[CIS-PAGID] Cryptosporidium in CD40L

[Donald Cuong Vinh, Dr]

Were the anti-parasitics used singly, or in combination? Paromomycin is poorly absorbed from the GI tract, so may not be effective in targeting biliary problems. Because Crypto is an intracellular protozoa, the combination of azithro to nitazoxanide (NTZ) may be better than NTZ alone; there is some very limited data that rifamycins (e.g. rifabutin, rifaximin) MAY also have some activity as part of a combo regimen, the rationale being that azithro & rifamycins get into intracellular 'somes. Also, may need to consider higher doses of NTZ (instead of usual 500 BID dose, may need to go to 1000 BID or higher)

Based on animal models, I wonder if there is a role for adjunctive IFN-g ?
Don




Donald C. Vinh, MD
Assistant Professor
Division of Infectious Diseases,
Division of Allergy & Clinical Immunology
Dept of Medicine; Dept of Medical Microbiology
McGill University Health Centre - Montreal General Hospital
1650 Cedar Ave, Rm A5-156
Montreal, Quebec,  Canada H3G 1A4
Ph: 514-934-1934 x42419 (office); x42811 (admin assist)
Fax: 514-934-8423
e-mail: donald.vinh at mcgill.ca
________________________________________
From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] On Behalf Of Puck, Jennifer [puckj at peds.ucsf.edu]
Sent: Sunday, May 22, 2011 12:55 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Cryptosporidium in CD40L

Would appreciate ideas for a young man with CD40L deficiency and a bad case of cryptosporidium. He was previously healthy on immunoglobulin, G-CSF for neutropenia, and TMP/SMX 3x per week for prophylaxis against pneumocystis (his presenting infection in infancy).
He first got a headache and then diarrhea 6-8 weeks ago, and his stool was positive for cryptosporidium as an outpatient. The diarrhea became explosive and bloody requiring hospital admission, and he continued to have secretory diarrhea and positive stools despite paromomycin, nitazoxanide, and azithromycin and TPN/complete NPO bowel rest.

There is no HLA-matched sibling for BMT, and we are looking at the unrelated donor registry. BMT may be the best long term option, and I have read that BMT be required to clear the infection.

Do others have experience with severe cryptosporidium in CD40L deficiency? Will symptoms eventually subside? What type of lab tests and imaging are useful to follow these patients? LFTs? Ultrasound? MRI? Endoscopy? Will attempts at oral feeding be helpful, neutral, or just induce further diarrhea and delay gut healing?

Jennifer M. Puck, M.D.
Professor of Pediatrics
University of California, San Francisco, Box 0519
513 Parnassus Avenue, HSE 301A
San Francisco, CA  94143-0519

Email: puckj at peds.ucsf.edu
Phone: 415 476-3181
FAX: 415 502-5127