A Case Series of Lung Transplant Recipients Who Developed Life Threatening Diarrhea from Cryptosporidium Contaminated Water Supply

Author(s): Hirra Chaudhary, Adam B. Cochrane, Sajal Tanna, Shambhu Aryal, Zein Kattih, Jared D. Wilkinson, Alan Nyquist, Anju Singhal, Vikramjit Khangoora, Christopher King, Oksana A Shlobin, Steven D. Nathan, Christopher Thomas

Background: Cryptosporidium is a protozoan known to cause acute gastroenteritis. Solid organ transplant recipients are at increased risk of infection but reports of infection in lung transplant recipients are limited. In September 2023, the Baltimore City Department discovered low levels of Cryptosporidium within the Druid Lake Reservoir. We present three cases of cryptosporidiosis in lung transplant recipients at our institution and report their disease course, response to treatment, and potential affiliation with the reservoir contamination.

Methods/Results: Chart reviews were conducted on the three cases of cryptosporidiosis in lung transplant recipients at our institution between 2023 to 2024. Case 1: 47-year-old female from near Baltimore with a bilateral lung transplant (BLTx) for bronchiectasis presented with severe sepsis from Cryptosporidium diarrhea and C. dificile colitis. She was started on nitazoxanide and oral vancomycin and discharged on hospital day 7. Case 2: 60-year-old male from Baltimore with a redo BLTx presented with septic shock due to Cryptosporidium diarrhea and was upgraded to the ICU. He started on norepinephrine drip, steroids, broad-spectrum antibiotics, and nitazoxanide. He was discharged home on hospital day 19. Case 3: 35-year-old male with a BLTx for cystic fibrosis presented with severe sepsis, renal failure and electrolyte derangement due to Cryptosporidium diarrhea and was upgraded to the ICU. He was started on nitazoxanide and discharged on hospital day 4.

Conclusion: To our knowledge, this represents the largest case series of Cryptosporidium in lung transplant recipients. It is important to include cryptosporidiosis on the differential for these patients.