Patient Encounter

A 35-year-old man with a past medical history significant for recent kidney transplant presents with diarrhea for one month. He reports 4 to 5 watery stools per day. He also complains of abdominal pain and weight loss. He denies any fever, nausea, and vomiting. Stool studies including fecal leukocytes, culture, and ova and parasites were all negative.

What additional diagnostic test should you order and why?

An acid-fast staining of stool was positive for Cryptosporidium parvum. What treatment would you recommend for this patient?

Prevention of cryptosporidiosis can prove difficult because the oocysts are resilient

to many disinfectants and antiseptics, including ammonia, alcohol, and chlorine. Therefore, most traditional water-treatment methods, including filtration, do not eradicate all oocysts, which is problematic in the face of the small infective dose of Cryptosporidium. Routine screening of drinking water should be considered for water-

treatment plants, and severely immunocompromised individuals should be advised to

avoid water in lakes and streams and contact with young animals. For these persons, drinking water should be brought to a boil and cooled before ingestion.

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