. Retrieved from: http://emedicine.medscape.com/article/215490-treatment#aw2aab6b6b6

Casemore, D.P., Garder, C.A., and O'Mahony, C. "Cryptosporidial infection, with special reference to nosocomial transmission of Cryptosporidium parvum: a review." Folia Parasitol, 1994; 41 (1): 17-21.

Cryptosporidiosis in Immunocompromised Persons (2012) Illinois Department of Health. Healthbeat. Retrieved from: http://www.idph.state.il.us/public/hb/hbcrypto.htm

Doyle, P.S., Crabb, J., and Petersen, C. "Anti-Cryptosporidium parvum antibodies inhibit infectivity in vitro and in vivo."Infect Immun, 1993 Oct; 61 (10): 4079-84.

Flanigan, T.P. And Soave, R. "Cryptosporidiosis." Prog Clin Parasitol, 1993; 1-20.

Goodgame, R.W. "Understanding intestinal spore-forming protozoa: cryptosporidia, microsporidia, isospora, and cyclospora." Ann Intern Med, 1996 Feb 15; 124 (4): 429-41.

Hannahs, G. (nd) Cryptosporidium parvum: an emerging pathogen. Kenyon College. Retrieved from: http://biology.kenyon.edu/slonc/bio38/hannahs/crypto.htm

Johnson, D.W., Pieniazek, N.J., Griffin, D.W., Misener, L., and Rose, J.B. "Development of a PCR protocol for sensitive detection of Cryptosporidium oocysts in water samples." Appl Environ Microbiol, 1995 Nov; 61 (11): 3849-55.

Keusch, G.T., Hamer, D., Joe, A., Kelley, M., Griffiths, J., and Ward, H. "Cryptosporidia -- who is at risk?" Schweiz Med Wochenschr, 1995 May… [END OF PREVIEW]

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