LETTER TO EDITOR
|Year : 2007 | Volume
| Issue : 7 | Page : 418-419
Concomitant severe infection with Cryptosporidium parvum and Hymenolepis nana in an AIDS patient
AR Meamar1, M Rezaian2, M Mohraz3, R Hadighi1, EB Kia2
1 Iran University of Medical Sciences, Tehran, Iran
2 School of Public Health and Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
3 Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
A R Meamar
P. O. Box: 14155-5983, Tehran - 14496
|How to cite this article:|
Meamar A R, Rezaian M, Mohraz M, Hadighi R, Kia E B. Concomitant severe infection with Cryptosporidium parvum and Hymenolepis nana in an AIDS patient. Indian J Med Sci 2007;61:418-9
|How to cite this URL:|
Meamar A R, Rezaian M, Mohraz M, Hadighi R, Kia E B. Concomitant severe infection with Cryptosporidium parvum and Hymenolepis nana in an AIDS patient. Indian J Med Sci [serial online] 2007 [cited 2013 May 23];61:418-9. Available from: http://www.indianjmedsci.org/text.asp?2007/61/7/418/33192
The association of acquired immunodeficiency syndrome (AIDS) and fatal cryptosporidiosis has been frequently reported, all around the world  ; however, there are rare cases concerning hyperinfection due to H. nana in AIDS patients, although it is a common helminth in such patients. 
In June 2005, a 39-year-old Afghan male, positive for human immunodeficiency virus (HIV) antibodies, was admitted to a hospital. He was cachectic, with fever, productive cough, diarrhea and weight loss of 22 kg, during the previous 6 months. His CD4 cell counts were <50 mm 3 . His diarrheic stool sample was subjected to standard parasitological examinations. The simple wet-mount preparation revealed the presence of H. nana eggs. After formalin-ether concentration  and examination of the sediment, a large number of H. nana eggs were observed. Modified Ziehl-Neelsen staining of stool smear also revealed a large number of Cryptosporidium oocysts [Figure - 1]. The intensity of infections was quantified by counting the number of eggs and oocysts in every 20 µl of the concentrated stool specimen. Accordingly, for H. nana, 71 eggs and for Cryptosporidium more than 150 oocysts were counted in every 20 µl of the sediment. No other parasite or pathogenic bacteria was found by either stool examination or culture. The day after the admission, the patient died in severe dehydration and shock; so no further laboratory examination was possible to perform on the patient.
Immunocompetent patients with enteric H. nana infection are generally asymptomatic and worm burdens are low.  In contrast, in immunocompromised hosts, H. nana might be expected to produce a more intense hyperinfection syndrome. However, no such instance has yet been reported. 
Although cryptosporidiosis can be acquired at any time during the course of HIV infection, major mortality and morbidity occur almost exclusively in patients with CD4 counts below 180 cells/mm 3 . Above this level, generally spontaneous recovery occurs.  The present case of HIV infection had a very low CD4 count (<50 per mm 3 ), and this might be responsible for persistent intestinal parasitic infection with chronic diarrhea and ultimate death.
It is not clear whether the patient had acquired his infections from his original country, Afghanistan. Due to short stay of the patient in the hospital, not all necessary laboratory examinations could be performed; hence the implications of H. nana are not clear, and only massive infection is justified - which suggests that severe immunosuppression condition has probably favored the uncontrolled internal autoinfection of this parasite. Whether the subspecies of H. nana, as proposed by some authors,  indicating the existence of two subspecies including H. nana nana in humans and H. nana fraterna in murine rodents, may have any role in the happening of such phenomenon is not known.
This case of concomitant severe infection with C. parvum and H. nana in an AIDS patient emphasizes that in addition to cryptosporidiosis, H. nana may also alter to a mode of extensive replication in severely immunocompromised patients. However, its role as an opportunistic parasite is still unclear and needs more evidence.
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[Figure - 1]