Prevalence and clinical significance of Cryptosporidium infection in patients with hepatitis B virus-associated acute-on-chronic liver failure

Summary Background Patients with acute-on-chronic liver failure (ACLF) are often highly susceptible to microbial infection due to a depressed immune system. This study was carried out to investigate the prevalence and clinical significance of Cryptosporidium infection in patients with hepatitis B virus (HBV)-associated ACLF in Hunan Province, China. Methods Fecal samples from 218 patients with HBV-associated ACLF, 122 patients with chronic hepatitis B (CHB), and 140 children with diarrhea were collected; Cryptosporidium infection was detected by auramine–phenol staining, modified acid-fast staining, and the polymerase chain reaction. The clinical characteristics of this parasitic infection in Cryptosporidium-positive ACLF patients were further evaluated. Results The prevalence of Cryptosporidium infection in the HBV-associated ACLF patients was 6.0% (13/218), which was markedly higher than that found in CHB patients (0.8%, 1/122) and in children with diarrhea (1.4%, 2/140). Although watery diarrhea was not seen in the 13 Cryptosporidium-positive ACLF patients, eight (61.5%) of them had diarrhea. Moreover, our investigation showed that Cryptosporidium infection was not associated with the severity of the disease in ACLF patients. Conclusions The prevalence of Cryptosporidium infection is high among patients with HBV-associated ACLF and might be a significant cause of diarrhea in this population.