{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:17:34Z","timestamp":1782778654790,"version":"3.54.5"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T00:00:00Z","timestamp":1638576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cryptosporidium is a major cause of diarrheal disease worldwide, including chronic disease in malnourished children and patients with acquired immune deficiency syndrome. There are increasing reports of cryptosporidiosis in transplant patients, especially from middle-income countries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The literature on treatment of cryptosporidiosis in transplant patients was reviewed and included no controlled trials but only small case series. Nitazoxanide, azithromycin, spiramycin, and combination therapies have been used, but none are consistently efficacious.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We present a case of chronic diarrhea from cryptosporidiosis in a renal transplant patient. His illness resolved with decreasing immunosuppression and treatment with the 3-drug combination of nitazoxanide, azithromycin, and rifaximin.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although current therapies are not reliably effective in the absence of an effective cellular immune response, combination therapies hold promise for improved responses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofab610","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T09:52:55Z","timestamp":1638697975000},"source":"Crossref","is-referenced-by-count":18,"title":["Resolution of Cryptosporidiosis in Transplant Recipients: Review of the Literature and Presentation of a Renal Transplant Patient Treated With Nitazoxanide, Azithromycin, and Rifaximin"],"prefix":"10.1093","volume":"9","author":[{"given":"Ewa","family":"Tomczak","sequence":"first","affiliation":[{"name":"Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April N","family":"McDougal","sequence":"additional","affiliation":[{"name":"Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9668-4632","authenticated-orcid":false,"suffix":"Jr","given":"A Clinton","family":"White","sequence":"additional","affiliation":[{"name":"Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,4]]},"reference":[{"key":"2021123116402528700_CIT0001","doi-asserted-by":"crossref","first-page":"568","DOI":"10.15585\/mmwr.mm6825a3","article-title":"Cryptosporidiosis outbreaks - United States, 2009-2017.","volume":"68","author":"Gharpure","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2021123116402528700_CIT0002","doi-asserted-by":"crossref","first-page":"e568","DOI":"10.1016\/S2214-109X(19)30076-2","article-title":"The incidence, aetiology, and adverse clinical consequences of less severe diarrhoeal episodes among infants and children residing in low-income and middle-income countries: a 12-month case-control study as a follow-on to the Global Enteric Multicenter Study (GEMS).","volume":"7","author":"Kotloff","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2021123116402528700_CIT0003","doi-asserted-by":"crossref","first-page":"e1309","DOI":"10.1016\/S2214-109X(18)30349-8","article-title":"Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: a reanalysis of the MAL-ED cohort study.","volume":"6","author":"Platts-Mills","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2021123116402528700_CIT0004","doi-asserted-by":"crossref","first-page":"e758","DOI":"10.1016\/S2214-109X(18)30283-3","article-title":"Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study.","volume":"6","author":"Khalil","year":"2018","journal-title":"Lancet Glob Health"},{"key":"2021123116402528700_CIT0005","doi-asserted-by":"crossref","first-page":"247","DOI":"10.4103\/ijmm.IJMM_18_179","article-title":"Intestinal cryptosporidiosis in renal transplant recipients: Prevalence, species detection and comparative evaluation of SSU rRNA and Cryptosporidium oocyst wall protein genes.","volume":"36","author":"Ghoshal","year":"2018","journal-title":"Indian J Med Microbiol"},{"key":"2021123116402528700_CIT0006","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1097\/TP.0000000000001503","article-title":"Cryptosporidium spp. infection in solid organ transplantation: The Nationwide \u201cTRANSCRYPTO\u201d Study.","volume":"101","author":"Lanternier","year":"2017","journal-title":"Transplantation"},{"key":"2021123116402528700_CIT0007","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/tid.12336","article-title":"Cryptosporidium infection after renal transplantation in an endemic area.","volume":"17","author":"Bhadauria","year":"2015","journal-title":"Transpl Infect Dis"},{"key":"2021123116402528700_CIT0008","first-page":"127","article-title":"Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan.","volume":"3","author":"Raja","year":"2014","journal-title":"J Nephropathol"},{"key":"2021123116402528700_CIT0009","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.exppara.2018.08.001","article-title":"Human cryptosporidiosis in immunodeficient patients in France (2015-2017).","volume":"192","author":"Costa","year":"2018","journal-title":"Exp Parasitol"},{"key":"2021123116402528700_CIT0010","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S1473-3099(14)70772-8","article-title":"A review of the global burden, novel diagnostics, therapeutics, and vaccine targets