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P382. Cryptosporidiosis and inflammatory bowel disease

C. Pernat

University Clinical Center Maribor, Maribor, Slovenia

Aim: Cryptosporidiosis is typically an acute short-term infection, that affects the intestines of mammals. In immunocompetent people the main symptom is self-limiting diarrhea. Immunocompromised individuals can developed more severe form of cryptosporidiosis with chronic diarrhea. Many of them never completely eliminate cryptosporidium from their bodies. Because of their disease and because of therapy of their disease, inflammatory bowel disease (IBD) patients are immunocompromited.

Material and Methods: Between January 2008 and December 2009 in 5 male patients with IBD during re-evaluation of disease activity infection with cryptosporidium vas identified. 2 patients with ulcerative colitis (UC) have been treated with mesalazine and corticosteroids. 2 patients with UC and 1 patient with Crohns disease (CD) have been on maintenance infliximab therapy. In all patients oocysts were indentified in the stool by microscopy by modificated Ziehl-Nielson method.

Results: All patients were treated symptomatic. 2 patients with UC on standard therapy recovered with rehidration and electrolyte correction after 5 weeks of severe diarrhea. Patient with CD and 1 patient with UC on maintenance infliximab therapy developed chronic diarrhea with malnurtition and wasting. After exclusion of infliximab and symptomatic therapy patient with CD recovered; after elimination of cryptosporidium from his body after 6 month switching to adalimumab was done. Patient with UC did not eliminate cryptosporidium and had several relapses of UK and relapses of watery diarrhea treated symptomaticly. 1 patient with UC on maintenance infliximab therapy developed severe diarrhea with dehidration and after 3 weeks severe active UK. Because of life threatening condition colectomy was done.

Conclusion: Cryptosporidiosis is one of the most common waterborne disease. The parasite is transmitted by environmentally hardy microbial cysts that, once ingested, exists in the small intestine and result in an infection of intestinal epithelial tissue. Immunocompromised individuals, such as IBD patients, can develope severe form of cryptosporidiosis, which could cause relaps of IBD despite maintaining therapy. The problem is that there is no reliable treatment for cryptosporidium enteritis.