Cryptosporidiosis differential diagnosis: Difference between revisions

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{{Cryptosporidiosis}}
{{Cryptosporidiosis}}
{{CMG}} {{AE}} {{AKI}}
==Overview==
Cryptosporidiosis primarily presents with [[diarrhea]]<nowiki/>sandhould bethus  differentiated from other causes of [[diarrhea]] which can be [[viral]], [[bacterial]] or [[parasitic]].
==Differential Diagnosis==
<small>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Organism
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Age predilection
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Travel History
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Incubation Size (cell)
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Incubation Time
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;"|History and Symptoms
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;"|Diarrhea type∞
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Food source
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;"|Specific consideration
|-
!style="background:#4479BA; color: #FFFFFF|Fever
!style="background:#4479BA; color: #FFFFFF|N/V
!style="background:#4479BA; color: #FFFFFF|Cramping Abd Pain
!style="background:#4479BA; color: #FFFFFF|Small Bowel
!style="background:#4479BA; color: #FFFFFF|Large Bowel
!style="background:#4479BA; color: #FFFFFF|Inflammatory
!style="background:#4479BA; color: #FFFFFF|Non-inflammatory
|-
| rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Viral'''
| colspan="2"  style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Rotavirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<2 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10<sup>2</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mostly in day cares, most common in winter.
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Norovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10 -10<sup>3</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Most common cause of gastroenteritis, abdominal tenderness,
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Adenoviridae|Adenovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<2 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>5</sup> -10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |No seasonality
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Astrovirus]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<5 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |72-96 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Seafood
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mostly during winter
|-
| rowspan="11" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Bacterial'''
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Escherichia coli]]''
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[ETEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any age
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>8</sup> -10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EPEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<1 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>†</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |6-12 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw beef and chicken
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EIEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>†</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Hamburger meat and unpasteurized milk
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Similar to [[shigellosis]], can cause bloody diarrhea
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EHEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |3-4 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked or raw hamburger (ground beef) 
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Known as ''[[Escherichia coli O157:H7|E. coli]]'' [[Escherichia coli O157:H7|O157:H7]], can cause [[Hemolytic-uremic syndrome|HUS]]/[[TTP]].
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[EAEC]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-18 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause prolonged or persistent diarrhea in children
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Salmonella|Salmonella sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |6 to 72 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Can cause [[salmonellosis]] or [[typhoid fever]].
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Shigella|Shigella sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10 - 200
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |8-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Campylobacter|Campylobacter sp.]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<5 y, 15-29 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>4</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-5 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables,  seafood and contaminated water.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[bacteremia]], [[Guillain-Barré syndrome]] (GBS), [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] (HUS) and recurrent [[colitis]]
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Yersinia enterocolitica]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>4</sup> -10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-11 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[reactive arthritis]]; [[glomerulonephritis]]; [[endocarditis]]; [[erythema nodosum]].
can mimic [[appendicitis]] and mesenteric [[lymphadenitis]].
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Clostridium perfringens]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |> 10<sup>6</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |16 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Can survive high heat,
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Vibrio cholerae]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10<sup>6</sup>-10<sup>10</sup>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |24-48 h
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>-</nowiki>
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hypotension]], [[tachycardia]], decreased [[Turgor|skin turgor]]. Rice-water stools
|-
| rowspan="7" align="center" style="background:#4479BA; color: #FFFFFF;"|'''Parasites'''
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Protozoa
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Giardia lamblia]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-5 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 cyst
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-2 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contaminated water
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause [[malabsorption syndrome]] and severe [[weight loss]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Entamoeba histolytica]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |4-11 y
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |<10 cysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-4 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Contaminated water and raw foods
