Cryptosporidiosis is a protozoal infection caused mainly by Cryptosporidium parvum and C. hominis 1. In immunocompetent individuals, it causes self-limiting diarrhea, but in people living with HIV/AIDS, it may progress to severe disseminated forms 2, including rare pulmonary involvement. Transmission occurs primarily via the fecal-oral route, but in advanced immunosuppression, inhalation of oocysts is also possible. Specific treatment has limited efficacy, making antiretroviral therapy (ART) essential 3. A 36-year-old previously healthy man was hospitalized with postprandial nausea, vomiting, and yellowish diarrhea for three weeks, with decreasing frequency over time. He developed persistent dry cough, hiccups, heartburn, epigastric pain, and a 12-kg weight loss in 22 days. On examination, he was pale, with mild hepatomegaly, pulmonary crackles, and epigastric tenderness. Abdominal CT revealed retroperitoneal and mesenteric lymphadenopathy. HIV serology was positive. Initial stool tests for Cryptosporidium sp. and Isospora were negative. Sputum smear microscopy revealed acid-fast bacilli, leading to the initiation of tuberculosis treatment (RHZE). During hospitalization, he developed daily afternoon fever, anal incontinence, progressive respiratory distress, and required non-invasive ventilation. After 15 days of RHZE, a new sputum smear revealed Cryptosporidium sp. cysts, which were also detected in a new stool sample. Nitazoxanide and ART were initiated. Despite treatment, he maintained severe diarrhea and respiratory discomfort, progressing to orotracheal intubation and vasopressor support. He died 17 days after treatment initiation. The pulmonary form of cryptosporidiosis is rare and underdiagnosed, with nonspecific symptoms often attributed to tuberculosis or other opportunistic infections. Inhalation of oocysts and hematogenous spread are possible mechanisms 2. Antiparasitic therapy alone has low efficacy, and early ART is crucial for control 3. Disseminated cryptosporidiosis should be investigated in PLHIV with persistent diarrhea and respiratory symptoms, especially in cases unresponsive to antibiotics and antiparasitics. Simultaneous testing of stool and sputum samples contributes to the diagnosis and better management of the case.
Dias et al. (Sun,) studied this question.