Case history

Case history #1

A previously healthy 2-year-old girl presents with voluminous diarrhoea that has lasted for 5 days, accompanied by some vomiting. She has been unable to eat much and is currently afebrile, although her mother reports some fever. No blood has been noted in the stool. The illness started a week after a visit to a petting farm where she stroked several of the animals, including calves.

Case history #2

A 41-year-old man with HIV infection complains of persistent, rather watery diarrhoea that has been continuing for several months. He has noted no blood in his stools but has lost weight. He has not been taking antiretroviral therapy, and his CD4 lymphocyte count is 48/mm^3.

Other presentations

Cryptosporidium may cause chronic intractable and life-threatening disease in people with deficient T-cell function, particularly those with primary T-cell immune deficiencies, advanced HIV infection, lymphoma, or leukemia (especially children).[1] The whole GI tract, including the gallbladder and pancreatic duct, can be affected, which may lead to pancreatitis, cholecystitis, sclerosing cholangitis, and, rarely, consequent biliary cirrhosis.[1]

Tracheobronchial involvement is uncommon but can occur, and sinusitis has also been described in these groups. Cryptosporidiosis in a patient with advanced HIV infection may rarely present as pneumoretroperitoneum as a result of pneumatosis cystoides intestinalis, in which gas-containing cysts occur in the gut wall and may rupture.[1]

Asymptomatic carriage also occurs, at least among young children, including those in industrialised countries.[12][13][14][15][16][17][18]​​ In low-middle income countries, large scale studies have demonstrated that Cryptosporidium infection causes lasting health impacts and high mortality in malnourished infants and young children. Ongoing malnutrition, stunted growth, wasting and cognitive deficit are among the impacts across sub-Saharan Africa, South America and South East Asia.[19][20][21][22][23][24]​​[25][26]​​

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