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause intestinal amebiasis and amebic liver abscess
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Cryptosporidium parvum]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-100 oocysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |7-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Juices and milk
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause copious diarrhea and [[dehydration]] in patients with [[AIDS]] especially with  180 > [[CD4|CD<sub>4</sub>]]
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Cyclospora cayetanensis]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |10-100 oocysts
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |7-10 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Fresh produce, such as raspberries, basil, and several varieties of lettuce.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |More common in rainy areas
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Helminths
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Trichinella]]'' [[Trichinella|spp]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Two viable larvae (male and female)
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1-4 we
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked meats
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |More common in hunters or people who eat traditionally uncooked meats
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Taenia (tapeworm)|Taenia]]'' [[Taenia (tapeworm)|spp]]
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 larva or egg
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |2-4 m
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Undercooked beef and pork
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Neurocysticercosis]]: Cysts located in the brain may be asymptomatic or [[seizures]], increased [[intracranial pressure]], [[headache]].
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |''[[Diphyllobothrium|Diphyllobothrium latum]]''
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Any ages
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |1 larva
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |15 d
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |-
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |Raw or undercooked fish.
|style="padding: 5px 5px; background: #F5F5F5;" align="center" |May cause vitamin B<sub>12</sub> deficiency
|}
<br><br>
</small>
Cryptosporidiosis must be differentiated from other diseases that may cause [[chronic diarrhea]], [[weight loss]], and [[abdominal pain]] especially in [[Immunocompromised|immunocompromised patients]].
{| style="border: 0px; font-size: 120%; margin: 3px; width:1000px;" align="center"
|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 200px;" | Prominent clinical findings
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Giardiasis|Chronic giardiasis]]<ref name="pmid11113253">{{cite journal |vauthors=Thompson RC |title=Giardiasis as a re-emerging infectious disease and its zoonotic potential |journal=Int. J. Parasitol. |volume=30 |issue=12-13 |pages=1259–67 |year=2000 |pmid=11113253 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Giardiasis|Chronic giardiasis]] may develop after acute episode of giardiasis or without any acute events.
* Loose foul smelling stools
* [[Flatulence]]
* [[Fatigue]]
* [[Weight loss]]
* [[Steatorrhea]]
* Some patients develop acquired [[lactose intolerance]] (manifested by exacerbation of symptoms following ingestion of dairy products)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Microscopic identification of the organism in the stool
* [[Hypoalbuminaemia]]
* [[Vitamin B12]] and [[Folate deficiency|folate deficiencies]] (as the organism inhabits the [[duodenum]])
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cryptosporidiosis]]<ref name="pmid17172373">{{cite journal |vauthors=Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L |title=Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City |journal=Am. J. Trop. Med. Hyg. |volume=75 |issue=6 |pages=1095–8 |year=2006 |pmid=17172373 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Incubation period]] is 7-10 days.
* In [[immunocompetent]] patients:
:* Disease might be asymptomatic or cause [[gastroenteritis]] (but without any biliary involvement)
:* [[Gastroenteritis]] usually resolves spontaneously within 14 days.
* In [[immunocompromised]] patients:
:* Disease is usually more severe and prolonged (especially in severly [[Immunocompromised|immunocomprmised patients]] with [[CD4|CD4 count]] < 100 cells/microL).
:* [[Cryptosporidiosis]] may involve the [[biliary tract]] and the [[liver]].
:* [[Weight loss]]
:* [[RUQ|Abdominal RUQ]] [[tenderness]] might be present if [[biliary]] or [[hepatic]] involvement is present.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Microscopic identification of the [[organism]] in the stool: The [[oocysts]] appear red on staining with modified acid fast staining
* [[PCR]]: Most specific and sensitive diagnostic tool. [[PCR]] is expensive and used in limited cases.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cystoisospora belli|Cystoisosporiasis (isosporiasis)]]<ref name="pmid1889046">{{cite journal |vauthors=Current WL, Garcia LS |title=Cryptosporidiosis |journal=Clin. Microbiol. Rev. |volume=4 |issue=3 |pages=325–58 |year=1991 |pmid=1889046 |pmc=358202 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Cystoisospora belli|Cystoisosporiasis]] is usually seen in [[Immunocompromised|immunocompromised patients]].
* [[Incubation period]] can last up to 2 weeks
* [[Watery diarrhea]] that is profuse and foul smelling
* Constitutional symptoms ([[headache]], [[Low-grade fever|low grade fever]], [[myalgia]] and [[malaise]])
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Isospora]] ova or parasites can be visualized on stool microscopic examination.
* [[Endoscopy|Upper GI endoscopy]] may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Tropical sprue]]<ref name="pmid1091526">{{cite journal |vauthors=Klipstein FA, Schenk EA |title=Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure |journal=Gastroenterology |volume=68 |issue=4 Pt 1 |pages=642–55 |year=1975 |pmid=1091526 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* History of travel to a tropical region (for a period more than a month)
* [[Chronic diarrhea]]
* [[Steatorrhea]]
* Examination may show signs of [[vitamin deficiencies]] (eg [[glossitis]])
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Megaloblastic anemia]] that might progress into [[pancytopenia]]
* [[Hypoalbuminaemia]]
* [[Vitamin D Deficiency|Vitamin D defeciency]] and [[hypocalcemia]]
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Parasitic diseases]]
[[Category:Infectious disease]]
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Latest revision as of 18:25, 31 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Cryptosporidiosis primarily presents with diarrheasandhould bethus differentiated from other causes of diarrhea which can be viral, bacterial or parasitic.

