(ATN) Treatment Leads on Cryptosporisiosis: Preliminary Report on Opportunistic Infection

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(ATN) Treatment Leads on Cryptosporisiosis: Preliminary Report on Opportunistic Infection

AIDS TREATMENT NEWS No. 049 - January 29, 1988
John S. James


Cryptosporidiosis is a serious, sometimes fatal opportunistic infection which causes severe diarrhea. Persons with a normal immune system can get the disease, which seems to be responsible for many cases of ordinary diarrhea, but recover in a few days or at most about two weeks.

However, persons with a serious immune deficiency may not recover, and at least 20 drugs expected to be effective against this organism have been tried but they largely failed to work. No one knows why the parasite which causes the illness is so resistant to available antibiotics.

Some people with AIDS do recover spontaneously from cryptosporidiosis, however, and at least one drug does seem to cure or control the disease in some people.

This article cannot offer a complete or authoritive coverage of cryptosporidiosis. Instead, we called physicians, alternative practitioners, and persons with AIDS, to collect leads about treatments they may have found helpful or have reason to believe might offer promise. We didn't find confirmed cures, of course, but several treatments are clearly worth more investigation. These are listed after the "background" section below.

Readers should be warned that we have not been able to check out these treatments - their dangers or supporting - evidence - as much as we usually do. The leads presented here are only options to consider and explore with one's physician. We hope this article will help researchers by highlighting a wide range of treatment options worthy of investigation.

Background

An authoritative review of the published literature, covering what was known about cryptosporidiosis as of July 1987, appears in "Cryptosporidiosis: Overview, Epidemiology, Microbiology and pathogenesis" by Constance Wofsy, M.D. This article was published on AIDS Knowledge Base, a computerized collection of AIDS articles written mainly for physicians. We summarized some of the information in this article; our comments are in parenthesis:

* The organism cryptosporidium, a protozoan (single-cell animal), was first discovered in animals in 1907, and in humans in 1975. It is an intestinal parasite which later was found to cause many cases of ordinary diarrhea. (Presumably it has long been a common infection in humans, but was not recognized until recently because it was hard to diagnose.) The organism is related to the protozoan which causes toxoplasmosis.

* Infection can be diagnosed by bowel biopsy, or by examination of stools, but special techniques must be used for the stool examination, since otherwise the protozoan looks like yeast and can easily be missed.

* The disease can spread from person to person or from animal to persons, probably by feces to mouth transmission. The incubation period is 5 to 14 days.

* Even in severe cases, cryptosporidiosis causes little structura] damage to the intestines. This finding suggests that the organism may cause the diarrhea by secreting a toxin, as cholera does. (It also suggests that full recovery should be possible even after severe illness, if the organism could be eliminated or if the effect of the toxin could be blocked.)

* Cryptosporidiosis usually appears late in AIDS, when other infections are present. But this disease alone, if it lasts more than a month in a person not known to have any other immune deficiency, is now officialy part of the definition of AIDS. About 4% of AIDS cases are diagnosed this way, with cryptosporidiosis as the presenting infection.

(The disease seems less common than we had feared. Many physicians and other practitioners we spoke to who treat AIDS patients had seen few or no cases.)

* Cryptosporidium can sometimes spread outside the digestive tract, to the gall bladder or respiratory system, but it has not been found to infect other organs.

* In an animal study, 25 drugs which were tried failed to treat cryptosporidiosis efectively. In humans only one drug, spiramycin, seemed to cure or control the disease in some cases.

Spiramycin, an antibiotic with little toxicity, is manufactured by Rhone Poulenc and used in Canada and Europe to treat a number of infections, including toxoplasamosis. In 1982, the US Centers for Disease Control reported that the drug showed benefit in some cases of cryptosporidiosis. But today (over five years later) the drug is still available in the US only for investigational use. (Today at least one placebo-controlled trial being conducted in the US, apparently required as part of the FDA approval process. Meanwhile we don't know how many US patients are or are not able to get spiramycin when medically indicated.)

* Besides spiramycin, most medical treatment for cryptosporidiosis has been supportive, such as fluid and electrolyte replacement, antidiarrheals, and sometimes total parenteral nutrition (intravenous feeding) if the patient cannot absorb food.

Additional Background

We interviewed a gastroenterologist who has treated a number of cases of cryptosporidiosis, and he added the following information:

* The disease can vary greatly in severity. If the infection is in the lower bowel only, the persons can still absorb food. The disease is worse if it also affects the small intestines and the stomach.

