Cryptosporidium is a parasitic infection that has been increasingly reported in children and immunocompromised patients, particularly those who have undergone organ transplants. It can be transmitted through contaminated food or water, poor hand hygiene after touching pets, and even high temperature and humidity living environments. Cryptosporidium infection can cause watery diarrhea lasting more than two weeks, poor response to antibiotic therapy, vomiting, anorexia, abdominal pain, and low-grade fever. It can also lead to increasing immune-rejection of the transplanted liver, increasing transaminases, and symptoms associated with sclerosing cholangitis. However, Cryptosporidium may not be detected in a patient’s stool culture. Therefore, a three-pronged approach of history taking, symptomatology, and pathogenic examination is required for diagnosis in LT patients.
Treating Cryptosporidium infection in LT patients requires careful consideration by physicians, as NTZ is the only available drug to treat Cryptosporidium. This drug acts against the parasite by inhibiting pyruvate-ferric oxidoreductase activity and enhancing the body’s immune response. However, adjustment of immunosuppressive regimens needs to be considered first in the treatment of Cryptosporidium infection in LT patients, and reducing immunosuppression is first recommended. In previous trials, LT patients on cyclosporine were less likely to be infected with Cryptosporidium and develop graft dysfunction than patients on tacrolimus. Therefore, cyclosporine is recommended when necessary, and lymphocyte sorting counts are regularly tested and controlled to achieve a state in which the organism responds well to Cryptosporidium but does not cause serious immune-rejection.
It is important to emphasize that Cryptosporidium infection has become a serious but neglected factor affecting the survival and quality of life of LT patients. Cryptosporidium screening should be routinely performed to identify and treat the infection early when receiving LT patients with diarrhea. Clinicians should focus heavily on the immunosuppressive treatment of patients to find a balance between anti-immunorejection and anti-infection. There are fewer drugs available for treating Cryptosporidium infection in LT patients, and drugs under development offer hope for future control of this disease.
