• Corpus ID: 3040642

Update: treatment of cryptosporidiosis in patients with acquired immunodeficiency syndrome (AIDS).

@article{1984UpdateTO,
  title={Update: treatment of cryptosporidiosis in patients with acquired immunodeficiency syndrome (AIDS).},
  author={},
  journal={MMWR. Morbidity and mortality weekly report},
  year={1984},
  volume={33 9},
  pages={
          117-9
        }
}

• Published 1984
• Medicine
• MMWR. Morbidity and mortality weekly report

In November 1982, 21 patients with acquired immunodeficiency syndrome (AIDS) and severe, protracted diarrhea caused by cryptosporidiosis were reported; the report concluded that no effective treatment for cryptosporidiosis was known at that time ( 1). Since then, 91 additional AIDS patients with chronic cryptosporidiosis have been reported to CDC. Although no therapy has been consistently effective in treating them, preliminary reports suggest that a few may have responded to treatment with spiramycin (Rovamycine,* Rhone-Poulenc Pharma, Montreal) or the combination of quinine and clindamycin. Since December 1 982, physicians at the University of Miami, Florida, have used spiramy­ cin to treat seven AIDS patients with chronic cryptosporidiosis; six other AIDS patients with cryptosporidiosis have been treated with spiramycin at five other institutions; and one nonAIDS patient with chronic cryptosporidiosis associated with a bone marrow transplant has re­ ceived the drug. Thirteen of the 14 patients were adults; they received 1 g of spiramycin orally three or four times a day. The 14th patient, a 2-year-old child, received 500 mg orally twice a day. No adverse effects were attributed to the drug. Three of the 13 AIDS patients were apparently cured after 3-4 weeks of spiramycin thera­ py (i.e., all three improved symptomatically, and intestinal biopsies and three successive stool examinations after therapy were negative). Follow-up 6-7 months after discontinuation of spiramycin revealed that all three remained asymptomatic. Two have subsequently died from causes related to their underlying immunodeficiency—one with Kaposi's sarcoma, the other with Pneumocystis carinii pneumonia. In an additional three AIDS patients, gastrointestinal symptoms improved rapidly with spir­ amycin (in two cases, within 48 hours of starting the drug), but these patients continued to have Cryptosporidium in their stools. Spiramycin was continued for variable periods of time, but when therapy was stopped, diarrhea in each patient promptly recurred. On reinitia­ tion of spiramycin, two of the three again improved, but the third continued to have severe di­ arrhea and has since died. One of the two surviving patients had Cryptosporidium detected in his stool at weekly intervals for the first ZVi months of therapy. The patient recently had three negative stools, and spiramycin was stopped; he now has been off therapy for 2 weeks and remains asymptomatic. The remaining seven AIDS patients did not respond symptomatically or parasitologically to spiramycin. Three, however, died within 2-7 days after starting spiramycin. None of the deaths was attributed to spiramycin. A non-AIDS patient with chronic cryptosporidiosis, acquired after receiving a bone marrow transplant, also improved with spiramycin therapy. She began spiramycin after suf-