Monday, March 21, 2011

Case of the Week 154

A biopsy of the large intestine was performed on a 43 year old HIV positive male with chronic watery diarrhea. Hematoxylin and eosin stained sections are shown below, which reveal multiple small (5-7 micron diameter) objects that appear to sit on the mucosal surface.

Large intestine mucosal surface, 400x original magnification. Objects of interest shown by arrow heads.


1000x original magnification


Deep mucosal crypt in the large intestine, 400x original magnification


1000x original magnification


What additional tests could be performed for confirmation?
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7 comments:

  1. Alasdair HillMarch 21, 2011 at 9:09 AM

    Difficult one! I think it might be Cryptosporidium pavum owing to the site and morphology of the parasite, the symptoms and the fact the patient is HIV positive; crypto can be fatal in HIV+ and is one of the most common infections assoc. with HIV.

    Other tests include Z-N staining...is there an antigen test for this????

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  2. AnonymousMarch 21, 2011 at 10:08 AM

    Cryptosporidium -- used a modified acid-fast stain to confirm.

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  3. AnonymousMarch 21, 2011 at 12:21 PM

    Cryptosporidium oocysts. Should be about 5 microns in diameter. If an AIDS patient, look also for Isospora belli.

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  4. AnonymousMarch 21, 2011 at 12:43 PM

    Cryptosporidia. We've seen lot's in SF and oddly almost never recognized isospora on biopsy which is intraepithelial usually (only see maybe 1/yr in stool so I don't think just stupid pathologist).

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  5. AnonymousMarch 22, 2011 at 11:38 AM

    Agree: Cryptosporidium

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  6. AnonymousMarch 22, 2011 at 6:31 PM

    Cryptosporidium, and I believe there is an antigen test, and also PCR for this, though not widely done.

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  7. Lukus RobertsApril 1, 2011 at 8:27 AM

    Agree - Cryptosproidium pavum

    stool sample examination?

    ReplyDelete