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Cryptosporidiosis in paediatric renal transplantation

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Abstract

Diarrhoea in transplantation may be secondary to infectious agents and immunosuppressive drugs. The use of combined immunosuppressive drugs increases the incidence of infectious diarrhoea. We retrospectively collected all diarrhoea episodes during a 3-year period in 199 pediatric renal transplant recipients, including 47 patients receiving a kidney transplant during this period. We diagnosed 64 diarrhoea episodes (32% of the patients, 10.7% per year). Fourteen diarrhoea episodes could be attributed to the immunosuppressive treatment, and 12 remained without diagnosis. Nineteen patients (<10%) receiving mycophenolic acid (MPA) developed diarrhoea, 14 of whom had episodes attributable to the immunosuppressive treatment. Reducing the MPA dose or switching to another immunosuppressant did not induce graft rejection, if at all, for at least 6 months. Thirty-eight diarrhoea episodes were caused by infectious agents: viruses in 16 patients, bacterial agents in ten patients, Candida albicans in four cases and parasitic agents in eight cases (Giardia lambdia in one patient and Cryptosporidium in seven patients). In our cohort, Cryptosporidium was responsible for 18% of the infectious diarrhoea and 11% of all causes of diarrhoea, and it affected 3.5% of the newly transplanted patients during the 3-year study period. The clinical presentation of the disease was profuse and persistent diarrhoea with acute renal failure in all patients. We propose that oocysts be screened for in the stool during the early stages of tests for determining the origin of infectious diarrhoea. Disease treatment requires early specific treatment (nitazoxanide) for extended periods of time in conjunction with supportive rehydration.

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Acknowledgments

We thank Karine Guyot (Institut Pasteur, Lille, France) and the Cryptosoridium ANOFEL network for genotyping the isolates and Joost P. Schanstra (Inserm U858, Toulouse, France) for proofreading the manuscript and for helpful comments.

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Authors and Affiliations

  1. Department of Pædiatric Nephrology, Children’s Hospital, Centre de Référence du Sud Ouest des Maladies Rénales Rares, 330 Avenue de Grande Bretagne TSA 70034, 31059, Toulouse, France

    Flavio Bandin, Arnaud Garnier & Stéphane Decramer

  2. Department of Pædiatric Nephrology, Robert Debré Hospital, 48 boulevard Serurier, 75019, Paris, France

    Theresa Kwon & Veronique Baudouin

  3. Department of Parasitology and Mycology, Rangueil University Hospital, Avenue Jean Poulhès TSA 50032, 31059, Toulouse, France

    Marie-Denise Linas, Alexis Valentin & Sophie Cassaing

  4. Department of Pædiatric, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87000, Limoges, France

    Vincent Guigonis

  5. Department of Microbiology, Robert Debré Hospital, 48 Boulevard Serurier, 75019, Paris, France

    Agnes Carol

Authors
  1. Flavio Bandin
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  2. Theresa Kwon
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  3. Marie-Denise Linas
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  4. Vincent Guigonis
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  6. Sophie Cassaing
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  10. Stéphane Decramer
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Correspondence to Stéphane Decramer.

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Bandin, F., Kwon, T., Linas, MD. et al. Cryptosporidiosis in paediatric renal transplantation. Pediatr Nephrol 24, 2245–2255 (2009). https://doi.org/10.1007/s00467-009-1274-y

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  • DOI: https://doi.org/10.1007/s00467-009-1274-y

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