Cryptosporidium: Difference between revisions
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*Protozoa causing diarrhea. | *Protozoa causing diarrhea. | ||
**Oocysts are 4-6 µm in diameter and exhibit partial acid-fast staining. | **Oocysts are 4-6 µm in diameter and exhibit partial acid-fast staining. | ||
*Mostly commonly seen in HIV+ | *Mostly commonly seen in [[HIV]]+ | ||
*Most common cause of chronic diarrhea in HIV patients. | *Most common cause of chronic diarrhea in [[HIV]] patients. | ||
===Environmental Exposures=== | ===Environmental Exposures=== | ||
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*Handling infected cattle. | *Handling infected cattle. | ||
==Clinical | ==Clinical Features== | ||
Symptoms usually appear one week after infection which include: | Symptoms usually appear one week after infection which include: | ||
*Fever | *[[Fever]] | ||
*Nausea/vomiting | *[[Nausea/vomiting]] | ||
* | *[[Abdominal pain]]/cramps | ||
*Watery diarrhea | *Watery [[diarrhea]] | ||
*Dehydration | *Dehydration | ||
*Weight loss | *Weight loss | ||
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{{Template:Diarrhea DDX}} | {{Template:Diarrhea DDX}} | ||
== | ==Evaluation== | ||
* Stool acid-staining test | *No eosinophilia | ||
* Stool Culture | *Stool acid-staining test | ||
*Stool Culture | |||
==Management== | ==Management== | ||
*If non-sick appearing and not immunocompromised, medication often not needed.<ref>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.</ref> | *If non-sick appearing and not immunocompromised, medication often not needed.<ref>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.</ref> | ||
*Antiparasitics such as nitazoxanide for immunocompromised patients.<ref>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.</ref> | *Antiparasitics such as [[nitazoxanide]] for immunocompromised patients.<ref>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.</ref> | ||
*IV/PO hydration if dehydration present. | *IV/PO hydration if dehydration present. | ||
*If patient not on HAART therapy, consider contacting HIV/ID for initiating therapies. | *If patient not on HAART therapy, consider contacting HIV/ID for initiating therapies, as disease is self-limited in CD4 > 200<ref>Cabada MM et al. Cryptosporidiosis Clinical Presentation. Aug 2018. https://emedicine.medscape.com/article/215490-clinical.</ref> | ||
**Diarrhea and fluid loss much worse in individuals with CD4 counts < 50. | |||
*Admission if severe dehydration or electrolyte imbalance. | *Admission if severe dehydration or electrolyte imbalance. | ||
==Disposition== | ==Disposition== | ||
* Most of these patient's can be discharged with close | *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 | *If patient has electrolyte abnormalities or severely dehydrated consider observation placement vs admission for rehydration therapy | ||
==See Also== | ==See Also== |
Latest revision as of 04:07, 17 October 2018
Background
- 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.
Environmental Exposures
- Swim regularly in pools with insufficient sanitation.
- Hikers who drink untreated water.
- Handling infected cattle.
Clinical Features
Symptoms usually appear one week after infection which include:
- Fever
- Nausea/vomiting
- Abdominal pain/cramps
- Watery diarrhea
- Dehydration
- Weight loss
Differential Diagnosis
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[1]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
Evaluation
- No eosinophilia
- Stool acid-staining test
- Stool Culture
Management
- If non-sick appearing and not immunocompromised, medication often not needed.[2]
- Antiparasitics such as nitazoxanide for immunocompromised patients.[3]
- 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[4]
- Diarrhea and fluid loss much worse in individuals with CD4 counts < 50.
- Admission if severe dehydration or electrolyte imbalance.
Disposition
- 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
See Also
External Links
References
- ↑ 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.