Cryptosporidiosis Flashcards

(42 cards)

1
Q

What is cryptosporidiosis caused by?

A

Various species of the protozoan parasite Cryptosporidium

The three species that most commonly infect humans are C. hominis, C. parvum, and C. meleagridis.

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2
Q

What is the primary symptom of cryptosporidiosis?

A

Diarrhea

Infection typically causes diarrhea, especially in immunocompromised individuals.

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3
Q

What CD4 T lymphocyte cell count is associated with the greatest risk for severe cryptosporidiosis?

A

CD4 cell counts <100 cells/mm3

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4
Q

How does the incidence of cryptosporidiosis in people with HIV in high-income countries compare to low-income countries?

A

The incidence has decreased in high-income countries, now <1 case per 1,000 person-years.

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5
Q

How is cryptosporidiosis transmitted?

A

Through ingestion of Cryptosporidium oocysts

Viable oocysts can be transmitted from infected humans or animals.

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6
Q

What are common clinical manifestations of cryptosporidiosis?

A

Watery diarrhea, nausea, vomiting, lower abdominal cramping

Disease severity can range from asymptomatic to profuse diarrhea.

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7
Q

What diagnostic method is traditionally used to identify cryptosporidiosis?

A

Microscopic identification of oocysts in stool with acid-fast staining

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8
Q

What newer diagnostic methods are being increasingly used for cryptosporidiosis?

A

Antigen detection and polymerase chain reaction

These methods can identify more cases than traditional microscopic methods.

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9
Q

What is the recommended approach for preventing exposure to Cryptosporidium for people with HIV?

A

Education on transmission methods, handwashing, avoiding contaminated water or food

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10
Q

True or False: Cryptosporidium oocysts are resistant to chlorine.

A

True

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11
Q

What should people with HIV do to minimize the risk of cryptosporidiosis while swimming?

A

Avoid swallowing water and swimming in potentially contaminated water

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12
Q

What is the recommended action during municipal water supply outbreaks?

A

Boil water for at least 1 minute

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13
Q

Fill in the blank: The preferred management strategy for cryptosporidiosis includes aggressive _______ and electrolyte replacement.

A

rehydration

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14
Q

What is the role of antiretroviral therapy (ART) in managing cryptosporidiosis?

A

Initiating ART helps achieve immune restoration and resolve clinical cryptosporidiosis

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15
Q

What is the recommended treatment regimen for cryptosporidiosis in adults?

A

Nitazoxanide 500 mg to 1,000 mg PO twice daily for at least 14 days

This should be combined with optimized ART and symptomatic treatment.

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16
Q

What should be avoided in late pregnancy when treating cryptosporidiosis?

A

Tincture of opium

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17
Q

What dietary restriction is recommended for individuals with cryptosporidiosis?

A

Avoid milk products

Diarrhea can cause lactase deficiency.

18
Q

What is the response rate of paromomycin in treating cryptosporidiosis?

A

67%

However, few cures were reported, and relapses were common.

19
Q

What should people with HIV traveling to low-income countries avoid?

A

Drinking tap water or using it to brush teeth

20
Q

What is the effect of rifabutin and clarithromycin in relation to cryptosporidiosis?

A

They have been found to protect against cryptosporidiosis

21
Q

What was the response rate of paromomycin in a meta-analysis of 11 published studies in humans?

A

67%

However, there were few cures and long-term success rates were only 33%

22
Q

What common issue was reported in patients treated with paromomycin?

A

Relapses were common

Long-term success rates were only 33%

23
Q

What is the effectiveness of paromomycin compared to placebo in patients with AIDS and cryptosporidiosis?

A

Limited effectiveness

Demonstrated in two randomized trials

24
Q

What may improve the response rate in patients receiving paromomycin?

A

ART (antiretroviral therapy)

Suggested by one case series

25
Should paromomycin be used instead of nitazoxanide?
Yes, in conjunction with ART but never instead of ART ## Footnote Classified as CIII recommendation
26
What should patients with cryptosporidiosis be offered as part of initial management?
ART ## Footnote Classified as AII recommendation
27
Can HIV protease inhibitors inhibit Cryptosporidium in animal and in vitro models?
Yes ## Footnote No clinical evidence supports PI-based ART as preferable in patients with documented cryptosporidiosis
28
What should patients be monitored for during therapy?
Signs of volume depletion, electrolyte imbalance, weight loss, and malnutrition ## Footnote Monitoring for IRIS is also important
29
What has been described in association with extraintestinal cryptosporidiosis?
Immune reconstitution inflammatory syndrome (IRIS) ## Footnote Observed in three cases
30
What are the main approaches to managing treatment failure in cryptosporidiosis?
Supportive treatment and optimization of ART ## Footnote Achieving full virologic suppression is key
31
What should guide the response to therapy in treatment failure?
Clinical response rather than stool test results ## Footnote Some advocate adding antiparasitic drugs
32
Are there any known pharmacologic interventions effective in preventing the recurrence of cryptosporidiosis?
No ## Footnote No known effective pharmacologic interventions
33
What are the mainstays of initial treatment of cryptosporidiosis during pregnancy?
Rehydration and initiation of ART ## Footnote Same as for nonpregnant individuals
34
Is pregnancy an indication for ART?
Yes ## Footnote Pregnancy should not preclude the use of ART
35
Is nitazoxanide teratogenic in animals?
No ## Footnote However, no data on use in human pregnancy are available
36
When can nitazoxanide be used in pregnancy?
After the first trimester in people with severe symptoms ## Footnote Classified as CIII recommendation
37
What is the absorption and associated risk of paromomycin in pregnancy?
Minimal systemic absorption ## Footnote Limited information about teratogenic potential
38
When can paromomycin be used in pregnancy?
After the first trimester in people with severe symptoms ## Footnote Classified as CIII recommendation
39
What is the status of loperamide in terms of absorption and birth defects?
Poorly absorbed and not associated with birth defects in animal studies ## Footnote One study noted increased risk of congenital malformations
40
When should loperamide be avoided during pregnancy?
In the first trimester ## Footnote Unless benefits outweigh potential risks
41
What is the preferred antimotility agent in late pregnancy?
Loperamide ## Footnote Classified as CIII recommendation
42
What risk is associated with opiate exposure in late pregnancy?
Neonatal respiratory depression and withdrawal ## Footnote Tincture of opium is not recommended in late pregnancy