Cryptosporidium

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Summary of Cryptosporidium

Cryptosporidiosis is a parasitic disease caused by Cryptosporidium, a genus of protozoan parasites. It affects the distal small intestine in both immunocompetent individuals (in whom it causes mild watery diarrhea) and immunocompromised (e.g., persons with AIDS) individuals (in whom it causes severe, potentially fatal diarrhea). It is primarily spread through the consumption of oocysts in contaminated water, and identification is via acid-fast staining. Prevention is accomplished by filtration of city water supplies, and treatment in immunocompetent patients is with nitazoxanide.

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Cryptosporidium

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CRYPTOSPORIDIUM osms.it/cryptosporidium PATHOLOGY & CAUSES ▪ Cryptosporidiosis: diarrheal disease caused by Cryptosporidium (intestinal intracellular protozoan parasite) ▪ Life-cycle can be completed in one host ▫ Immunocompetent hosts: self-limited diarrhea ▫ Immunocompromised hosts: lifethreatening complications CAUSES ▪ Cryptosporidium oocysts (infective form) transmitted via fecal → oral route ▫ Infected individual/animal feces contaminates food; drinking, swimming water → fecally-contaminated food/ water ingestion ▪ Parasites → intestinal epithelial inﬂammation → villi structure distortion → ↓ absorption, ↑ secretion → watery diarrhea ▫ Sclerosing cholangitis/acalculous cholecystitis, respiratory cryptosporidiosis, pancreatitis RISK FACTORS ▪ Endemic-area exposure (tropical countries, Kuwait), immune deﬁciencies, poor hygiene ▪ Interpersonal transmission: sexual partners, daycare centers, household members COMPLICATIONS ▪ Dehydration, ﬂuid and electrolyte imbalance SIGNS & SYMPTOMS ▪ Host’s immune status-dependant 400 OSMOSIS.ORG DIAGNOSIS LAB RESULTS Microscopic oocyte identiﬁcation ▪ Stool; bile secretion, affected GIT aspirates; affected GIT tissue biopsy; respiratory secretion Polymerase chain reaction (PCR) ▪ More sensitive, speciﬁc ▪ Differentiates between Cryptosporidium genotypes Monoclonal antibodies and enzyme immunoassays (EIA) ▪ Monoclonal antibody test against oocyst wall ▪ More sensitive, speciﬁc than light microscope TREATMENT MEDICATIONS ▪ Immunocompetent host: antidiarrheal, antimicrobial agents ▪ Immunocompromised host: antiretroviral therapy (HIV-infected individuals), antimicrobial agents, azithromycin (severe diarrhea) OTHER INTERVENTIONS ▪ Immunocompetent host: oral/IV ﬂuid/ electrolyte-loss replacement

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Cryptosporidium

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Questions

USMLE® Step 1 style questions USMLE

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A 45-year-old man comes to the clinic because of diarrhea, nausea, and abdominal pain. He has had voluminous bowel movement since yesterday. He did not notice any blood in his stool. He has had diarrhea on and off for the past few months, but it has recently gotten much worse. His temperature is 38.3°C (101°F), pulse is 90/min, respirations are 18/min, and blood pressure is 115/75 mm Hg. He has a history of intravenous drug use. Physical examination shows white plaques on his buccal mucosa and tongue that can be scrapped off. Modified acid-fast staining of a stool sample shows pink oocysts. Which of the following is the most likely cause of this patient's diarrhea?

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