- Protozoa causing diarrhea.
- Oocysts are 4-6 µm in diameter and exhibit partial acid-fast staining.
- Mostly commonly seen in HIV+
- Most common cause of chronic diarrhea in HIV patients.
- Swim regularly in pools with insufficient sanitation.
- Hikers who drink untreated water.
- Handling infected cattle.
Symptoms usually appear one week after infection which include:
- Viral (e.g. rotavirus)
- GI Bleed
- Mesenteric Ischemia
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
- Enterotoxigenic E. coli (most common cause of watery diarrhea)
- Norovirus (often has prominent vomiting)
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
- No eosinophilia
- Stool acid-staining test
- Stool Culture
- If non-sick appearing and not immunocompromised, medication often not needed.
- Antiparasitics such as nitazoxanide for immunocompromised patients.
- IV/PO hydration if dehydration present.
- If patient not on HAART therapy, consider contacting HIV/ID for initiating therapies, as disease is self-limited in CD4 > 200
- Diarrhea and fluid loss much worse in individuals with CD4 counts < 50.
- Admission if severe dehydration or electrolyte imbalance.
- Most of these patient's can be discharged with close primary care/HIV follow up.
- If patient has electrolyte abnormalities or severely dehydrated consider observation placement vs admission for rehydration therapy
- Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
- White AC Jr. Cryptosporidiosis species. In: Mandell GL, Bennett JE, Dolin R, ed. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 209:3547-60.
- Lima AAM, Samie A, Guerrant RL. Cryptosporidiosis. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases. Philadelphia, Pa: Elsevier-Churchill Livingstone; 2011:640-63.
- Cabada MM et al. Cryptosporidiosis Clinical Presentation. Aug 2018. https://emedicine.medscape.com/article/215490-clinical.