zithromax and Cryptosporidiosis

Topics: AIDS-Related Opportunistic Infections; Animals; Antiretroviral Therapy, Highly Active; Azithromycin; Biliary Tract Diseases; Coccidiostats; Cryptosporidiosis; Humans; Immunocompromised Host; Nitro Compounds; Paromomycin; Rifamycins; Rifaximin; Thiazoles

Cryptosporidium parvum is a protozoan which can cause severe debilitating disease in immunocompromised individuals. Animal models have shown that cellular immunity is the most important factor against the development of the disease. Individuals with a humoral immune deficiency are also at risk. In HIV-infected patients there is a clear relationship between disease severity and CD4 cell counts. Insight into the pathogenesis and development of new agents is hampered by the lack of an in vitro culture system. Prevention is of the utmost importance due to the difficulties of therapy and the severity of clinical disease which can develop. Oocysts are highly resistant to commonly used disinfectants. In HIV-infected patients with cryptosporidiosis, antiretroviral therapy should be instituted or modified. Moreover, non-specific therapy with antidiarrhoeal agents should also be instituted. If no effect is seen, therapy with paromomycin 500 mg 4 times daily for 2-3 weeks should be initiated, followed by maintenance therapy with 500 mg twice daily to prevent relapse.

Topics: AIDS-Related Opportunistic Infections; Animals; Anti-Bacterial Agents; Azithromycin; Cryptosporidiosis; Cryptosporidium parvum; Humans; Mice

Cryptosporidiosis is a coccidian infection that usually occurs in children an immunocompromised patients. With the AIDS (Acquired Immunodeficiency Syndrome) epidemic there have been an increased number of clinical cases and still we don't have an optimal therapeutic regimen to eradicate the infection. Since 1907 when the organism was first described, a large amount of anti-infective agents have been used without success. We present herein a review of the new therapeutic approaches, although none of them is satisfactory and new studies are required for the development of an optimal treatment. Symptomatic and nutritional support are the unique treatment we have so far.

Topics: Adenine; Amprolium; Animals; Azithromycin; Coccidiostats; Colostrum; Cryptosporidiosis; Eflornithine; Humans; Immunoglobulins; Spiramycin; Transfer Factor; Zidovudine

The MORDOR trial in Niger, Malawi, and Tanzania found that biannual mass distribution of azithromycin to children younger than 5 years led to a 13.5% reduction in all-cause mortality (NCT02048007). To help elucidate the mechanism for mortality reduction, we report IgG responses to 11 malaria, bacterial, and protozoan pathogens using a multiplex bead assay in pre-specified substudy of 30 communities in the rural Niger placebo-controlled trial over a three-year period (n = 5642 blood specimens, n = 3814 children ages 1-59 months). Mass azithromycin reduces Campylobacter spp. force of infection by 29% (hazard ratio = 0.71, 95% CI: 0.56, 0.89; P = 0.004) but serological measures show no significant differences between groups for other pathogens against a backdrop of high transmission. Results align with a recent microbiome study in the communities. Given significant sequelae of Campylobacter infection among preschool aged children, our results support an important mechanism through which biannual mass distribution of azithromycin likely reduces mortality in Niger.

Topics: Anti-Bacterial Agents; Azithromycin; Campylobacter Infections; Child; Child Mortality; Child, Preschool; Cryptosporidiosis; Drug Resistance, Bacterial; Escherichia coli Infections; Follow-Up Studies; Giardiasis; Humans; Immunoglobulin G; Infant; Malaria; Mass Drug Administration; Niger; Rural Population; Salmonella Infections

The present study evaluated the therapeutic efficacy of azithromycin, co-trimoxazole and kalvangi (Nigella sativa, also known as Black Cumin) against Cryptosporidium parvum infection in calves under field conditions. The experimental calves were treated with azithromycin (group A) at 1500 mg/calf/day, co-trimoxazole (group B) at 30 mg Kg-1 and kalvangi seeds powder (group C) at 750 mg Kg-1 BW orally for 7 days. Calves in the group D were naturally infected with C. parvum , untreated animals (positive control) while the calves in the group E were uninfected negative control animals. A significant decrease (p < 0.05) in oocyst counts for calves in groups A, B and C was observed compared to group D. When the oocyst counts amongst the treatment groups A, B and C were compared, a significant decrease (p < 0.05) was observed in group A. On day 21 post-treatment, the efficacy of azithromycin, co-trimoxazole and kalvangi in calves was 88.2% (95% C.I. ± 15.4), 45% (95% C.I. ± 21.8) and 27.8% (95% C.I. ± 20.7), respectively. This study confirmed previous reports of azithromycin efficacy against C. parvum infection, but found co-trimoxazole and kalvangi to be ineffective for this infection under these treatment regimens.

