Skip to main content
NCBI home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1998 Feb;51(2):138–142. doi: 10.1136/jcp.51.2.138

Chronic cryptosporidiosis in patients with AIDS: stable remission and possible eradication after long-term, low dose azithromycin.

D Dionisio 1, A Orsi 1, G Sterrantino 1, M Meli 1, S Di Lollo 1, L Ibba Manneschi 1, M Trotta 1, M Pozzi 1, L Sani 1, F Leoncini 1
PMCID: PMC500509  PMID: 9602688

Abstract

AIMS: To investigate the effectiveness of long term, low dose azithromycin treatment for chronic cryptosporidiosis in patients with AIDS. METHODS: Azithromycin was administered as initial daily treatment to 13 patients with AIDS: 6 patients received 500 mg for 30 to 40 days (mean 35); 3 patients received 1000 mg for 21 to 50 days (mean 37); and 4 patients received 1500 mg for 20 days. Nine of the 13 patients were also given low dose maintenance treatment with different schedules of azithromycin for 30 to 360 days (mean 129). Patients were monitored, during and after treatment, for parasite shedding in stool and for daily stool frequency and body weight. All but one patient had severe immunodeficiency. RESULTS: Long term, low dose maintenance treatment was associated with major clinical and parasitological benefits: there was probable eradication of infection in 2 patients, and 7 patients showed a complete response with persistent high decrease (5 patients) or clearance (2 patients) of parasite in stool. The drug was well tolerated, and there was no relapse either during treatment or during follow up (up to 21 months). These results were more impressive than those observed after the short term initial course of azithromycin, which was unable at any tested dose to achieve parasite clearance in stool (except in the patient with less advanced immunodeficiency) or to prevent relapse in 3 patients who discontinued treatment. Reversible side effects occurred with the 1500 mg daily dose. CONCLUSIONS: Long term, low dose azithromycin is well tolerated and may induce stable remission of chronic cryptosporidiosis in patients with AIDS. It may lead to probable eradication of the infection in some patients, even those with severe immunodeficiency.

Full text

PDF
138

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benhamou Y., Caumes E., Gerosa Y., Cadranel J. F., Dohin E., Katlama C., Amouyal P., Canard J. M., Azar N., Hoang C. AIDS-related cholangiopathy. Critical analysis of a prospective series of 26 patients. Dig Dis Sci. 1993 Jun;38(6):1113–1118. doi: 10.1007/BF01295729. [DOI] [PubMed] [Google Scholar]
  2. Blanshard C., Francis N., Gazzard B. G. Investigation of chronic diarrhoea in acquired immunodeficiency syndrome. A prospective study of 155 patients. Gut. 1996 Dec;39(6):824–832. doi: 10.1136/gut.39.6.824. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cirioni O., Giacometti A., Balducci M., Drenaggi D., Del Prete M. S., Scalise G. Anticryptosporidial activity of paromomycin. J Infect Dis. 1995 Oct;172(4):1169–1170. doi: 10.1093/infdis/172.4.1169. [DOI] [PubMed] [Google Scholar]
  4. Dupont C., Bougnoux M. E., Turner L., Rouveix E., Dorra M. Microbiological findings about pulmonary cryptosporidiosis in two AIDS patients. J Clin Microbiol. 1996 Jan;34(1):227–229. doi: 10.1128/jcm.34.1.227-229.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Dupont C., Bougnoux M. E., Turner L., Rouveix E., Dorra M. Microbiological findings about pulmonary cryptosporidiosis in two AIDS patients. J Clin Microbiol. 1996 Jan;34(1):227–229. doi: 10.1128/jcm.34.1.227-229.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Flanigan T., Whalen C., Turner J., Soave R., Toerner J., Havlir D., Kotler D. Cryptosporidium infection and CD4 counts. Ann Intern Med. 1992 May 15;116(10):840–842. doi: 10.7326/0003-4819-116-10-840. [DOI] [PubMed] [Google Scholar]
  7. Garcia L. S., Bruckner D. A., Brewer T. C., Shimizu R. Y. Techniques for the recovery and identification of Cryptosporidium oocysts from stool specimens. J Clin Microbiol. 1983 Jul;18(1):185–190. doi: 10.1128/jcm.18.1.185-190.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Goldin R. D., Hunt J. Biliary tract pathology in patients with AIDS. J Clin Pathol. 1993 Aug;46(8):691–693. doi: 10.1136/jcp.46.8.691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Goodgame R. W., Genta R. M., White A. C., Chappell C. L. Intensity of infection in AIDS-associated cryptosporidiosis. J Infect Dis. 1993 Mar;167(3):704–709. doi: 10.1093/infdis/167.3.704. [DOI] [PubMed] [Google Scholar]
  10. Hicks P., Zwiener R. J., Squires J., Savell V. Azithromycin therapy for Cryptosporidium parvum infection in four children infected with human immunodeficiency virus. J Pediatr. 1996 Aug;129(2):297–300. doi: 10.1016/s0022-3476(96)70258-5. [DOI] [PubMed] [Google Scholar]
  11. Mannheimer S. B., Soave R. Protozoal infections in patients with AIDS. Cryptosporidiosis, isosporiasis, cyclosporiasis, and microsporidiosis. Infect Dis Clin North Am. 1994 Jun;8(2):483–498. [PubMed] [Google Scholar]
  12. Rehg J. E. A comparison of anticryptosporidial activity of paromomycin with that of other aminoglycosides and azithromycin in immunosuppressed rats. J Infect Dis. 1994 Oct;170(4):934–938. doi: 10.1093/infdis/170.4.934. [DOI] [PubMed] [Google Scholar]
  13. Rehg J. E. Activity of azithromycin against cryptosporidia in immunosuppressed rats. J Infect Dis. 1991 Jun;163(6):1293–1296. doi: 10.1093/infdis/163.6.1293. [DOI] [PubMed] [Google Scholar]
  14. Ritchie D. J., Becker E. S. Update on the management of intestinal cryptosporidiosis in AIDS. Ann Pharmacother. 1994 Jun;28(6):767–778. doi: 10.1177/106002809402800615. [DOI] [PubMed] [Google Scholar]
  15. Tzipori S., Rand W., Theodos C. Evaluation of a two-phase scid mouse model preconditioned with anti-interferon-gamma monoclonal antibody for drug testing against Cryptosporidium parvum. J Infect Dis. 1995 Oct;172(4):1160–1164. doi: 10.1093/infdis/172.4.1160. [DOI] [PubMed] [Google Scholar]
  16. Vargas S. L., Shenep J. L., Flynn P. M., Pui C. H., Santana V. M., Hughes W. T. Azithromycin for treatment of severe Cryptosporidium diarrhea in two children with cancer. J Pediatr. 1993 Jul;123(1):154–156. doi: 10.1016/s0022-3476(05)81562-8. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES