Case 6: A Migrant Worker with Abdominal Pain and Diarrhea

Question | Discussion | References | CME Credit

You answered:

	The clinical manifestations and the stool findings are most consistent with cryptosporidiosis. Treatment should be initiated with paromomycin (Humatin) or nitazoxanide (Alinia).

This answer is incorrect. Although the clinical manifestations are consistent with cryptosporidiosis, the findings on the modified acid-fast stain of the stool sample revealed an elliptical oocyst (25 by 15 um) that is much larger than the round Cryptosporidium parvum oocysts (4 to 6 um wide). Thus, the stool findings are not consistent with cryptosporidiosis.

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

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