Topics: Animals; Anti-Infective Agents; Azithromycin; Cattle; Cattle Diseases; Cryptosporidiosis; Cryptosporidium parvum; Feces; Female; Male; Nigella sativa; Parasite Egg Count; Phytotherapy; Plant Preparations; Powders; Seeds; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To investigate the effectiveness of long term, low dose azithromycin treatment for chronic cryptosporidiosis in patients with AIDS.. Azithromycin was administered as initial daily treatment to 13 patients with AIDS: 6 patients received 500 mg for 30 to 40 days (mean 35); 3 patients received 1000 mg for 21 to 50 days (mean 37); and 4 patients received 1500 mg for 20 days. Nine of the 13 patients were also given low dose maintenance treatment with different schedules of azithromycin for 30 to 360 days (mean 129). Patients were monitored, during and after treatment, for parasite shedding in stool and for daily stool frequency and body weight. All but one patient had severe immunodeficiency.. Long term, low dose maintenance treatment was associated with major clinical and parasitological benefits: there was probable eradication of infection in 2 patients, and 7 patients showed a complete response with persistent high decrease (5 patients) or clearance (2 patients) of parasite in stool. The drug was well tolerated, and there was no relapse either during treatment or during follow up (up to 21 months). These results were more impressive than those observed after the short term initial course of azithromycin, which was unable at any tested dose to achieve parasite clearance in stool (except in the patient with less advanced immunodeficiency) or to prevent relapse in 3 patients who discontinued treatment. Reversible side effects occurred with the 1500 mg daily dose.. Long term, low dose azithromycin is well tolerated and may induce stable remission of chronic cryptosporidiosis in patients with AIDS. It may lead to probable eradication of the infection in some patients, even those with severe immunodeficiency.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Azithromycin; CD4 Lymphocyte Count; Chronic Disease; Cryptosporidiosis; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Treatment Outcome

Post-COVID-19 conditions encompass a wide range of health problems, including enteritis, but their association with parasitic infections has not yet been investigated. This study analyzed gastrointestinal symptoms, medical histories, fecal Cryptosporidium oocysts, and the history of COVID-19 infection in patients who attended the Faculty of Medicine, Cairo University, from January to July 2021. Fecal biomarkers, including H. pylori, occult blood, fecal calprotectin (FCAL), and TNF-a, were measured, and Cryptosporidium spp. genotypes were molecularly characterized among post-COVID-19 patients using RFLP. Preliminary results from 210 post-COVID-19 patients revealed that group 1 (Cryptosporidiumpositive) (n = 49) and group 2 (Cryptosporidium-negative) (n = 161) showed no significant difference in the prevalence rate of diabetes mellitus (DM). While group 2 was linked to diarrhea, only infections with Cryptosporidium post-COVID-19 were related to chronic diarrhea, vomiting, and weight loss. A total of 220 healthy subjects served as negative controls. Administering azithromycin, hydroxychloroquine, and ivermectin was significantly related to an increased risk of Cryptosporidium infection in group 1, whereas only azithromycin was more frequently recorded in group 2. Antioxidant supplementation insignificantly affected the incidence of cryptosporidiosis. Cryptosporidiosis with a history of COVID-19 was linked to H. pylori infections, increased inflammatory biomarkers (FCAL and TNF-a), and occult blood when compared with group 2. Cryptosporidium genotype 1 was the most commonly occurring subset in individuals with post-COVID-19. The findings demonstrated that aggravating gastrointestinal manifestations, increased fecal biomarkers and anti-COVID-19 therapeutic interventions are significantly related to the existence of Cryptosporidium oocysts in patients with post-COVID-19, indicating the predominance of.

Topics: Azithromycin; COVID-19; Cryptosporidiosis; Cryptosporidium; Diarrhea; Humans

Topics: Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Antiprotozoal Agents; Azithromycin; Child; Cryptosporidiosis; Cryptosporidium; Disease Management; Humans; Leukemia, Myeloid, Acute; Male; Paromomycin; Prognosis

Cryptosporidiosis in raptors and falcons is well-known to be caused by Cryptosporidium baileyi and associated mainly with respiratory pathology. This report presents the diagnosis of an atypical cryptosporidiosis event caused by Cryptosporidium parvum, that to the authors' knowledge, is a case observed for the first time in falcons. Two falcons (Gyrfalcon x Peregrine hybrids) were presented for annual check without any clinical signs. Hematology, biochemistry, fecal and crop parasitology, radiographic and endoscopic examinations were performed. Endoscopy revealed microcystic formation of the caudal lung field in the two falcons, adhesions and air sac alterations. Sampling and subsequent cytology revealed fungal spores and acid fast stain organisms (identified as Cryptosporidium spp.). Feces and affected lung tissue was further send for Cryptosporidium spp.-DNA detection. Fecal samples and lung tissue tested positive for Cryptosporidium spp. gp60 gene by PCR. By sequence analysis of the gp60 gene locus, diagnosis of C. parvum was confirmed with 100% homology. Despite the fact that falcons didn't recover after 1 month of therapy, eight months after the initial examination they were clinically healthy and had satisfactory flying performance. No other falcons were observed with C. parvum infections in the facility so far. The possible source, infection route and implications are discussed.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Communicable Diseases, Emerging; Cryptosporidiosis; Cryptosporidium parvum; DNA, Protozoan; Falconiformes; Genotype; High-Throughput Nucleotide Sequencing; Lung; Polymerase Chain Reaction; United Arab Emirates

