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Cryptosporidium Infection in Patients With Primary Immunodeficiencies

Wolska-Kusnierz, Beata*; Bajer, Anna; Caccio, Simone; Heropolitanska-Pliszka, Edyta*; Bernatowska, Ewa*; Socha, Piotr*; van Dongen, Jacques§; Bednarska, Malgorzata; Paziewska, Anna; Sinski, Edward

Journal of Pediatric Gastroenterology & Nutrition: October 2007 - Volume 45 - Issue 4 - p 458–464
doi: 10.1097/MPG.0b013e318054b09b
Original Articles: Hepatology and Nutrition

Background: Cryptosporidium species infection is usually self-limited in immunocompetent populations, but can be severe and life-threatening among immunocompromised individuals, particularly in patients with AIDS and in these patients with primary immunodeficiencies (PIDs).

Patients and Methods: A group of 5 patients with genetically confirmed hyper-IgM syndrome type 1 (XHIM) and one patient with primary CD4 lymphopenia were enrolled in the study. At least 2 stool samples and a bile sample in one patient were examined for Cryptosporidium oocysts by a modified Ziehl-Neelsen technique, by immunofluorescence assay using a commercial kit, as well as by molecular analysis followed by genotyping. Immunological status at the time of PID diagnosis and the complex picture of disease are presented.

Results: Chronic cryptosporidiosis was confirmed in 3 patients with XHIM and in one patient with primary CD4 lymphopenia. Molecular diagnosis showed the presence of C parvum, C hominis, and C meleagridis in analyzed specimens.

Conclusions: Cryptosporidium infection with serious clinical symptoms observed in patients with hyper-IgM syndrome calls for regular, repeated screening in this group of patients.

*Gastroenterology, Hepatology and Immunology Clinic, Children's Memorial Health Institute, Italy

Department of Parasitology, Faculty of Biology, University of Warsaw, Poland, Italy

Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy

§Department of Immunology, Erasmus University, Rotterdam, The Netherlands

Received 28 June, 2006

Accepted 30 January, 2007

Address correspondence and reprint requests to Beata Wolska-Kusnierz, MD, Children's Memorial Health Institute, Av Dzieci Polskich 20, Warsaw 04-730, Poland (e-mail: bwolska@interia.pl).

This work was supported by the State Committee for Scientific Research, KBN, through the Faculty of Biology, Warsaw University intramural grant, BW no.1601/53 (A.B.); and KBN grant no. 2PO4C09827 (E.S.) and grant EURO-POLICY-PID SP23-CT-2005-006411.

© 2007 Lippincott Williams & Wilkins, Inc.