Enteric Coccidiosis in Renal Transplant Recipients: A Pilot Study
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Unusual enteric protozoal pathogens are being encountered more frequently in clinical practice specially after the identification of the acquired immune deficiency syndrome (AIDS). Meanwhile renal transplant recipients are 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, lsospora 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.