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Digestive Diseases and Sciences

, Volume 41, Issue 11, pp 2286–2290 | Cite as

Diagnosis ofCryptosporidium parvum in patients with severe diarrhea and AIDS

  • Paul D. Greenberg
  • Johannes Koch
  • John P. Cello
Intestinal Pisorders, Inflammatory Bowel Pisease, Immunology, And Microbiology

Abstract

The sensitivity of noninvasive stool microscopy and endoscopic biopsies from the upper and lower gastrointestinal tract in the diagnosis ofCryptosporidium parvum in patients with AIDS is not known. We evaluated 30 severely immunocompromised patients with AIDS and diarrhea caused byC. parvum. C. parvum was diagnosed by either stool microscopy, endoscopic biopsy, or both. Patients submitted a mean (±sem) of 3.3±0.3 stool samples, each microscopically evaluated for ova and parasites. Upper and lower endoscopy were performed in all patients and endoscopic biopsies were taken throughout the gastrointestinal tract. Diarrhea had been present for a mean of 13.5 ± 2.3 months and mean daily stool weight was 1224 ± 127 g. Overall, individual stool samples were insensitive, as only 53% demonstratedC. parvum. When multiple stool samples were considered for each patient, 73% of subjects demonstratedC. parvum in at least one stool sample. The sensitivity of endoscopy with mucosal biopsy varied by anatomical location: stomach (11%), duodenum (53%), terminal ileum (91%), and colon (60%). The terminal ileum was significantly more likely than the duodenum to demonstrateC. parvum (P=0.03). Thus, duodenal biopsies are much less sensitive than those from the terminal ileum in the diagnosis ofC. parvum. In AIDS patients with diarrhea undergoing colonoscopy, intubation of the terminal ileum should be performed when feasible. Although individual stool samples are insensitive in detectingC. parvum, the diagnostic yield is improved by the collection of multiple samples.

Key words

Cryptosporidium parvum AIDS diarrhea diagnosis endoscopy stool microscopy 

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Copyright information

© Plenum Publishing Corporation 1996

Authors and Affiliations

  • Paul D. Greenberg
    • 1
  • Johannes Koch
    • 1
  • John P. Cello
    • 1
  1. 1.From the Division of Gastroenterology, Hepatology, and Clinical Nutrition, San Francisco General Hospital, Department of MedicineUniversity of CaliforniaSan Francisco

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