Re: HIV with diarrhoe
harry206 - 05-13-09 11:35

Modified Acid fast stain first step ----> If + :cryptosporidium (self limiting), Isospora
[Also Microsporidia in stools show spores , whereas crypto & isospora shows oocyte]
--------> If (-) -----> Colonoscopy ----> biopsy ---->
CMV (Large intranucleic, basophilic cytoplasmic lesion)

Re: HIV with diarrhoe
zkadhem - 05-13-09 11:37

ok very nice

Re: HIV with diarrhoe
meduploader - 05-13-09 14:08

In HIV infected patients, diarrhea can be due to a variety of organisms. To identify the causal organism prior to instating therapy, do a stool culture, exam the stool for ova and parasites, and test for C. dificile toxin.
AF stain --> + ive for crytposporidum, isospora - causes profuse, watery diarrhea. NO blood or giant cells on colon biopsy.
if negative do colonoscopy
In an HIV infected patient, bloody diarrhea and a normal stool exam are highly suspicious for CMV colitis and warrant a colonoscopy with biopsy. CMV is a common opportunistic pathogen in HIV infected pts and may cause esophagitis, colitis, proctitis, gastritis, and small bowel disease. Pts with CMV colitis present with chronic bloody diarrhea, abdominal pain, and a CD4 count less than 50 cells/uL. Colonoscopy shows multiple mucosal erosions and colonic ulceration. Biopsy shows the presence of large cells with eosinophilic intranuclear and basophilic intracytoplasmic inclusions (“owl’s eye� effect). Tx with acyclovir, or foscarnet.
E. histolytica: is a parasite that causes bloody diarrhea. On stool exam you can see trophozoites. Colonoscopy shows the presence of flask-shaped colonic ulcers.
MAI: disseminated infection can cause chronic diarrhea and weight loss; however, the diarrhea is NON bloody and generally involves the small intestine. Do a biopsy with culture to dx.