0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37
Cryptosporidiosis 4319 days, can be up to 8 weeks. Cysts shed up to 7–8 weeks. Recov-
ery occurs. In immunosuppressed, symptoms can be prolonged or
permanent, and of varying severity.tests
■Basic tests: blood: no specific findings
■Basic tests: urine: normal
■Specific tests:
➣a) Stool examination, concentrated, stained with acid-fast tech-
nique shows oocysts. May need several stools to find parasite.
ELISA for cryptosporidium antigen in stool available, which is
approximately as accurate.
➣b) Biopsy of small or large bowel.
■Other tests: Serology (IFA, ELISA) available, but rises slowly, not use-
ful in acute case. PCR not yet widely available.differential diagnosis
■Most causes of acute diarrhea without blood. Stool exam can resem-
ble cyclospora (also acid-fast).management
What to Do First
■Assess need for fluid and electrolyte replacement. Assess overall
immunocompetence.General Measures
■Determine source of infection if possible (could be water supply).
Instruction in hygiene to prevent spread.specific therapy
Indications
■Severe diarrhea, immunocompromised patients.Treatment Options
■No specific chemotherapy is reliable. In immunocompetent patients
use antimotility agents and rehydration, as infection is self-limited.
In immunocompromised patients paromomycin, clarithromycin
may be helpful.Side Effects & Complications
■None beyond dehydration, electrolyte imbalance. For immunocom-
promised patients, see HIV section.
■Contraindications to treatment: absolute: none.