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Cryptosporidium spp. Infection in Solid Organ Transplantation: The Nationwide “TRANSCRYPTO” Study

Lanternier, Fanny MD, PhD; Amazzough, Karima MD; Favennec, Loic MD, PhD; Mamzer-Bruneel, Marie-France MD, PhD; Abdoul, Hendy MD; Tourret, Jérome MD, PhD; Decramer, Stéphane MD, PhD; Zuber, Julien MD, PhD; Scemla, Anne MD; Legendre, Christophe MD, PhD; Lortholary, Olivier MD, PhD; Bougnoux, Marie-Elisabeth MD, PhD; the ANOFEL Cryptosporidium National Network and Transplant Cryptosporidium Study Group

doi: 10.1097/TP.0000000000001503
Original Clinical Science-General

Background: Diarrhea is a frequent complication of solid organ transplantation. Cryptosporidiosis is classically reported in patients with acquired immunodeficiency syndrome and emerged as a cause of persistent diarrhea in solid organ transplant patients.

Methods: Through the ANOFEL Cryptosporidium National Network and the French Transplantation Society, we collected all cryptosporidiosis cases identified in solid organ transplanted patients between 2006 and 2010 in France.

Results: We reported 47 solid organ transplant recipients (41 kidneys) with cryptosporidiosis, mostly men (68%), with a median age of 52 (6-70) years old. Five patients had additional immunodepression favoring cryptosporidiosis (CD40 ligand deficiency [n = 1], human immunodeficiency virus infection [n = 4]). Cryptosporidiosis occurred at a median time of 3.4 (0-19.8) years posttransplant. Exposure to environmental risk factors was found before infection onset in 18 patients. Time between first symptoms and diagnosis was 10 (2-110) days. Four patients had associated extraintestinal location (biliary tract [n = 3] and lung [n = 1]). Thirty-five patients received specific therapy against cryptosporidiosis ie nitozoxanide, 25 in monotherapy, and 10 in association with azithromycin, 13 in association with immunosuppression (IS) reduction. Four patients were cured with IS treatment tapering only. The others patients had neither IS reduction nor specific therapy against cryptosporidiosis. Cryptosporidiosis was complicated by renal failure in 15 patients. Symptoms resolved after a median of 10 days of treatment. Six patients relapsed and 3 died, 1 with evolutive infection.

Conclusions: Cryptosporidiosis is a late posttransplant infection that disseminated to biliar duct or lung in 9% of patients. When limited to digestive tract, infection may resolve without IS reduction.

This French multicenter study is the largest study of Cryptosporidium infection in transplant patients outside of endemic areas like India, and shows that it can be eradicated without immunosuppressive reduction in many patients.

1 Université Paris Descartes, Service de maladies infectieuses et tropicales, Hôpital Necker-Enfants malades, Assistance Publique des Hôpitaux de Paris (AP-HP), Imagine Institute, Paris, France.

2 Unité de parasitology-Mycologie, Hôpital Universitaire de Rouen, Rouen, France.

3 Service de Transplantation rénale, Hôpital Necker Enfants malades, AP-HP, Paris, France.

4 Unité de Recherche Clinique/Centre d'Investigation Clinique, Hôpital Universitaire Necker Enfants malades, AP-HP, Paris, France.

5 Département d'Urologie, Néphrologie et Transplantation, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, APHP, Univ. Pierre et Marie Curie, Paris, France.

6 Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Médecine Interne, Néphrologie Pédiatrique, Hôpital des enfants, Centre de Référence des maladies rénales rares du Sud Ouest. (SORARE), Toulouse, France.

7 Université Paris Descartes, Unité de Parasitologie-Mycologie, Service de Microbiologie Clinique, Hôpital Necker Enfants Malades, APHP, Paris, France.

Received 11 May 2016. Revision received 7 August 2016.

Accepted 21 August 2016.

Supported by the French Transplantation Society.

The authors declare no conflicts of interest.

F.L., K.A., O.L., and M.E.B. contributed equally to this work.

F.L. designed the study, analyzed the results, wrote the article, K.A. collected the data, analyzed the results, and wrote the article. L.F. revised the article. M.-F.M.-B. designed the study. H.A. performed the statistical analysis. J.T. participated in data collection and revised the articcle. S.D. participated in data collection and revised the article. J.Z. revised the article. A.S. revised the article. C.L. revised the article. O.L. designed the study and wrote the article. M.-E.B. designed the study and wrote the article.

Correspondence: Marie-Elisabeth Bougnoux, Unité de Parasitologie-Mycologie, Service de Microbiologie, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015, Paris, France. (marie-elisabeth.bougnoux@aphp.fr).

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