CRYPTOSPORIDIOSIS IN A CASE OF CELIAC DISEASE

Abstract

Cryptosporidium is a coccidian protozoan parasite which causes cryptosporidiosis in the humans. Four species of cryptosporidium are pathogenic to humans of which Cryptosporidium parvum is the most common. Cryptosporidiosis accounts for more than 6% of all diarrhoeal diseases, mostly in children [1, 2]. A recent study from Karachi has reported the frequency of cryptosporidiosis in children at 1.7% [3]. It infects both the immunocompetent as well as immunocompromised hosts. Humans are infected when they ingest cryptosporidium oocysts. Transmission can be person-to-person, zoonotic or water-borne. The intestinal tract is the principal site of infection. Although pathogenesis of cryptosporidiosis is not well understood, impaired intestinal absorption with increased secretion into the gut lumen is seen. Impairment in both humoral and cell-mediated immunity is involved. The entire life cycle of the parasite occurs in a single host and the oocysts are excreted in fully infective form. Cryptosporidium oocysts are resistant to most disinfectants including aldehydes and halogens [1,2]. The disease is usually characterized by prolonged diarrhoea especially in the immunocompromised and malnourished. It is important to be aware of this complication in these patients. As our case shows, while diagnosis of cryptosporidiosis is easy, routine stool examination does not detect the cryptosporidium oocysts. Specific request must be made to the laboratory for tests for cryptosporidium.

Case Report

A 10 years old boy was admitted to a private hospital in Rawalpindi in July 2003 with history of chronic, often severe diarrhoea for the last five years. The diarrhoea was usually triggered after intake of food. Two years earlier he had been diagnosed as a case of celiac disease and put on gluten-free diet. Although, his condition improved appreciably; six months later diarrhoea recurred. The child was seen by several doctors and received treatment for malaria and tuberculosis on clinical suspicion. A battery of laboratory investigations including repeated stool examinations and cultures were done but the cause of diarrhoea could not be ascertained. His condition deteriorated progressively as the severity of diarrhoea increased