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Treatment of cryptosporidiosis: do we know what we think we know?

Cabada, Miguel M; White, A Clinton Jr.

Current Opinion in Infectious Diseases: October 2010 - Volume 23 - Issue 5 - p 494–499
doi: 10.1097/QCO.0b013e32833de052
Gastrointestinal infections: Edited by Nicholas J. Beeching and A. Clinton White

Purpose of review: The management of cryptosporidiosis is fraught with controversies. New research on diagnostics and medications has reached the field in recent years. Therefore, familiarity with key features of current management tools is important. We discuss diagnostic and therapeutic aspects of cryptosporidiosis focusing on evidence behind the medications available to date.

Recent findings: Molecular methods provide a clearer understanding of cryptosporidiosis epidemiology. The major determinants of severity still are host immune status and parasite species. Children and immunosuppressed individuals, especially with HIV/AIDS, are disproportionately affected. Nitazoxanide is an important advance in treatment of HIV negative patients. However, recent research confirms the limited effectiveness of antiparasitic drugs to treat cryptosporidiosis in AIDS. Questions remain about using partially active drugs paromomycin and nitazoxanide for treatment. Potent antiretroviral combinations modify disease epidemiology and are key components of therapy in AIDS. However, it is unclear whether this is due solely to immune reconstitution or due in part to antiparasitic effects of HIV protease inhibitors. Newer candidate drugs are in development.

Summary: There is better understanding of the epidemiology of cryptosporidiosis and promising new diagnostic methods. There are significant challenges in terms of control and treatment of cryptosporidiosis among the groups at risk.

Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA

Correspondence to A. Clinton White Jr. MD, 301 University Boulevard Rt 0435, Galveston, TX 77555, USA Tel: +1 409 747 1910; fax: +1 409 772 6527; e-mail: address: acwhite@utmb.edu

© 2010 Lippincott Williams & Wilkins, Inc.