Current WL , Garcia LS , 1991. Cryptosporidiosis. Clin Microbiol Rev 4: 325.
Pantenberg B et al.2008. Intestinal immune response to human Cryptosporidium sp. Infection Infect Immun 76: 23–29.
Brudno JN , Kochenderfer JN , 2016. Toxicities of chimeric antigen receptor T cells: recognition and management. Blood 127: 3321–3330.
Brudno JN et al.2020. Safety and feasibility of anti-CD19 CAR T cells with fully human binding domains in patients with B-cell lymphoma. Nat Med 26: 270–280 (Erratum in: Nat Med. 2020 May;26(5):803, PMID: 31959992).
Abramson JS et al.2020. Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study. Lancet 396: 839–852.
Neelapu SS et al.2018. Chimeric antigen receptor T-cell therapy—assessment and management of toxicities. Nat Rev Clin Oncol 15: 47–62 (Epub 2017 Sep 19).
Neelapu SS et al.2017. Axicabtagene ciloleucel CAR T-cell therapy in refractory large b-cell lymphoma. N Engl J Med 377: 2531–2544.
Wudhikarn K et al.2020. Infection during the first year in patients treated with CD19 CAR T cells for diffuse large B cell lymphoma. Blood Cancer J 10: 79.
Hill JA et al.2018. Infectious complications of CD19-targeted chimeric antigen receptor- modified T-cell immunotherapy. Blood 131: 121–130.
Bhoj VG , Arhontoulis D , Wertheim G , 2016. Persistence of long-lived plasma cells and humoral immunity in individuals responding to CD19-directed CAR T-cell therapy. Blood 128: 360–370.
Fung M et al.2019. Increased risk of infectious complications in older patients with indolent non-hodgkin lymphoma exposed to bendamustine. Clin Infect Dis 68: 247–255.
Saito H , Maruyama D , Maeshima AM , 2015. Prolonged lymphocytopenia after bendamustine therapy in patients with relapsed or refractory indolent B-cell and mantle cell lymphoma. Blood Cancer J5: e362.
Hirayama AV et al.2019. High rate of durable complete remission in follicular lymphoma after CD19 CAR-T cell immunotherapy. Blood 134: 636–640.
Chavez MA , White AC Jr ., 2018. Novel treatment strategies and drugs in development for cryptosporidiosis. Expert Rev Anti Infect Ther16: 655–661.
Amenta M et al.1999. Intestinal protozoa in HIV-infected patients: effect of rifaximin in Cryptosporidum parvum and Blastocystis hominis infections. J Chemother 11: 391–395.
Nachipo P et al.2018. Evaluating the safety, tolerability, pharmacokinetics and efficacy of clofazimine in cryptosporidiosis (CRYPTOFAZ): study protocol for a randomized controlled trial. Trials 19: 456.
Madbouly N , El Amir A , Abdel Kader A , Rabee I , Farid A , 2021. The immunomodulatory activity of secnidazole-nitazoxanide in a murine cryptosporidiosis model. J Med Microbiol 70 (Epub 2021 Feb 23). doi: 10.1099/jmm.0.001327.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||211||50||7|
Cryptosporidial diarrhea is uncommon in immunocompetent individuals, more often seen in severely immunocompromised patients. Severe refractory cases have been described in patients with HIV/AIDS before the advent of modern antiretroviral therapy due to an inability to mount an adequate cellular immune response. We describe an 85-year-old patient post–chimeric antigen receptor T-cell therapy relapsed lymphoma who developed refractory Cryptosporidium spp. diarrhea in the setting of persistent CD4+ cytopenia. Despite receiving multiple antiparasitic agents, including failure of a prolonged course of nitazoxanide, the patient experienced persistent symptoms for 9 months with repeatedly positivity stool Cryptosporidium spp. direct fluorescent antibody (DFA) test. We highlight this case of refractory Cryptosporidium spp. and the importance of recognizing the pathogen in a non–HIV-infected immunosuppressed host.
Authors’ addresses: Caitlin Trottier, Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: email@example.com. Christina F. Yen, Infection Control, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: firstname.lastname@example.org. Grace Malvar, Pathology, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: email@example.com. David E. Avigan, Hematology and Hematologic Malignancies, Beth Israel Deaconess Medical Center, Boston, MA, E-mail: firstname.lastname@example.org. Jon Arnason, Beth Israel Deaconess Medical Center, Oncology, Boston, MA, E-mail: email@example.com. Carolyn D. Alonso, Beth Israel Deaconess Medical Center, Infectious Diseases, Boston, MA, E-mail: firstname.lastname@example.org.