Abstract
The aim of this study was to evaluate the epidemiology and clinical significance of Cryptosporidium in patients with diarrhea and chronic liver diseases. The study included 150 patients with chronic liver diseases and diarrhea, and 50 subjects with diarrhea as a control group. Stool samples were screened for the presence of Cryptosporidium by microscopic examination after modified Ziehl-Neelsen staining and detection of Cryptosporidium coproantigen by enzyme-linked immunosorbent assay (ELISA). The prevalence of Cryptosporidium infection in patients with chronic liver diseases was 30% (45/150) versus 14% (7/50) in controls. Cryptosporidium infection increased with the progression of chronic liver diseases from Child-Pugh class A to Child-Pugh class C (p< 0.001) and from model for end-stage liver disease (MELD) score ≤ 9 to MELD score > 9 (p< 0.031). Nine patients in Child-Pugh class C with diarrhea associated with Cryptosporidium infection developed hepatic encephalopathy, and only diarrhea was identified as a precipitating factor for hepatic encephalopathy. Cryptosporidium is one of the important causes of diarrhea in patients with chronic liver diseases. The infection significantly increased with the progression of chronic liver diseases. In patients with advanced chronic liver diseases, Cryptosporidium infection may be a precipitating factor of hepatic encephalopathy.
Highlights
The aim of this study was to evaluate the epidemiology and clinical significance of Cryptosporidium in patients with diarrhea and chronic liver diseases
Vomiting was more significant in the chronic liver diseases group than in the control group (p < 0.05), while there was no difference in terms of fever (p = 0.48)
The duration of diarrhea ranged from three to six days, and all patients with Cryptosporidium infection showed no intractable diarrhea in both groups (Table 1)
Summary
The aim of this study was to evaluate the epidemiology and clinical significance of Cryptosporidium in patients with diarrhea and chronic liver diseases. Conclusions: Cryptosporidium is one of the important causes of diarrhea in patients with chronic liver diseases. Cryptosporidium infection continues to be a significant health problem recognized to be an important cause of diarrhea in both immunocompromised and immunocompetent people [2,3]. It is an obligate intracellular extracytoplasmic protozoan parasite that is a major cause of diarrheal illness worldwide [4]. C. parvum, the most common cause of cryptosporidiosisin humans, can be divided into two major genotypes. Cryptosporidium organisms are known to be zoonotic pathogens, human-to-human transmission seems to be the most common way of transmission, through the fecal-oral route, by the ingestion of Cryptosporidium oocysts through the consumption of food, drink, or recreational water contaminated with fecal matter [8,9]
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