Question | Discussion | References | CME Credit

Updated April 1, 2010

Case 9: A 31-Year-Old Woman with AIDS and Cryptosporidiosis

Authors: Brian R. Wood, MD David H. Spach, MD

Learning Objectives

A 31-year-old HIV-infected woman presents with severe diarrhea and dizziness. She has long-standing HIV disease and her most recent CD4 count was 24 cells/mm3. For approximately 2 years, she has not taken any medications related to her HIV disease. The diarrhea began about 10 days ago and now she is having 10 to 15 watery stools per day, abdominal cramping, and nausea. Physical examination shows a thin female with a temperature of 38.1°C, blood pressure of 86/60 mmHg, and minimal diffuse abdominal tenderness with deep palpation. A modified acid-fast stain on a stool sample is presumptively identified as Cryptosporidium species (Figure 1).

Which of the following is TRUE regarding diarrheal illness caused by Cryptosporidium in HIV-infected patients?

A Most patients acquire Cryptosporidium from exposure to undercooked meat.
B Among antimicrobial agents studied for the treatment of cryptosporidiosis, the combination of azithromycin (Zithromax) plus paromomycin (Humatin) is the most effective therapy.
C Recommended treatment consists of high-dose trimethoprim-sulfamethoxazole (Bactrim, Septra).
D Immune restoration with antiretroviral therapy is considered essential in the management of patients with cryptosporidiosis.

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    Figure 1 - Modified Acid-fast Staining of Stool Samples Showing Cryptosporidium OocystsFigure 1