A case of septic shock due to delayed diagnosis of Cryptosporidium infection after liver transplantation

Author:

Tie Xin,Zhang Zhongwei,Zhou Ran,Li Yi,Xu Jinmei,Yin WanhongORCID

Abstract

Abstract Background Cryptosporidium is recognized as a significant pathogen of diarrhea disease in immunocompromised hosts, and studies have shown that Cryptosporidium infection is high in solid organ transplantation (SOT) patients and often has serious consequences. Because of the lack of specificity of diarrheasymptoms cased by Cryptosporidium infection, it is rarely reported in patients undergoing liver transplantation (LT). It frequently delays diagnosis, coming with severe consequences. In clinical work, diagnosing Cryptosporidium infection in LT patients is also complex but single, and the corresponding anti-infective treatment regimen has not yet been standardized. A rare case of septic shock due to a delayed diagnosis of Cryptosporidium infection after LT and relevant literature are discussed in the passage. Case presentation A patient who had received LT for two years was admitted to the hospital with diarrhea more than 20 days after eating an unclean diet. After failing treatment at a local hospital, he was admitted to Intensive Care Unit after going into septic shock. The patient presented hypovolemia due to diarrhea, which progressed to septic shock. The patient's sepsis shock was controlled after receiving multiple antibiotic combinations and fluid resuscitation. However, the persistent diarrhea, as the culprit of the patient's electrolyte disturbance, hypovolemia, and malnutrition, was unsolved. The causative agent of diarrhea, Cryptosporidium infection, was identified by colonoscopy, faecal antacid staining, and blood high-throughput sequencing (NGS). The patient was treated by reducing immunosuppression and Nitazoxanide (NTZ), which proved effective in this case. Conclusion When LT patients present with diarrhea, clinicians should consider the possibility of Cryptosporidium infection, in addition to screening for conventional pathogens. Tests such as colonoscopy, stool antacid staining and blood NGS sequencing can help diagnose and treat of Cryptosporidium infection early and avoid serious consequences of delayed diagnosis. In treating Cryptosporidium infection in LT patients, the focus should be on the patient's immunosuppressive therapy, striking a balance between anti-immunorejection and anti-infection should be sought. Based on practical experience, NTZ therapy in combination with controlled CD4 + T cells at 100–300/mm3 was highly effective against Cryptosporidium without inducing immunorejection.

Funder

YiLi

Publisher

Springer Science and Business Media LLC

Subject

Infectious Diseases

Reference27 articles.

1. Desai AN. Cryptosporidiosis. JAMA. 2020;323(3):288. https://doi.org/10.1001/jama.2019.18691. (PMID: 31961421).

2. Checkley W, White AC Jr, Jaganath D, Arrowood MJ, Chalmers RM, Chen XM, Fayer R, Griffiths JK, Guerrant RL, Hedstrom L, Huston CD, Kotloff KL, Kang G, Mead JR, Miller M, Petri WA Jr, Priest JW, Roos DS, Striepen B, Thompson RC, Ward HD, Van Voorhis WA, Xiao L, Zhu G, Houpt ER. A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for Cryptosporidium. Lancet Infect Dis. 2015 15(1):85–94. 10. 1016/S1473–3099(14)70772–8. Epub 2014 Sep 29. PMID: 25278220; PMCID: PMC4401121.

3. Goodgame RW, Kimball K, Ou CN, White AC Jr, Genta RM, Lifschitz CH, Chappell CL. Intestinal function and injury in acquired immunodeficiency syndrome-related cryptosporidiosis. Gastroenterology. 1995;108(4):1075–82. https://doi.org/10.1016/0016-5085(95)90205-8. (PMID: 7698574).

4. Bouzid M, Hunter PR, Chalmers RM, Tyler KM. Cryptosporidium pathogenicity and virulence. Clin Microbiol Rev. 2013;26(1):115–34. https://doi.org/10.1128/CMR.00076-12. (PMID: 23297262; PMCID: PMC3553671).

5. Herrero JI, Benlloch S, Bernardos A, Bilbao I, Castells L, Castroagudin JF, González L, Irastorza I, Navasa M, Otero A, Pons JA, Rimola A, Suárez F, Casanovas T, Otero E, Rodríguez M, Serrano T, Otero S, López I, Miras M, Prieto M; MITOS Study Group. Gastrointestinal complications in liver transplant recipients: MITOS study. Transplant Proc. 2007 39(7):2311–3. 10. 1016/j. transproceed. 2007. 06. 012. PMID: 17889174.

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3