Difference between revisions of "Cryptosporidium"
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**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=== | ||
| Line 12: | Line 12: | ||
==Clinical Features== | ==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 | ||
| Line 22: | Line 22: | ||
{{Template:Diarrhea DDX}} | {{Template:Diarrhea DDX}} | ||
| − | == | + | ==Evaluation== |
*No eosinophilia | *No eosinophilia | ||
*Stool acid-staining test | *Stool acid-staining test | ||
| Line 29: | Line 29: | ||
==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 | ||
Latest revision as of 04:07, 17 October 2018
Contents
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.