Recent reports highlighting the global significance of cryptosporidiosis among children, have renewed efforts to develop control measures. We have optimized the gnotobiotic piglet model of acute diarrhea to evaluate azithromycin (AZR), nitazoxanide (NTZ), or treatment with both against Cryptosporidium hominis, the species responsible for most human cases. Piglets, animals reproducibly clinically susceptible to C. hominis, when inoculated with 106 oocysts, developed acute diarrhea with oocyst excretion in feces within 3 days. Ten day-treatment with recommended doses for children, commencing at onset of diarrhea, showed that treatment with AZR or NTZ relieved symptoms early in the treatment compared with untreated animals. Piglets treated with AZR exhibited no reduction of oocyst excretion whereas treatment with NTZ significantly reduced oocyst shedding early, increasing however after 5 days. While treatment with AZR+NTZ led to considerable symptomatic improvement, it had a modest effect on reducing mucosal injury, and did not completely eliminate oocyst excretion. Doubling the dose of AZR and/or NTZ did not improve the clinical outcome, confirming clinical observations that NTZ is only partially effective in reducing duration of diarrhea in children. This investigation confirms the gnotobiotic piglet as a useful tool for drug evaluation for the treatment of cryptosporidiosis in children.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Antiparasitic Agents; Azithromycin; Cryptosporidiosis; Cryptosporidium; Disease Models, Animal; Drug Therapy, Combination; Nitro Compounds; Sus scrofa; Swine; Thiazoles; Treatment Outcome

Seventy Kunming mice were randomly divided into four groups named as normal control group (10), Cryptosporidium infected group (20), allitridin treatment group (20) and azithromycin treatment group (20). After infection, each mouse in allitridin treatment and azithromycin treatment groups were given 1.5 mg/d allitridin or 2 mg/d azithromycin by gavage for 12 days, respectively. The mice were observed and the oocysts shedding in fecal pellets were counted daily after treatment. The level of secretory IgA (sIgA) in intestinal fluid of proximal jejunum was determined. The pathological changes in mucous membrane of proximal jejunum were observed by HE staining. Compared with infection group, the level of oocyst shedding was considerably lower in the two treatment groups (P < 0.05). There was a significant difference in sIgA level in intestinal fluid between allitridin treatment group (5.16 p.l/ml) and azithromycin treatment group (3.7 microl/ml) (P < 0.05). Pathological examination of intestinal mucous membrane showed that swollen mucous membrane and focal necrosis of tissue were observed in infection group, and less inflammatory cell infiltration occurred in the two treatment groups. Allitridin and azithromycin are effective in the treatment of Cryptosporidium infection. Allitridin can enhance the defense function of intestinal mucosa.

Topics: Allyl Compounds; Animals; Azithromycin; Cryptosporidiosis; Cryptosporidium parvum; Feces; Female; Immunoglobulin A, Secretory; Intestinal Mucosa; Jejunum; Male; Mice; Mice, Inbred Strains; Random Allocation; Sulfides

Digestive cryptosporidiosis (DC) can mimic GVHD after allogeneic haematopoietic stem cell transplantation (HSCT), thus requiring a reduction of immunosuppressive drugs and a specific therapy, whereas GVHD requires an intensification of immunosuppression. We systematically searched for cryptosporidiosis by light microscopy, immunochromatography and PCR in HSCT recipients who presented with at least one episode of diarrhoea. Of 115 consecutive patients allografted between July 2006 and November 2008, we analysed stools in 52 of 56 patients meeting these criteria. We identified Cryptosporidium parvum in 5 of the 52 patients (9.6%) at a median of 503 days (range 20-790) after HSCT. In those five patients, the median CD4+ cell and B lymphocyte counts were 60/mm3 (0-234) and 0/mm3 (0-96), respectively. Two patients died of invasive fungal infections. In the other three patients, diarrhoea disappeared after a median of 5 weeks following onset of bitherapy with azithromycine and nitazoxanide; they were still alive 433, 380 and 1179 days after the DC diagnosis. DC is probably under diagnosed after HSCT because it is difficult to detect during the asymptomatic phase. Early bitherapy and reduction of immunosuppression seem efficacious. In our series, DC has a seasonal pattern and is promoted by profound T lymphopenia.

Topics: Adult; Animals; Azithromycin; Cryptosporidiosis; Cryptosporidium parvum; Diagnosis, Differential; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppression Therapy; Lymphopenia; Male; Middle Aged; Nitro Compounds; Thiazoles; Transplantation, Homologous; Young Adult

To date Cryptosporidium muris has been identified by microscopy and genotyping in cats in two studies. We report morphological and genetic evidence of a mixed C. muris and C. felis infection in a cat and provide the first histological, immunohistochemical, in situ hybridisation and genetic confirmation of a C. muris infection in the stomach of a cat. The cat suffered persistent diarrhoea after the initial consultation, which remained unresolved, despite several medical interventions. Further studies are required to determine the range, prevalence and clinical impact of Cryptosporidium species infecting cats.

