Cryptosporidium Infection in Pediatric Patients with
Lymphohematopoietic mphohematopoietic Malignancies

Fariba Berenji1, PhD; Nona Zabolinejad*2, MD; Hamidreza Kianifar3, MD; Zahra Badeii4,
MD; Abdollah Banihashem4, MD; Simin Hiradfar2, MD
1. Parasitologist, Department of Parasitology, Mashhad University of Medical Sciences, IR Iran
2. Pathologist, Department of Pathology, Mashhad University of Medical Sciences, IR Iran
3. Pediatric Gastroentrologist, Department of Pediatrics, Mashhad University of Medical Sciences, IR Iran
4. Pediatric Hematologist, Department of Pediatrics, Mashhad University of Medical Sciences, IR Iran

Abstract
Objective: Cryptosporidium parvum is a common protozoan pathogen with worldwide distribution. It
localizes on the intestinal cells and prolonged diarrhea in immunocompromised patients. The aim of
this study was to estimate the prevalence and the clinical features of enteric cryptosporidiosis in
pediatric patients with lymphohematopoietic malignancies.
Material & Methods: In this cross-sectional study stool samples were collected from 100 children
(67 boys, 33girls) with lymphohematopoietic malignancies who underwent chemotherapy between
the ages of 6 months and 17 years (mean age 7.5 years). All of the specimens were examined for the
oocysts of C. parvum by modified Ziehl Neelsen (MZN) staining technique and coproantigens of C.
parvum by ELISA.
Findings: Cryptosporidium infection was detected in 22 patients. 16 (72.7%) of the infected patients
were male and 6 (27.3) female. 7 (31.8%) patients were <5 years, 8 (36.4%) 5-10 years and 7(31.8)
>10 years old. Parasites were detected in 19/85 (86.4%) patients with ALL, 2 of 5 (9.1%) with AML,
and 1 of 10 (4.5%) with NHL. Clinical symptoms were found in 11 (50%) of the patients. We found
longer duration of chemotherapy in patients who were positive for cryptosporidium infection
(Mean=2067 days) in comparison to negative group (Mean=258.5 days) (ANOVA, f=2.82, P=0.04).
Conclusion: The incidence of cryptosporidium infection was 22% among pediatric patients with
lymphohematopoietic malignancies. We recommend evaluation of these patients with at least two
different diagnostic methods in order to prevent possible life threatening outcomes.

Key Words: Cryptosporidium sp.; Cryptosporidiosis; Lymphohematopoietic malignancies;
Immunocompromised patient