Cryptosporidia are protozoan parasites that cause diarrhea in many species, including humans. Cryptosporidium parvum and C. hominis account for almost all human infections. Infectious oocysts in feces may be spread either by direct human-to-human contact or by contaminated water supplies. Groups at risk include travelers, children in day-care facilities, male homosexuals, animal handlers, veterinarians, and other healthcare personnel. Immunocompromised individuals are especially vulnerable. After ingestion, the mature oocyte releases sporozoites that invade host epithelial cells, Infection usually is self-limited. In AIDS patients and other immunocompromised individuals, severe secretory diarrhea may require hospitalization and supportive therapy.
The most effective therapy for cryptosporidiosis in AIDS patients is immune restoration with highly active antiretroviral therapy (HAART). Nitazoxanide has shown activity in treating cryp-tosporidiosis in immunocompetent children and may also be effective in adults. Its efficacy in children and adults with AIDS is not clearly established; the lower the CD4 count, the less likely a patient is to respond. Nevertheless, nitazoxanide is the only drug approved for cryptosporidiosis in the U.S.
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