Cryptosporidiosis in Renal Transplant Recipients: Uncovering Risk Factors, Treatment Strategies, and the Role of Food Handlers in Transmission

Background Cryptosporidium is a common but understudied cause of diarrhea in solid organ transplant recipients. We explored its prevalence, risk factors, treatment strategies, and transmission through food handlers in renal transplant recipients (RTRs). Materials and Methods A retrospective analysis was conducted over a year at a tertiary hospital, focusing on RTRs with diarrhea. Diarrhea was bifurcated into Cryptosporidium -related and non- Cryptosporidium diarrhea for comparative analysis. Results Among 60 RTRs with diarrhea, 18 (30%) had Cryptosporidium infection. The Cryptosporidium group (66.7%, p=0.04) saw more frequent induction with anti-thymocyte globulin (ATG). Within 6 months of induction therapy or rejection treatment with pulse steroids, 72% of cases occurred. Higher rates of Cryptosporidiosis were observed with non-vegetarian diets (83.3%, p=0.01), lower education levels (p=0.01), and consumption of unboiled water (72.2%, p=0.15). Hospitalization was higher in the Cryptosporidium group (88.9%, p=0.01). Co-infections occurred in 27.8%, with extra-intestinal manifestations in 83%. Modification in immunosuppressive therapy was required in 66.7% (p<0.001). Relapse occurred in 12% of patients; all had infected food handlers. Graft complications were frequent in the Cryptosporidium group (38.9%, p=0.002). Food handlers had higher infection rates in the Cryptosporidium positive group (55.5% vs. 4.8%, p<0.01, OR=25). Conclusion Cryptosporidium infection in RTRs is linked to immunosuppression, dietary habits, and poor hygiene among food handlers. Effective management requires education, improved hygiene, and immunosuppressive adjustments.