Enteric Coccidiosis in Renal Transplant Recipients: A Pilot Study
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at greater risk of developing opportunistic infections due to their immunosuppressed state. In this multi-centre study three stool specimens from 104 renal transplant recipients were stained with: Modified Ziehl-Neelsen, Auramine Rhodamine, Kinoyoun Acid Fast, Giemsa and Gomori stains and then examined microscopically for the identification of the characteristic oocysts of Cryptosporidia, Cyclosporidia, Isospora and Microspora. The studied group included 52 subjects with gastro-intestinal symptoms and 52 asymptomatic subjects serving as a control group. Our results showed that Cryptosporidia oocysts were seen in 29 subjects (55.8%) in the symptomatic group and in 14 subjects (25.9%) in the asymptomatic group. All infected cases had cryptosporidia oocyst in their stool: 88.4% as a single infection, 9.3% mixed infection with isosporiosis, 2.3% mixed infection with cyclosporiosis, while no infection with microsporiosis was detected. The rate of enteric coccidiosis correlated positively with the duration of the kidney transplant but not with other variables including the immuno-suppressive therapy regimen, the total dose of steroids and the number of rejection episodes. Enteric coccidiosis is an important cause of gastro-intestinal symptoms in renal transplant recipients and special staining procedures for the identification of these protozoal pathogens in stool specimens should be requested in such patients presenting with diarrhea and/or abdominal pain. Key Words: Protozoa - Coccidiosis - Renal transplant. Introduction RENAL transplant recipients are at greater risk of developing various infections due to several factors including-among others-treatment with immunosuppressive drugs. Most of these infections are opportunistic caused by unusual pathogens M. Since the identification of the acquired immunodeficiency syndrome (AIDS), the number of parasitic pathogens recognized and the frequency with which they are encountered in clinical practice as opportunitic infections have constantly increased. Five new intestinal protozoa have been increasingly identified in patients with AIDS namely: cryptosporidia, tnicrosporidia, sarcosporidia, cyclospora and isospora . Human infections with these organisms occurs through ingestion of infectious particle called spore or oocyst. These exist to liberate sporozoites which in turn enter and infect intestinal epithelial cells [31. Infected patients may be asymptomatic or may present with self-limited acute diarrheal illness. AIDS patients and immuno- compromised hosts on the other hand may present with chronic persistent and Lifethreatening diarrhea . Based upon these facts the present work was designed to study the prevalence of coccidial infections in renal transplant recipients, symptomatology pattern and relationship to the overall inununosuppressive state.