Topics: Animals; Antiprotozoal Agents; Azithromycin; Cat Diseases; Cats; Cryptosporidiosis; Cryptosporidium; Diarrhea; Male

Cryptosporidium species and Giardia intestinalis are the most common enteric protozoan pathogens affecting humans worldwide. In recent years, nitazoxanide has been licensed in the United States for the treatment of cryptosporidiosis in non-immunodeficient children and adults, becoming the first drug approved for treating this disease. There is a need for a highly effective treatment for cryptosporidiosis in immunodeficient patients, but the quest for such a drug has proven to be elusive. While not effective against Cryptosporidium, nitroimidazoles such as metronidazole or tinidazole are effective treatments for giardiasis and can be administered as a single dose. Albendazole and nitazoxanide are effective against giardiasis but require multiple doses. Nitazoxanide is the first new drug developed for treating giardiasis in more than 20years. New potentially promising drug targets in Cryptosporidium and Giardia have been identified, but there appears to be little activity toward clinical development of new drugs.

Topics: AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Antiparasitic Agents; Antiretroviral Therapy, Highly Active; Azithromycin; Benzimidazoles; Cryptosporidiosis; Giardia lamblia; Giardiasis; Humans; Nitro Compounds; Nitroimidazoles; Paromomycin; Roxithromycin; Thiazoles

Cryptosporydium parvum is an intracellular parasite that infects gastrointestinal epithelium and produces diarrhea that is self-limited in immunocompetent persons but potentially life-threatening in immunocompromised, especially those with the acquired immunodeficiency syndrome (AIDS). C. parvum enteric infection's incidence in a pediatric HIV/AIDS cohort, during a 6 years period, was studied. Clinical and immunologic characteristics of the dual infection were also recorded. Highly active antiretroviral therapy (HAART) was started or continued by all the patients during follow-up. Azithromicyn was used as antiparasitic drug. Cryptosporidiosis incidence was 13.7%; 33 out 240 children showed chronic diarrhea lasting 14 days at least, or recurrent, without dehydration and electrolytic disturbance. Peripheral blood T CD4+ percentage levels of the patients were variable and without relationship with C. parvum presence. Viral load levels in 31 out 33 patients were over cut-off at the enteric episode time. Mild or moderate eosinophilia were recorded in 23% of the patients and other intestinal parasites were present in 11 children. When the number of enteric episodes were compared with the clinical and immunological patient's status, not significant differences were recorded. HAART is the best treatment to improve immune function in HIV patients avoiding potentially fatal complications that accompany acute diarrhea during concomitant infection with C. parvum.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; AIDS-Related Opportunistic Infections; Animals; Anti-HIV Agents; Antiparasitic Agents; Antiretroviral Therapy, Highly Active; Argentina; Azithromycin; CD4-Positive T-Lymphocytes; Child; Child, Preschool; Cryptosporidiosis; Cryptosporidium parvum; Humans; Immunocompromised Host; Incidence

Cryptosporidium parvum causes severe long-standing diarrhea in immunocompromised patients. Sclerosing cholangitis caused by C. parvum is a rare complication in transplant recipients. We report herein the presentation of Cryptosporidium-associated cholangitis in an adult liver transplant patient diagnosed by liver biopsy. The patient improved on treatment with azithromycin and paromomycin.

Topics: Animals; Azithromycin; Cholangitis, Sclerosing; Cryptosporidiosis; Cryptosporidium parvum; Humans; Immunocompromised Host; Liver Transplantation; Male; Middle Aged; Paromomycin; Treatment Outcome

Topics: Azithromycin; Child, Preschool; Cryptosporidiosis; Hodgkin Disease; Humans; Male; Neoplasm Recurrence, Local; Risk Factors; Treatment Failure

Cryptosporidium species infection is usually self-limited in immunocompetent populations, but can be severe and life-threatening among immunocompromised individuals, particularly in patients with AIDS and in these patients with primary immunodeficiencies (PIDs).. A group of 5 patients with genetically confirmed hyper-IgM syndrome type 1 (XHIM) and one patient with primary CD4 lymphopenia were enrolled in the study. At least 2 stool samples and a bile sample in one patient were examined for Cryptosporidium oocysts by a modified Ziehl-Neelsen technique, by immunofluorescence assay using a commercial kit, as well as by molecular analysis followed by genotyping. Immunological status at the time of PID diagnosis and the complex picture of disease are presented.. Chronic cryptosporidiosis was confirmed in 3 patients with XHIM and in one patient with primary CD4 lymphopenia. Molecular diagnosis showed the presence of C parvum, C hominis, and C meleagridis in analyzed specimens.. Cryptosporidium infection with serious clinical symptoms observed in patients with hyper-IgM syndrome calls for regular, repeated screening in this group of patients.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Cryptosporidiosis; Cryptosporidium; Fatal Outcome; Female; Hematopoietic Stem Cell Transplantation; Humans; Hyper-IgM Immunodeficiency Syndrome; Immunocompromised Host; Immunoglobulins; Immunologic Deficiency Syndromes; Infant; Male; Paromomycin; Poland; Retrospective Studies; T-Lymphocytopenia, Idiopathic CD4-Positive

