Cryptosporidiosis Treatment & Management

Author: Miguel M Cabada, MD; Chief Editor: Burke A Cunha, MD more...

Updated: Jun 3, 2011

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Approach Considerations
Antiparasitic Therapy
Symptomatic Therapy
Dietary Considerations
Prevention of Cryptosporidiosis
Consultations
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Approach Considerations

In patients with cryptosporidiosis, antiparasitic therapy is combined with symptomatic treatment, including nutritional therapy to avoid potentially fatal malnutrition.

Patients with acalculous cholecystitis should generally be treated with cholecystectomy.

Also see Pediatric Cryptosporidiosis.

Antiparasitic Therapy

Nitazoxanide significantly shortens the duration of diarrhea and can decrease the risk of mortality in malnourished children.^[12]Trials have also demonstrated efficacy in adults.^{[13, 14]}

Initial studies with antiparasitic drugs in patients with AIDS and cryptosporidiosis were disappointing. Nitazoxanide, paromomycin, and azithromycin are partially active. Combination antiretroviral therapy that includes an HIV protease inhibitor is associated with dramatic improvement in many cases.^{[1, 2]}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.

However, 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.

Symptomatic Therapy

Symptomatic therapy includes replacement of fluids, provision of appropriate nutrition, and treatment with antimotility agents. Loperamide or diphenoxylate-atropine may help in some cases. More potent opiates, including anhydrous morphine (Paregoric), may work in some cases that fail to respond to milder agents. Patients should avoid dietary lactose.

Dietary Considerations

Attention to nutritional aspects of patient care is crucial, because malnutrition can cause death. Lactose intolerance is common in cryptosporidiosis, and lactose-containing foods should be avoided. Enteral nutrition is usually sufficient; studies have not supported the use of parenteral nutrition.^[15]

Prevention of Cryptosporidiosis

Drinking water should be purified by filtration. This can be accomplished using 1-μm water filters when drinking tap water. Patients with AIDS should drink only filtered water.

Boil or filter water in countries with a high risk of transmission.

Avoid newborn animals (eg, calves, lambs), including domestic animals. New pets for patients with AIDS should be older than 6 months and should not have diarrhea.

Healthcare workers, childcare workers, food handlers, and health-compromised patients should avoid fecal-oral spread by wearing gloves and washing their hands after contact with human feces. Spread can occur after activities such as changing diapers.^[16]

Consultations

The following specialists should be consulted:

Infectious disease specialist - For consideration of antiparasitic and antiretroviral therapy
Gastroenterologist - For ERCP and sphincterotomy; endoscopy sometimes required for diagnosis
General surgeon - For suspected acalculous cholecystitis

Proceed to Medication

Contributor Information and Disclosures

Author

Miguel M Cabada, MD Fellow in Infectious Diseases, University of Texas Medical Branch School of Medicine

Miguel M Cabada, MD is a member of the following medical societies: Infectious Diseases Society of America, International Society for Infectious Diseases, and International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

A Clinton White Jr, MD The Paul R Stalnaker, MD, Distinguished Professor of Internal Medicine, Director, Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch School of Medicine

A Clinton White Jr, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society of Tropical Medicine and Hygiene, Christian Medical & Dental Society, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey D Band, MD Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Damon Eisen, MD, to the development and writing of the source article.

References

White AC Jr. Cryptosporidiosis (Cryptosporidium hominis, Cryptosporidium parvum, other species). In: Mandell GL, Bennett JE, Dolin R, ed. Principles and Practice of Infectious Diseases. 6^th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2005:3215-3228.
Lima AAM, Samie A, Guerrant RL. Cryptosporidiosis. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases. Philadelphia, Pa: Elsevier-Churchill Livingstone; 2011:640-63.
Yoder JS, Beach MJ. Cryptosporidium surveillance and risk factors in the United States. Exp Parasitol. Jan 2010;124(1):31-9. [Medline].
Yoder JS, Harral C, Beach MJ. Cryptosporidiosis surveillance - United States, 2006-2008. MMWR Surveill Summ. Jun 11 2010;59(6):1-14. [Medline].
Amin OM. Seasonal prevalence of intestinal parasites in the United States during 2000. Am J Trop Med Hyg. Jun 2002;66(6):799-803. [Medline].
Nair P, Mohamed JA, DuPont HL, et al. Epidemiology of cryptosporidiosis in North American travelers to Mexico. Am J Trop Med Hyg. Aug 2008;79(2):210-4. [Medline]. [Full Text].
Wumba R, Longo-Mbenza B, Mandina M, et al. Intestinal parasites infections in hospitalized AIDS patients in Kinshasa, Democratic Republic of Congo. Parasite. Dec 2010;17(4):321-8. [Medline].
Mondal D, Haque R, Sack RB, Kirkpatrick BD, Petri WA Jr. Attribution of malnutrition to cause-specific diarrheal illness: evidence from a prospective study of preschool children in Mirpur, Dhaka, Bangladesh. Am J Trop Med Hyg. May 2009;80(5):824-6. [Medline].
Opintan JA, Newman MJ, Ayeh-Kumi PF, et al. Pediatric diarrhea in southern Ghana: etiology and association with intestinal inflammation and malnutrition. Am J Trop Med Hyg. Oct 2010;83(4):936-43. [Medline]. [Full Text].
O'connor RM, Shaffie R, Kang G, Ward HD. Cryptosporidiosis in patients with HIV/AIDS. AIDS. Mar 13 2011;25(5):549-60. [Medline].
Kaushik K, Khurana S, Wanchu A, Malla N. Evaluation of staining techniques, antigen detection and nested PCR for the diagnosis of cryptosporidiosis in HIV seropositive and seronegative patients. Acta Trop. Jul 2008;107(1):1-7. [Medline].
Amadi B, Mwiya M, Musuku J, et al. Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomised controlled trial. Lancet. Nov 2 2002;360(9343):1375-80. [Medline].
Rossignol JF, Kabil SM, el-Gohary Y, Younis AM. Effect of nitazoxanide in diarrhea and enteritis caused by Cryptosporidium species. Clin Gastroenterol Hepatol. Mar 2006;4(3):320-4. [Medline].
Rossignol JF, Ayoub A, Ayers MS. Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. J Infect Dis. Jul 1 2001;184(1):103-6. [Medline].
Kotler DP, Fogleman L, Tierney AR. Comparison of total parenteral nutrition and an oral, semielemental diet on body composition, physical function, and nutrition-related costs in patients with malabsorption due to acquired immunodeficiency syndrome. JPEN J Parenter Enteral Nutr. May-Jun 1998;22(3):120-6. [Medline].
Lee MB, Greig JD. A review of gastrointestinal outbreaks in schools: effective infection control interventions. J Sch Health. Dec 2010;80(12):588-98. [Medline].
Cabada MM, White AC Jr. Treatment of cryptosporidiosis: do we know what we think we know?. Curr Opin Infect Dis. Oct 2010;23(5):494-9. [Medline].
Pantenburg B, White AC Jr. Nitazoxanide. In: Grayson ML, ed. Kucer's The Use of Antibiotics. 6^th ed. London, United Kingdom: Hodder Arnold; 2010:2132-9.

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