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Case 6: A Migrant Worker with Abdominal Pain and Diarrhea

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C The clinical manifestations and stool analysis are most consistent with intestinal tuberculosis. An intestinal wall biopsy should be performed to make a definitive diagnosis.

This answer is incorrect. Although the patient could have intestinal tuberculosis, most HIV-infected patients with tuberculosis present with findings other than severe diarrhea.  In addition, the findings on the stool smear do not suggest a diagnosis of intestinal tuberculosis.  The Mycobacterium tuberculosis organisms are markedly smaller than the oocyst shown here and do not have an elliptical shape.

A The clinical manifestations and the modified acid-fast smear of the stool sample are consistent with a diagnosis of cystoisosporiasis. Treatment should be initiated with trimethoprim-sulfamethoxazole (Bactrim, Septra).
B The patient most likely has giardiasis.  Treatment should be initiated with metronidazole (Flagyl) or tinidazole (Tindamax).
D The clinical manifestations and the stool findings are most consistent with cryptosporidiosis. Treatment should be initiated with paromomycin (Humatin) or nitazoxanide (Alinia).

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