Cryptosporidium has been recognized as an emerging zoonotic agent of intestinal cryptosporidiosis leading to diarrhea, malabsorption syndrome, and weight loss in AIDS patients. In the present case, oocysts of zoonotic Cryptosporidium parvum were detected in the sputum and stool samples of an AIDS patient with a 3-month history of intestinal cryptosporidiosis. The oocysts were detected by modified Ziehl-Neelsen staining; confirmation was achieved by nested polymerase chain reaction (PCR), targeting the most polymorphic region of the 18S rRNA gene. Genotyping was done by restriction endonuclease digestion of the PCR product. The zoonotic C. parvum bovine genotype was identified in both intestinal and respiratory samples. Treatment with both azithromycin and paromomycin resulted in improvement of both intestinal and respiratory symptoms, as well as the elimination of the parasite. This is the first report of the identification of Cryptosporidium sp. oocysts in the respiratory samples obtained from an AIDS patient in Iran. Pulmonary cryptosporidiosis should be considered whenever an AIDS patient with intestinal cryptosporidiosis develops respiratory symptoms.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Antiprotozoal Agents; Azithromycin; Cryptosporidiosis; Cryptosporidium parvum; DNA Fingerprinting; DNA, Protozoan; DNA, Ribosomal; Drug Therapy, Combination; Feces; Genotype; Humans; Lung Diseases, Parasitic; Male; Oocysts; Paromomycin; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Sputum

Extra-intestinal cryptosporidiosis, especially of the biliary and respiratory tract, is likely in the course of an intestinal involvement, whereas it is rare without such a localization. We report a case of pulmonary cryptosporidiosis without apparent intestinal involvement in an AIDS patient, with favourable outcome after antimicrobial combination therapy with paromomycin plus azithromycin. The successful response to antimicrobial treatment was subsequently maintained by effective highly active antiretroviral therapy (HAART). We suggest that respiratory cryptosporidiosis should be investigated in HIV-infected patients with pulmonary symptoms and low CD4 cell count, and, if detected, treatment should include HAART plus the combination of paromomycin and azithromycin.

Topics: AIDS-Related Opportunistic Infections; Animals; Antiretroviral Therapy, Highly Active; Azithromycin; Cryptosporidiosis; Cryptosporidium parvum; Drug Therapy, Combination; HIV Infections; Humans; Lung Diseases, Parasitic; Male; Middle Aged; Paromomycin; Treatment Outcome

Four children on chemotherapy for acute lymphoblastic leukemia presented with severe diarrhea and dehydration. Cryptosporidium was identified in the stools using modified Ziehl-Neelsen stain. Two of them received paromomycin and responded well. One was started on paromomycin for 10 days and although there was clinical improvement, his stools examination continued to be positive for Cryptosporidium. He then received azithromycin for 10 days. He responded well and his stools became negative for Cryptosporidium. The fourth patient received azithromycin from the start and responded well. Cryptosporidium should be considered in all immunocompromised children with severe or prolonged diarrhea, and since it is not seen in a routine ova and parasite examination, the laboratory should be notified for diagnostic confirmation using modified Ziehl-Neelsen stain. Immunocompromised children with Cryptosporidium diarrhea may benefit from paromomycin or azithromycin therapy.

Topics: Amebicides; Anti-Bacterial Agents; Azithromycin; Child, Preschool; Cryptosporidiosis; Diarrhea; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Male; Paromomycin; Precursor Cell Lymphoblastic Leukemia-Lymphoma

The study was conducted at a primary school in Abis 8 village. 88 children aged eleven years consented to participate in the present study. After fecal examination, 43 (48.8%) cases were found infected with Cryptosporidium. The mean oocysts number per high power field (HPF) ranged from (1.6-48 oocysts/HPF). Azitbromycin, praziquantel (PZQ) and mirazid were given to 13, 16 and 14 infected children respectively. Three weeks after treatment, azithromycin and praziquantel gave cure rates of 91% and 56.2% respectively with a percent reduction of oocysts in stools of 99% for azithromycin and 71.5% for PZQ. Mirazid was not effective. All the three drugs were well tolerated. It was concluded that azithromycin is highly effective in the treatment of children with cryptosporidiosis: PZQ decreases the infection rate and intensity.

Topics: Animals; Azithromycin; Child; Coccidiostats; Commiphora; Cryptosporidiosis; Cryptosporidium parvum; Feces; Female; Humans; Male; Oocytes; Parasite Egg Count; Phytotherapy; Plant Preparations; Praziquantel; Schools; Treatment Outcome

The in vitro activity of nitazoxanide alone and in combination with azithromycin and rifabutin was investigated against four clinical isolates of Cryptosporidium parvum. The susceptibility tests were performed by inoculation of the isolates on toe cell monolayers and determination of the parasite count after 48 h incubation at 37 degrees C. The culture medium was supplemented with Dulbecco's modified Eagle's medium containing serial dilutions of each agent. Antibiotic-free plates were used as controls. Experiments were performed in triplicate. Nitazoxanide showed moderate anticryptosporidial activity: it suppressed the growth of parasites by >50% at 8 mg/L. A parasite reduction of 79.8-83.9% was observed when nitazoxanide 8 mg/L was combined with azithromycin 8 mg/L and rifabutin 8 mg/L. The study suggests that nitazoxanide may be active in inhibiting C. parvum growth in vitro upon combination with azithromycin or rifabutin.