* In some patients, as in persons with cholera, the intestines expel water as if a pump were turned on by a biochemical switch. This mechanism apparently requires certain prostaglandins, and sometimes the switch can be turned on by drugs like indocin which inhibit prostaglandin synthesis. The patient still has the more usual diarrhea, however.

(Note: There are other indications that one kind prostaglandins are involved in causing damage in AIDS. Some physicians have used non-steroidal anti-inflamatory drugs like indocin to mitigate this damage, but word of this treatment possibility has not spread widely among physicians such as ibuprofen or even ordinary aspirin might also have a similar beneficial effect, but prescription drugs seem to be preferred by knowledgeable physicians.)

* This physician thought that somatostatin might be a valuable treatment for controlling the diarrhea in some cases. However, it has not yet been tried for cryptosporidiosis.

Treatment Leads

We only have sketchy information about most of these treatment possibilities, and list them here as leads for further research. We arranged this list more or less in order starting with the more conventional -- not necessarily more or less powerful, or better or worse. This list resulted from only a few days' research and is certainly incomplete. And we have largely omitted the many routine supportive therapies.

* Spiramycin. See discussion above.

* Hyperimmune milk. This treatment, developed by Donald Kotler, MD. of Columbia University St.Luke's/Roosevelt Hospital Center, extracts antibodies from milk of cows exposed to cryptosporidiosis. An ongoing study will need more volunteers; at this time, however, the project cannot get enough supplies of the milk extract. For information about the study, call Anita in Dr. Kotler's office, at (212) 870-6154.

An Australian team is also studying this trealment, but for children with a congenital immune deficiency, not with AIDS.

* Bovine transfer factor. We don't have details of this research at this time.

* AZT. There have been reports of cryptosporidiosis improving or clearing up entirely in some persons when they were treated with AZT. At this time we have little information. For one published report, see the letter in American Journal of Medicine, July 1987, page 187.

* Artemisia Annua. This herb, a close relative of wormwood, is used in China to treat malaria, and appears to be clearly effective against malaria which has become resistant to antibiotics. Malaria, like cryptosporidiosis, is caused by a protozoan.

We have heard a report that at least one US physician has obtained Artemisia Annua from China and used it successfully to treat cryptosporidiosis, but we have not yet been able to contact anyone with firsthand experience.

* Garlic. Garlic appears to have some effectiveness against many microorganisms. For example, it has been used in China to treat cryptococcal meningitis. While this disease is apparently unrelated to cryptosporidiosis, the indication that an active ingredient in garlic crossed the blood-brain barrier led John Athey, a well-known person with AIDS in San Francisco, to try large amounts of garlic for controlling his toxoplasmosis. According to his report at a seminar organized by Tom O'Connor (the author of Living With AIDS: Reaching Out), a large amount of garlic has clearly worked every time for him - not to cure the disease, but to control it and stop the symptoms. Toxoplasmosis is caused by a protozoan related to the one which causes cryptosporidiosis.

We did not, however, reach anyone who had used garlic for cryptosporidiosis, or who knew anyone who had. And the gastroenterologist we interviewed (above) doubted that it would work.

* Acidophilus. Acidophilus, commonly sold in health-food stores, consists of billions of living beneficial microorganisms which may help crowd out the disease causing ones. There are great variations in types of acidophilus and in the quality of the products. We heard good reports about the Jarro-Dophilus brand, and also about a brand from West Germany called Eugalan Forte.

* Hydrogen peroxide. We talked to one person who was convinced that drinking diluted hydrogen peroxide helped him recover from cryptosporidiosis; he was also using an aloe vera preparation and acidophilus. But there is much controversy about hydrogen peroxide. People disagree greatly about its possible benefits and dangers. We are looking for more information about this treatment, but don't have a clear picture at this time.

References

Allegra CJ and others. Trimetrexate For the Treatment of Pneumocystis Carinii Pneumonia In Patients With the Acquired Immunodeficiency Syndrome. New England Journal of Medicine, p. 978-985, October 15, 1987.

Klayman DL. Qinghaosu (Artemisinin): An Antimalarial Drug From China. Science p. 1049-1055, May 31 1985.

Horn, Bill. Bibliography On AIDS and Nutrition, Gastrointestinal Tract Lesions, Physiology and Organ Function. Published by Bill Horn, Nutrition Services, 1517 San Andreas Ave., San Jose, CA 95118, (415) 266-7040.

Wofsy C. Cryptosporidiosis: Overview, Epidemiology, Microbiology and Pathogenesis. Published on AIDS Knowledge Base computer system. Access is available through BRS Colleague information-retrieval service; for information call (800) 468- 0908.


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