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 [2].
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 [4].
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. |