Topics: AIDS-Related Opportunistic Infections; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Cell Survival; Cells, Cultured; Cryptosporidiosis; Cryptosporidium parvum; Humans; Nitro Compounds; Rifabutin; Thiazoles

A 24-year-old HIV-positive heterosexual woman with disseminated cryptosporidiosis was monitored from January 1998 to May 1999. During this period, consecutive stool, sputum, and bile examinations showed the constant presence of Cryptosporidium oocysts. Although the patient was repeatedly treated with oral paromomycin and azithromycin and, finally, nitazoxanide, her condition continued to deteriorate. In order to monitor the in vitro susceptibility of the parasite, specimens from various sites were collected periodically. When the first clinical isolate was tested, the antimicrobial agents used (azithromycin at a concentration of 8 mg/l, paromomycin at of 1 mg/ml, and nitazoxanide at 10 mg/l) produced a decrease in parasite counts of 26.5%, 63.4%, and 67.2%, respectively. Subsequent isolates of Cryptosporidium parvum showed similar susceptibilities. This case demonstrates that failure of clinical treatment corresponded to inadequate growth inhibition of the parasite in vitro.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Antiprotozoal Agents; Azithromycin; Cryptosporidiosis; Cryptosporidium; Drug Therapy, Combination; Feces; Female; Humans; Nitro Compounds; Paromomycin; Thiazoles; Treatment Outcome

Cryptosporidium parvum infection, a common cause of diarrhea in persons infected with the human immunodeficiency virus (HIV), is difficult to treat or prevent.. To evaluate relative rates of cryptosporidiosis in HIV-infected patients who were either receiving or not receiving chemoprophylaxis or treatment for Mycobacterium avium complex.. Analysis of prospectively collected data from HIV-infected patients' visits to their physicians since 1992.. Ten (8 private, 2 publicly funded) HIV clinics in 9 US cities.. A total of 1019 HIV-infected patients with CD4+ cell counts less than 0.075 x 10(9)/L.. Incidence of clinical cryptosporidiosis during treatment with clarithromycin, rifabutin, and azithromycin.. Five of the 312 patients reportedly taking clarithromycin developed cryptosporidiosis vs 30 of the 707 patients not taking clarithromycin (relative hazard [RH], 0.25 [95% confidence interval (CI), 0.10-0.67]; P=.004). Two of the 214 patients taking rifabutin developed cryptosporidiosis vs 33 of the 805 not taking rifabutin (RH, 0.15 [95% CI, 0.04-0.62]; P=.01). Prophylactic efficacy of either drug was 75% or greater. No protective effect was seen in the 54 patients reportedly taking azithromycin (RH, 1.48 [95% CI, 0.44-5.04]; P=.46).. Clarithromycin and rifabutin were highly protective against development of cryptosporidiosis in immune-suppressed HIV-infected persons in this analysis; further study is warranted.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antibiotics, Antitubercular; Azithromycin; Clarithromycin; Cryptosporidiosis; Female; HIV Infections; Humans; Likelihood Functions; Male; Prospective Studies; Rifabutin; Statistics, Nonparametric

Aside from effective antiretroviral therapy, there is no consistently effective antiparasitic therapy for cryptosporidiosis in AIDS. The purpose of this study was to assess safety, efficacy, and durability of combination therapy with paromomycin and azithromycin for chronic cryptosporidiosis. Patients with AIDS, chronic cryptosporidiosis, and < 100 CD4 cells/microL were treated with open-label paromomycin (1.0 g twice a day) plus azithromycin (600 mg once a day) for 4 weeks, followed by paromomycin alone for 8 weeks. In 11 patients, median stool frequency decreased from 6.5/day (baseline) to 4.9/day (week 4) and 3.0/day (week 12). Median reductions in 24-h oocyst excretion were 84%, 95%, and >99% at 2, 4, and 12 weeks, respectively. None of the responses were attributable to antiretrovirals. Of 5 survivors at 12-30 months of follow-up, 3 remain asymptomatic off medications, and 2 have chronic, mild diarrhea. Treatment of cryptosporidiosis with azithromycin and paromomycin was associated with significant reduction in oocyst excretion and some clinical improvement.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Anti-Bacterial Agents; Azithromycin; Coccidiostats; Cryptosporidiosis; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Paromomycin; Treatment Outcome

Topics: Aged; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Azithromycin; CD4 Lymphocyte Count; Cryptosporidiosis; Female; Humans; Renal Dialysis

Pilot studies of the safety and efficacy of 3 drugs thought to have anticryptosporidial activity were carried out to determine whether any of them are suitable for large-scale clinical trials. Open studies of the use of azithromycin, letrazuril and paromomycin in patients with acquired immunodeficiency syndrome (AIDS) and confirmed cryptosporidial diarrhoea for at least a month. Azithromycin 500 mg daily was ineffective. Letrazuril 150-200 mg daily was associated with an improvement in symptoms in 40% of patients treated and cessation of excretion of cryptosporidial oocysts in the stool in 70%; however biopsies remained positive. Paromomycin therapy was associated with a complete resolution of diarrhoea in 60% of patients treated and some improvement in symptoms in a further 5% but it did not eliminate the infection. None of the drugs had any major toxicities. Dose escalation studies of azithromycin should be performed. Letrazuril should be further investigated for efficacy in double-blind placebo-controlled trials. Paromomycin appears to result in prolonged symptomatic remission of cryptosporidial diarrhoea, but has no effect on cryptosporidial cholangitis.

