Case Report Successful eradication of cryptosporidium in kidney transplant recipients e Two case reports P.S. Priyamvada a, *, Sreejith Parameswaran b , Sandeep Morkhandikar c , Vijay Shankar c a Assistant Professor, Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India b Associate Professor, Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India c Senior Resident, Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605006, India article info Article history: Received 3 December 2013 Accepted 17 January 2014 Available online 4 February 2014 Keywords: Renal transplant Cryptosporidiosis Nitazoxanide Azithromycin abstract Cryptosporidium infection can present as refractory diarrhoea in solid organ transplant recipients. Many drugs have been shown in vitro activity against cryptosporidium. Opti- mum therapy to treat a clinical infection with cryptosporidium is not known. It is often difficult to achieve parasitological cure and this may require reduction of immunosup- pressive drugs coupled with antiparasitic agents. Nitazoxanide is a thiazolide antiparasitic which is currently approved for treatment of cryptosporidiosis in immunocompetent persons aged above one year. There are no guidelines for the treatment of cryptosporidiosis in solid organ transplant recipients. We report our experience of extended treatment with Nitazoxanide and Azithromycin for two post renal transplant patients with cryptospo- ridium diarrhoea which resulted in clinical as well as parasitological cure. Copyright ª 2014, Indian Society of Organ Transplantation. All rights reserved. 1. Introduction Cryptosporidium infection can present as refractory diarrhoea in solid organ transplant recipients. The most important determinant of disease severity is the immune status of the patient. Although clinical cure of the infection may be accomplished in more than 80%, parasite eradication may be successful only in 60e75% of immunocompetent patients. 1 The disease can be life threatening in HIV infected patients and patients on immunosuppressive drugs. 2. Case report 2.1. Case 1 A 35-year-old live unrelated kidney transplant recipient presented with severe watery diarrhoea 4 months post-trans- plant. She had developed antibody mediated rejection in the second week of transplantation and was successfully treated with 5 sessions of plasma exchange and low dose immuno- globulin. Her baseline serum creatinine was 1.2 mg/dl. Her * Corresponding author. E-mail address: priyamvadaps@gmail.com (P.S. Priyamvada). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/ijt indian journal of transplantation 8 (2014) 22 e24 2212-0017/$ e see front matter Copyright ª 2014, Indian Society of Organ Transplantation. All rights reserved. http://dx.doi.org/10.1016/j.ijt.2014.01.013