Difference between revisions of "Cryptosporidium"

(Management)
 
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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===
 
*Swim regularly in pools with insufficient sanitation.
 
*Swim regularly in pools with insufficient sanitation.
 
*Hikers who drink untreated water.
 
*Hikers who drink untreated water.
 
*Handling infected cattle.
 
*Handling infected cattle.
  
==Clinical Presentation==
+
==Clinical Features==
 
Symptoms usually appear one week after infection which include:
 
Symptoms usually appear one week after infection which include:
* watery diarrhea
+
*[[Fever]]
* dehydration
+
*[[Nausea/vomiting]]
* stomach cramps/pain
+
*[[Abdominal pain]]/cramps
* weight loss
+
*Watery [[diarrhea]]
* fever
+
*Dehydration
* nausea/vomiting
+
*Weight loss
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Template:Diarrhea DDX}}
 
{{Template:Diarrhea DDX}}
  
==Diagnosis==
+
==Evaluation==
* Stool acid-staining test
+
*No eosinophilia
* Stool Culture
+
*Stool acid-staining test
 +
*Stool Culture
  
 
==Management==
 
==Management==
* If patient non-sick appearing and not immunocompromised, medication often not needed
+
*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
+
*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.
  
 
==Disposition==
 
==Disposition==
* Most of these patient's can be discharged with close PMD/HIV follow up.
+
*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:

Differential Diagnosis

Acute diarrhea

Infectious

Noninfectious

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

  1. Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  2. 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.
  3. 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.
  4. Cabada MM et al. Cryptosporidiosis Clinical Presentation. Aug 2018. https://emedicine.medscape.com/article/215490-clinical.