Topics: Acetonitriles; AIDS-Related Opportunistic Infections; Animals; Azithromycin; Cholangitis, Sclerosing; Coccidiostats; Cohort Studies; Cryptosporidiosis; Cryptosporidium; Humans; Paromomycin; Pilot Projects; Triazines

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Child; Cryptosporidiosis; Gastroenteritis; Humans; Infant

We report two cases of cryptosporidiosis after CD34-selected PBSCT for lymphoma. While the first patient died of pulmonary cryptosporidiosis, treatment with paromomycin, azithromycin and subcutaneous low-dose rhIL-2 to improve numerical and functional T lymphocyte defects completely eliminated infection in the second patient. We conclude, that the removal of mature T lymphocytes by positive selection of CD34+ cells bears the risk of a delayed immune reconstitution resulting in an increased incidence of severe and sometimes fatal opportunistic infections. IL-2 might be useful in this situation by accelerating immune reconstitution and reducing the danger of opportunistic infections.

Topics: Adult; Antigens, CD34; Azithromycin; Cryptosporidiosis; Female; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells; Hodgkin Disease; Humans; Immunosuppression Therapy; Interleukin-2; Lung Diseases, Parasitic; Lymphocyte Subsets; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Opportunistic Infections; Paromomycin; Recombinant Proteins; Transplantation, Autologous

There is no known treatment for pulmonary cryptosporidiosis, a rare complication of intestinal cryptosporidiosis in AIDS patients. We report two cases of cryptosporidiosis which were unusual because (i) extracellular invasive forms of the parasite were found in the bronchoalveolar lavage and (ii) the outcome was favorable in one patient after treatment with azithromycin.

Topics: Adult; AIDS-Related Opportunistic Infections; Animals; Anti-Bacterial Agents; Azithromycin; Bronchoalveolar Lavage Fluid; Cryptosporidiosis; Cryptosporidium; Female; Humans; Lung Diseases, Parasitic; Macrophages, Alveolar; Male; Substance Abuse, Intravenous

Cryptosporidium parvum intestinal infection in immunodeficient patients can cause severe intestinal fluid losses with severe dehydration or chronic diarrhea with malnutrition. Therapies tried in human beings and animals include paromomycin, clarithromycin, azithromycin, octreotide, hyperimmune bovine colostrum, and bovine transfer factor. No specific therapy has been found to be consistently beneficial to children. We report azithromycin treatment of four children with acquired immunodeficiency syndrome who had severe diarrheal illnesses in which Cryptosporidium parvum was the sole pathogen detected. Three of these children had a marked decrease in stool volume and frequency within 36 hours of initiating therapy and resolution of diarrhea within 5 days; Cryptosporidium organisms became undetectable on examination of stool or colonic biopsy or by both after therapy was discontinued. A fourth patient required prolonged therapy with azithromycin to achieve clearance. Azithromycin therapy should be considered for immunocompromised patients with intestinal Cryptosporidium infection.

Topics: Adolescent; AIDS-Related Opportunistic Infections; Animals; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Colon; Cryptosporidiosis; Cryptosporidium parvum; Diarrhea; Feces; Humans; Intestinal Diseases, Parasitic; Male

The Third International Conference on the Macrolides, Azalides, and Streptogramins was held in Lisbon, Portugal. Conferees were given news on the latest advances in the development of innovative antibiotics belonging to these increasingly important groups of drugs, and learned of their expanding clinical indications. The following areas were emphasized at the conference: multiresistant gram-positive bacteremias in patients with serious underlying infections, azithromycin's effectiveness against acute community-acquired pneumonia, results of clarithromycin plus ethambutol in HIV-infected patients with MAC bacteremia, duodenal ulcers associated with Helicobacter pylori infections, and use of roxithromycin against AIDS-related cryptosporidium diarrhea.

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacteremia; Bacterial Infections; Clarithromycin; Clofazimine; Cryptosporidiosis; Drug Therapy, Combination; Duodenal Ulcer; Ethambutol; Humans; Microbial Sensitivity Tests; Mycobacterium avium-intracellulare Infection; Pneumonia; Smoking; Virginiamycin

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Animals; Anti-Bacterial Agents; Azithromycin; Community-Acquired Infections; Cryptosporidiosis; Humans; Injections, Intravenous; Malaria, Falciparum; Mycobacterium avium-intracellulare Infection; Plasmodium falciparum; Pneumonia; Pneumonia, Pneumocystis; Toxoplasmosis, Cerebral

To report a patient with non-HIV-related cryptosporidial diarrhea who was treated effectively with a regimen of high-dose azithromycin therapy.. A 42-year-old immunocompetent man contracted cryptosporidiosis from an ailing calf that he had purchased. He finally was admitted to the hospital because of excessive weight loss and profuse diarrhea. The patient was started on a course of high-dose azithromycin therapy and symptoms resolved within 48 hours. Follow-up stool cultures were negative for the parasite.. Although usually associated with immunocompromised patients, cryptosporidiosis occurs in immunocompetent hosts in a significant portion of the reported cases each year. Although self-limiting in most cases in this population, the disease can be severe at times and require treatment. Paromomycin therapy has been used in the past with good results. Although macrolides have had erratic effects against this parasite in the past, azithromycin (an azalide) demonstrated good efficacy in this patient.. Azithromycin has demonstrated that it may be an effective option for the treatment of cryptosporidiosis in immunocompromised patients. Studies involving its use in immunocompromised patients are currently underway.

