Duodenum - Cryptosporidiosis in an HIV Patient
Comments: This 38 year old Haitian computer programmer has been known to be HIV positive since 1991 when he presented with a CD4 count of 276 and new onset dyspnea secondary to bronchiectasis. Since then, he has received the full spectrum of HIV therapy which he has taken with variable compliance. His disease related complications have included shingles, chronic sinusitis, depression, and oral candidiasis. Two months prior to this exam, he presented with high volume diarrhea which on stool analysis revealed cryptosporidiosis. He was begun on paromomycin, azithromycin, and imodium, which eventually controlled his symptoms. He also restarted his antiretroviral therapy to gain more definitive control of the cryptosporidiosis. This exam was performed to evaluate the success of therapy.
On EGD, the duodenum is markedly abnormal with edema and nodularity of the mucosal surface. The fine endoscopic resolution permits visualization of edematous villi. The terminal ileum had a very similar appearance. The patient's CD4 count at the time of this endoscopy was 45 with a viral load of 114,000 copies per ml. Biopsies were taken revealing mucosal injury with villous flattening, regenerative epithelial changes and lamina propria inflammation. Higher power shows that the surface epithelium is lined by small round organisms (arrows) measuring 2-4 mm. The appearance is characteristic of cryptosporidiosis.
Most human cryptosporidial infections are caused by the species Cryptosporidium Parvum which invades and spends their life cycle in the intestinal epithelium. Diagnosis is made by the finding of the oocysts excreted in the stool using a modified acid fast stain or by ELISA or direct fluorescence antibody test of the stool. Antiprotozoal therapy usually fails to clear the organism in the setting of low CD4 counts. Thus, the main focus of therapy is the institution of aggressive antiretroviral therapy.
| Contributed by: |
Peter B. Kelsey, M.D. Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital |
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Citation: Kelsey, PB (May 06 2004). Duodenum - Cryptosporidiosis in an HIV Patient. The DAVE Project. Retrieved Sep, 4, 2010, from http://daveproject.org/viewfilms.cfm?film_id=130 Times viewed since Feb 2006: 8661 |
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