for cryptosporidium.","volume":"15","author":"Checkley","year":"2015","journal-title":"Lancet Infect Dis"},{"key":"2021123116402528700_CIT0011","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/QCO.0b013e32833de052","article-title":"Treatment of cryptosporidiosis: do we know what we think we know?","volume":"23","author":"Cabada","year":"2010","journal-title":"Curr Opin Infect Dis"},{"key":"2021123116402528700_CIT0012","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.cgh.2005.12.020","article-title":"Effect of nitazoxanide in diarrhea and enteritis caused by Cryptosporidium species.","volume":"4","author":"Rossignol","year":"2006","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2021123116402528700_CIT0013","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1086\/321008","article-title":"Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of nitazoxanide.","volume":"184","author":"Rossignol","year":"2001","journal-title":"J Infect Dis"},{"key":"2021123116402528700_CIT0014","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/S0140-6736(02)11401-2","article-title":"Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a 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cryptosporidium, cyclospora, giardia, and microsporidia, entamoeba histolytica, strongyloides, schistosomiasis, and echinococcus: guidelines from the American Society of transplantation infectious diseases community of practice.","volume":"33","author":"La Hoz","year":"2019","journal-title":"Clin Transplant"},{"key":"2021123116402528700_CIT0019","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1093\/infdis\/160.3.559","article-title":"Cryptosporidium infection in renal transplant patients.","volume":"160","author":"Roncoroni","year":"1989","journal-title":"J Infect Dis"},{"key":"2021123116402528700_CIT0020","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000189527","article-title":"Cryptosporidiosis and blastocystosis in renal transplant 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malignancies.","volume":"13","author":"Gentile","year":"1991","journal-title":"Rev Infect Dis"},{"key":"2021123116402528700_CIT0024","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/j.1399-3062.2012.00719.x","article-title":"Cryptosporidium enteritis in solid organ transplant recipients: multicenter retrospective evaluation of 10 cases reveals an association with elevated tacrolimus concentrations.","volume":"14","author":"Bonatti","year":"2012","journal-title":"Transpl Infect Dis"},{"key":"2021123116402528700_CIT0025","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/INF.0b013e31826780f7","article-title":"Cryptosporidiosis in children following solid organ transplantation.","volume":"31","author":"Krause","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"2021123116402528700_CIT0026","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1053\/j.ajkd.2007.11.013","article-title":"Incidence and risk factors for diarrhea following kidney 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HIV Outpatient Study (HOPS) Investigators.","volume":"279","author":"Holmberg","year":"1998","journal-title":"JAMA"},{"key":"2021123116402528700_CIT0038","doi-asserted-by":"crossref","first-page":"2889","DOI":"10.1097\/00002030-200012220-00010","article-title":"Rifabutin but not clarithromycin prevents cryptosporidiosis in persons with advanced HIV infection.","volume":"14","author":"Fichtenbaum","year":"2000","journal-title":"AIDS"},{"key":"2021123116402528700_CIT0039","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/jac\/45.4.453","article-title":"Activity of nitazoxanide alone and in combination with azithromycin and rifabutin against Cryptosporidium parvum in cell culture.","volume":"45","author":"Giacometti","year":"2000","journal-title":"J Antimicrob Chemother"},{"key":"2021123116402528700_CIT0040","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1179\/joc.1999.11.5.391","article-title":"Intestinal protozoa in HIV-infected patients: effect of rifaximin in Cryptosporidium parvum and Blastocystis hominis infections.","volume":"11","author":"Amenta","year":"1999","journal-title":"J Chemother"},{"key":"2021123116402528700_CIT0041","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1097\/QAI.0b013e31817beb78","article-title":"Resolution of severe cryptosporidial diarrhea with rifaximin in patients with AIDS.","volume":"48","author":"Gathe","year":"2008","journal-title":"J Acquir Immune Defic Syndr"},{"key":"2021123116402528700_CIT0042","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1093\/ndt\/gfh881","article-title":"A dance teacher with kidney-pancreas transplant and diarrhoea: what is the cause?","volume":"20","author":"Burdese","year":"2005","journal-title":"Nephrol Dial Transplant"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/1\/ofab610\/42003172\/ofab610.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/1\/ofab610\/42003172\/ofab610.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T16:42:34Z","timestamp":1640968954000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofab610\/6449491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,4]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofab610","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,1,1]]},"published":{"date-parts":[[2021,12,4]]},"article-number":"ofab610"}}