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Cryptosporidiosis; Diarrhea; Feces; Humans; Immunocompetence; Male; Zoonoses

Of six evaluated aminoglycosides, paromomycin was the only one that showed activity against Cryptosporidium parvum in immunosuppressed rats. Oral dosages > or = 200 mg/kg/day reduced the severity of ileal infections; however, paromomycin was ineffective against cecal and biliary tract infections at 400 mg/kg/day orally and 50 mg/kg/day intraperitoneally. Oral paromomycin (400 mg/kg/day) was also less effective than azithromycin (400 mg/kg/day) against Cryptosporidium infection involving the ileum, cecum, or biliary tract of immunosuppressed rats. The data suggest that paromomycin may be an effective treatment for acute cryptosporidiosis of the small intestine but is probably ineffective against large intestine or biliary tract infections in the immunosuppressed host.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Cecum; Cryptosporidiosis; Cryptosporidium parvum; Disease Models, Animal; Female; Ileum; Immunosuppression Therapy; Paromomycin; Rats; Rats, Sprague-Dawley

Cryptosporidium parvum, the protozoan responsible for cryptosporidiosis, continues to defy eradication with existing therapies. A review of the anticryptosporidial activity of several drugs in the dexamethasone-immunosuppressed rat model illustrates the multitude of factors that may contribute to the difficulty of assessing a drug's therapeutic efficacy against the protozoan and provides possible explanation for drug failure at the level of host-parasite interaction.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Coccidiostats; Cryptosporidiosis; Cryptosporidium parvum; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Drug Residues; Female; Immunocompromised Host; Intestine, Large; Intestine, Small; Rats; Rats, Sprague-Dawley

Two children with cancer received azithromycin for Cryptosporidium-associated diarrhea that was unresponsive to supportive care. One child had choleriform diarrhea requiring daily fluid replacement of up to 65% of his total body weight; the other had protracted diarrhea and wasting. In both cases, administration of azithromycin was followed by prompt clinical improvement.

Topics: Administration, Oral; Azithromycin; Child, Preschool; Combined Modality Therapy; Cryptosporidiosis; Diarrhea; Diarrhea, Infantile; Drug Evaluation; Erythromycin; Fluid Therapy; Humans; Infant; Male; Mediastinal Neoplasms; Neuroblastoma; Opportunistic Infections; Sarcoma

Glycoside antibiotics including the macrolide antibiotics azithromycin, clarithromycin, and erythromycin and the aminoglycoside paromomycin were administered alone or combined with doxycycline, minocycline, or tetracycline to neonatal BALB/c mice experimentally infected with Cryptosporidium parvum. Glycosides at 100 or 200 mg/kg of body weight and tetracyclines at 50 mg/kg of body weight were dissolved in dimethylsulfoxide (DMSO), which was then diluted with phosphate-buffered saline (PBS) and given orally by gavage. Drugs were administered at 0, 24, 48, and 72 hr postinfection (PI) for prophylaxis. Histologic sections of ileum, cecum, and colon from tissues fixed at 96 hr PI were examined microscopically to determine the number of developing parasites and assign a quantitative score based on infectivity. All groups that received glycosides had significantly (P < 0.01) lower scores than controls that received only DMSO/PBS. A range in efficacy was apparent. None or extremely few parasites were found in paromomycin- and azithromycin-treated groups, whereas few to moderate numbers of parasites were found in erythromycin- and clarithromycin-treated groups. The addition of tetracyclines did not consistently result in significantly lower scores.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Azithromycin; Clarithromycin; Cryptosporidiosis; Cryptosporidium parvum; Disease Models, Animal; Doxycycline; Drug Synergism; Drug Therapy, Combination; Erythromycin; Mice; Mice, Inbred BALB C; Minocycline; Paromomycin; Tetracyclines

Dexamethasone-immunosuppressed rats infected with Cryptosporidium parvum were used to assess the macrolides azithromycin and spiramycin for anticryptosporidial activity. Azithromycin consistently prevented ileal infection, while spiramycin was ineffective. The anticryptosporidial activity of azithromycin was dose-related, 200 mg/kg/day being the minimum dose that prevented infection. Therapeutically, azithromycin eliminated an established overt infection of the small intestine in immunosuppressed rats, but the infection recurred after azithromycin treatment was stopped. These findings suggest that azithromycin is a potentially useful anticryptosporidial agent and that long-term continuous administration may be necessary to treat cryptosporidiosis in the immunocompromised host.

Topics: Animals; Azithromycin; Cryptosporidiosis; Disease Models, Animal; Erythromycin; Female; Ileum; Immune Tolerance; Random Allocation; Rats; Rats, Inbred Strains; Spiramycin