Prevalence of cryptosporidiosis in renal transplant recipients presenting with acute diarrhea at a single center in Pakistan

Cryptosporidium is an intracellular protozoan organism which causes diarrhea,both in immunocompetent and immunocompromised hosts. Renal transplant recipients areprone to develop a variety of infections including protozoal infections. The aim of this study was to determine the prevalence of cryptosporidiosis in ourrenal transplant recipients presenting with acute diarrhea.Patients and During six months of the study, 644 renal transplant recipients presentedwith acute diarrhea. Single stool sample was obtained for detailed analysis including grossand microscopic examination for red blood cells, pus cells, ova, cysts, and protozoa. Themodified Ziehl-Neelsen (ZN) staining was done to identify the oocysts of cryptosporidia. Out of 644 renal transplant patients, oocysts of cryptosporidia were identifiedin 343 patients (53%). Detailed stool analysis of these patients showed the presence ofnumerous pus cells in 27 (7.9%) patients, co-infection with giardia intestinalis cysts in 15(4.3%), and entamoeba histolytica cysts in 10 (2.9%). In all, out of 343 patients, 43 (12.5%) haddual infection with bacteria and protozoa in addition to cryptosporidiosis. Cryptosporidium is an important pathogen causing acute diarrhea in renaltransplant recipients in our set up. Stool examination is usually negative for pus cells. It isrecommended that in all transplant recipients presenting with acute diarrhea modified ZNstaining should be done to rule out cryptosporidiosis in highly endemic areas like Pakistan.