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home - Colon - Colonic Infection - Cryptosporidiosis Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Cryptosporidiosis

Intracellular protozoan parasiteMost common GI parasitePresent in 2% with diarrhoeaSeroprevalence-40% Risk Factors for Infection:Immunosuppression.Poor sanitation and overcrowding.Rainy periods.Children < 2 years old.Dairy farmers (C. parvum). Diagnostic tests:-Oocysts identified on microscopy of 3 stool (poor sens) or tissue- fresh or formalin-fixed, by light or phase-contrast microscopy.-Acid-fast stains for microscopy-Monoclonal ab’s vs oocyst wall and antigen capture ELISA (good sensitivity).-PCR-for speciation and genotyp-ing.-Serology-(epidemiology only). Treatments:For immunocompetent hosts no tx needed unless persistent sx.For children nitazoxanide tx.For HIV patients start HAART to get CD4 > 100.Nitazoxanide or paromomycin alone or in combination with azithromycin can be used- not proven. Species:C.hominis (humans and animals).C.parvum (animals).C.felis, C.muris, C.canis, C.suis, and C.meleagridis have also been identified in some individuals. Cryptosporidiosis -Oocyst ingested-Releases motile banana shaped sporozoites The sporozoites mature asexually into meronts, which release merozoites intraluminally Merezoites reinvade host cells/mature into oocysts Transmission Methods:-Contaminated environment/ food.-Human-Human.-Animal-Human. Inflammatory changes present Associated with distortion of the villus architecture Can cause stricturing of biliary tree and cholangitis. Interferes with intestinal absorption and secre-tion. Incubation 7-10 days Clinical Presentations:Asymptomatic infection (up to 30%).Mild diarrheal illness assoc with cramps, N+V.Severe enteritis with or without biliary tract involvement.AIDS related illness. Lasts 10-14 days in immunocompetent patients (oocyst excretion can last longer) The diarrhea is acute or chronic, transient, inter-mittent or continuous, and scant or voluminous with up to 25 L/day of watery stool. Worse if CD4< 100 cells/uL20% HPB / Lung involvementCan cause acalculous chol-ecystitis or sclerosing cholan-gitis only 10-50 cysts needed -Cysts resistant to disinfectants/ filtr-tion. Prognosis10 % develop fulminant disease if HIV+ cryptosporidium- poor prognosisPreventionSpores can be eliminated with freezing, boiling, and by high concentra-tions of ammonia or formalin.Standard disinfectant doesnt workBoiling or filtering water may decrease the risk of infection in immunosu-pressed patients. Clinical Pres in HIV Written by Dr Sebastian Zeki

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