Cryptosporidium as a cause of diarrhoea

We herein describe 8 children [4 immunocompetent and 4 undergoing chemotherapy for acute lymphoblastic leukaemia] with severe diarrhoea and dehydration which was identified using modified Ziehl-Neelsen stain caused by Crytosporidium. The four immunocompetent children were treated with intravenous hydration only without specific antimicrobial therapy and they responded well. The other four immunocompromized children received intravenous hydration and antimicrobial chemotherapy. Two of them received paromomycin and responded well. One patient was started on paromomycin for 10 days, and although there was clinical improvement, his stool examination continued to be positive for Cryptosporidium. He then received azithromycin for 14 days to which he responded well and his stools became negative for Cryptosooridium. The fourth patient received azithromycin from the start and responded well. Cryptosporidium should be considered as a causative organism in children, especially those who are immunocompromized, and who present with severe or prolonged nonbloody diarrhoea. The organism is not seen in a routine 'ova and parasite' examination and the lab should be notified of its possibility in the differential diagnosis for diagnostic confirmation using modified Ziehl-Neelsen stain. Immunocompetent children with cryptosporidiosis will respond to intravenous hydration without specific antimicrobial therapy while immunocompromized children may benefit from paromomycin or azithromycin therapy. We wish to increase the awareness of this condition and its management in clinicians and microbiologists