Sa1992 Mucosal Healing With the Specific Carbohydrate Diet in Pediatric Crohn's Disease: Preliminary Results of a Prospective Pilot Study

Introduction: Cryptosporidiosis is an enteric parasitic infection that is associated with a self limiting illness in healthy patients. However, it can cause prolonged and severe life threatening complications especially in immunocompromised patients. The most common symptoms associated with Cryptosporidial infection include abdominal pain and diarrhea. In the absence of appropriate stool studies, Cryptosporidiosis in patients with inflammatory bowel disease (IBD) can be misdiagnosed as disease relapse and can lead to inappropriate therapy. Cryptosporidial infection has been well described among transplant recipients however; there is only a limited data available among children with IBD. Aim: The aim of this study is to describe the clinical characteristics and outcomes of Cryptosporidial infection among children with IBD. Methods: All the stool studies from children with a known diagnosis of IBD presenting with presumed relapse during the period 2004-2011 were reviewed after obtaining institutional review board approval. A positive Cryptosporidial infection is confirmation by identification of Cryptosporidial cysts on microscopic examination of stool sample. Results: Medical records of 170 patients treated for IBD were reviewed. Cryptosporidial infection was found in seven patients (four with Crohn's disease and three with ulcerative colitis) presenting with symptoms of disease relapse. Five patients were female and the median age was 13 years (range: 3-17). Four patients were on immunosuppressive medications (one on 6-mercaptopurine and three on infliximab) as their maintenance therapy and all required hospitalization due to worsening of symptoms. Inflammatory markers (CRP and ESR) were elevated in all but one patient. Three of the five patients treated with nitazoxanide had a shorter duration (mean = 6 days) of illness. All patients had complete resolution of symptoms with or without steroids by three weeks and no infection related complications were noted. No significant association between disease location and severity of infection was identified. However, all patients who required hospitalization were on immunosuppressive therapy. Conclusion: Cryptosporidiosis can cause significant illness and lead to increased need for hospitalization in patients receiving immunosuppressive therapy. It is important that all children presenting with IBD flare should have their stools examined for Cryptosporidium along with other pathogens. Nitazoxanide appears to be effective in addition to supportive therapy.