Eradication of Cryptosporidium in a child undergoing maintenance chemotherapy for leukemia using high dose azithromycin therapy

Purpose: To describe a case of severe diarrhea caused by Cryptosporidium in a patient undergoing maintenance chemotherapy. Important aspects of disease caused by Cryptosporidium, including diagnosis and treatment, are also reviewed. Methods and Results: A 4-year-old boy with acute lymphoblastic anemia in remission had a prolonged course of diarrhea and wasting. C parvum was identified in the gastrointestinal tract by biopsy and in the stool using modified acid fast staining. Improvement in the stool consistency was noted after 3 days of therapy with azithromycin, and, after 14 days of therapy, Cryptosporidium oocysts could no longer be identified in the stool. Conclusions: C parvum should be considered in all immunocompromised patients with severe or prolonged diarrhea, especially if there is no blood or leukocytes in the stool. Because Cryptosporidium is not always tested for in a routine ova and parasite examination, the lab should be notified if it is in the differential diagnosis. Azithromycin therapy may prove beneficial in the treatment of intestinal Cryptosporidium in immunocompromised individuals.