Human cryptosporidiosis

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 the 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.