zithromax and Lung-Diseases--Parasitic

Azithromycin can inhibit the growth of Toxoplasma gondii tachyzoïtes in vitro, but the effect is only observed with prolonged incubation with the drug, reflecting the delayed mode of action of this macrolide on the parasite. Azithromycin is probably acting by inhibition of protein synthesis but the site of action and fixation in the parasite has not been demonstrated. Azithromycin is also effective against intracystic bradyzoïtes in vitro, but long term administration of azithromycin to chronically infected mice failed to reduce the mean number of brain cysts. In models of acute toxoplasmosis, azithromycin was found to have a limited effect on brain infection, whereas parasites were cleared from blood and lungs of infected mice, resulting in a significant protection of treated mice comparatively to untreated controls. When azithromycin is combined with pyrimethamine or sulfadiazine, an additive effect is observed in vitro, and a remarkable synergistic effect is observed in vivo in the treatment of acute toxoplasmosis. Together, these results are in favor of the use of azithromycin in combined therapies for the treatment and/or prophylaxis of toxoplasmosis.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Drug Synergism; Drug Therapy, Combination; Humans; In Vitro Techniques; Lung Diseases, Parasitic; Mice; Pyrimethamine; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Animal; Toxoplasmosis, Cerebral

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

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