Abstract:

Lactobin-R is a commercial hyperimmune bovine colostrum with potent anticryptosporidial activity. It was administered to a 4 year old child with AIDS and severe diarrhoea associated with cryptosporidiosis. There was significant clinical improvement in the diarrhoea and permanent elimination of the parasite from the gut as assessed through serial jejunal biopsy and stool specimens.

Although the parasite cryptosporidium causes a self limiting diarrhoea illness in immunocompetent patients, it may be associated with life threatening diarrhoea in those with immunodeficiency.’ Uniformly effective treatment is unavailable at present, and immunotherapies, such as hyperimmune bovine colostrum, have given mixed results.24 We describe a 4 year old boy with AIDS whose cryptosporidiosis was successfully treated with a commercial hyperimmune bovine colostrum preparation.

Case report:

A 4 year old boy with vertically acquired HIV infection had a one month history of severe watery diarrhoea, vomiting, and failure to thrive. He was malnourished (weight of 13 kg, <3rd centile) with generalised lymphadenopathy and hepatosplenomegaly. Stool examination revealed cryptosporidia but no other pathogens. He was severely immunodeficient with a CD4 count of 0d19X109/l, but was negative for p24 antigen. He had specific iron, copper, and zinc deficiencies, and was hypoalbuminaemic (albumin concentration 30 g/l). Two weeks of oral spiramycin, at a dose of 100 mg/kg/day, had no effect on the diarrhoea or weight loss. Cryptosporidial oocysts continued to be isolated from the stool. Total parenteral nutrition was instituted, but regrading to enteral feeds was impossible due to vomiting. Azithromycin was given intravenously for three weeks at a dose of 2 5 mg/kg twice daily, and oral loperamide and subcutaneous diamorphine were added. Although there was a clear reduction in stool volume, he remained intolerant of feeds, and oocysts persisted in his stools.

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