Case 6: A Migrant Worker with Abdominal Pain and Diarrhea

Question | Discussion | References | CME Credit

You answered:

	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.

	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).
	The patient most likely has giardiasis. Treatment should be initiated with metronidazole (Flagyl) or tinidazole (Tindamax).
	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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