Gastric cryptosporidiosis: correlation between intensity of infection and histological alterations

Aims: A retrospective study was carried out to determine the histopathologi cal alterations of determine the histopathological alterations of the gastr ic mucosa associated with the presence of Cryptosporidium parasites in the stomach. Methods and results: Gastric biopsies from eight patients with AIDS and cry ptosporidiosis were reviewed, Most individuals were males (7/8, mean age 34 .7 years) intravenous drug users (6/8), with very low peripheral blood CD4 lymphocyte counts (< 150/mm(3); mean 56/mm(3)). Endoscopic examination show ed no significant mucosal abnormalities in half of the individuals; inflamm ation was observed in the other four individuals and was associated with er osions in two cases. The lesions observed (reactive changes, oedema, erosio ns, etc.) are not pathognomonic, since they are seen in most common acute a nd chronic gastrititis of various aetiologies (toxic, infectious, mechanica l). The histological examination showed Cryptosporidium parasites in the an trum-pylorus of all examined persons, whereas only two of them had parasite s in the corpus. Modifications of histological features consisted mostly of hyperplastic reactive changes of the gland epithelial and inflammation in the connective tissue of the lamina propria. No clear correlation was found between endoscopy and histological findings, whereas a close correlation b etween intensity of the infection and degree of histological alterations wa s observed. Conclusion: These findings suggest that, in individuals with AIDS, cryptosp oridiosis and severe immunodepression, upper endoscopy with random gastric biopsies should be performed, even in the absence of endoscopically appreci able lesions, The diagnosis of gastric cryptosporidiosis has to rely on his tological findings, and pathologists must be aware of the fact that Cryptos poridium parasites are mainly found in areas showing reactive hyperplasia.