Differential Diagnosis

Organism Age predilection Travel History Incubation Size (cell) Incubation Time History and Symptoms Diarrhea type∞ Food source Specific consideration
Fever N/V Cramping Abd Pain Small Bowel Large Bowel Inflammatory Non-inflammatory
Viral Rotavirus <2 y - <102 <48 h + + - + + - Mostly in day cares, most common in winter.
Norovirus Any age - 10 -103 24-48 h + + + + + - Most common cause of gastroenteritis, abdominal tenderness,
Adenovirus <2 y - 105 -106 8-10 d + + + + + - No seasonality
Astrovirus <5 y - 72-96 h + + + + + Seafood Mostly during winter
Bacterial Escherichia coli ETEC Any age + 108 -1010 24 h - + + + + - Causes travelers diarrhea, contains heat-labile toxins (LT) and heat-stable toxins (ST)
EPEC <1 y - 10 6-12 h - + + + + Raw beef and chicken -
EIEC Any ages - 10 24 h + + + + + Hamburger meat and unpasteurized milk Similar to shigellosis, can cause bloody diarrhea
EHEC Any ages - 10 3-4 d - + + + + Undercooked or raw hamburger (ground beef)  Known as E. coli O157:H7, can cause HUS/TTP.
EAEC Any ages + 1010 8-18 h - - + + + - May cause prolonged or persistent diarrhea in children
Salmonella sp. Any ages + 1 6 to 72 h + + + + + Meats, poultry, eggs, milk and dairy products, fish, shrimp, spices, yeast, coconut, sauces, freshly prepared salad. Can cause salmonellosis or typhoid fever.
Shigella sp. Any ages - 10 - 200 8-48 h + + + + + Raw foods, for example, lettuce, salads (potato, tuna, shrimp, macaroni, and chicken) Some strains produce enterotoxin and Shiga toxin similar to those produced by E. coli O157:H7
Campylobacter sp. <5 y, 15-29 y - 104 2-5 d + + + + + Undercooked poultry products, unpasteurized milk and cheeses made from unpasteurized milk, vegetables, seafood and contaminated water. May cause bacteremia, Guillain-Barré syndrome (GBS), hemolytic uremic syndrome (HUS) and recurrent colitis
Yersinia enterocolitica <10 y - 104 -106 1-11 d + + + + + Meats (pork, beef, lamb, etc.), oysters, fish, crabs, and raw milk. May cause reactive arthritis; glomerulonephritis; endocarditis; erythema nodosum.

can mimic appendicitis and mesenteric lymphadenitis.

Clostridium perfringens Any ages > 106 16 h - - + + + Meats (especially beef and poultry), meat-containing products (e.g., gravies and stews), and Mexican foods. Can survive high heat,
Vibrio cholerae Any ages - 106-1010 24-48 h - + + + + Seafoods, including molluscan shellfish (oysters, mussels, and clams), crab, lobster, shrimp, squid, and finfish. Hypotension, tachycardia, decreased skin turgor. Rice-water stools
Parasites Protozoa Giardia lamblia 2-5 y + 1 cyst 1-2 we - - + + + Contaminated water May cause malabsorption syndrome and severe weight loss
Entamoeba histolytica 4-11 y + <10 cysts 2-4 we - + + + + Contaminated water and raw foods May cause intestinal amebiasis and amebic liver abscess
Cryptosporidium parvum Any ages - 10-100 oocysts 7-10 d + + + + + Juices and milk May cause copious diarrhea and dehydration in patients with AIDS especially with 180 > CD4
Cyclospora cayetanensis Any ages + 10-100 oocysts 7-10 d - + + + + Fresh produce, such as raspberries, basil, and several varieties of lettuce. More common in rainy areas
Helminths Trichinella spp Any ages - Two viable larvae (male and female) 1-4 we - + + + + Undercooked meats More common in hunters or people who eat traditionally uncooked meats
Taenia spp Any ages - 1 larva or egg 2-4 m - + + + + Undercooked beef and pork Neurocysticercosis: Cysts located in the brain may be asymptomatic or seizures, increased intracranial pressure, headache.
Diphyllobothrium latum Any ages - 1 larva 15 d - - - + + Raw or undercooked fish. May cause vitamin B12 deficiency



Cryptosporidiosis must be differentiated from other diseases that may cause chronic diarrhea, weight loss, and abdominal pain especially in immunocompromised patients.

Disease Prominent clinical findings Laboratory or radiological findings
Chronic giardiasis[1]
Cryptosporidiosis[2]
  • Disease might be asymptomatic or cause gastroenteritis (but without any biliary involvement)
  • Gastroenteritis usually resolves spontaneously within 14 days.
  • Microscopic identification of the organism in the stool: The oocysts appear red on staining with modified acid fast staining
  • PCR: Most specific and sensitive diagnostic tool. PCR is expensive and used in limited cases.
Cystoisosporiasis (isosporiasis)[3]
  • Isospora ova or parasites can be visualized on stool microscopic examination.
  • Upper GI endoscopy may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
Tropical sprue[4]

References

  1. Thompson RC (2000). "Giardiasis as a re-emerging infectious disease and its zoonotic potential". Int. J. Parasitol. 30 (12–13): 1259–67. PMID 11113253.
  2. Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L (2006). "Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City". Am. J. Trop. Med. Hyg. 75 (6): 1095–8. PMID 17172373.
  3. Current WL, Garcia LS (1991). "Cryptosporidiosis". Clin. Microbiol. Rev. 4 (3): 325–58. PMC 358202. PMID 1889046.
  4. Klipstein FA, Schenk EA (1975). "Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure". Gastroenterology. 68 (4 Pt 1): 642–55. PMID 1091526.