Case 2

A 29 year-old woman with AIDS was admitted with fever, profuse watery diarrhea and right upper quadrant abdominal pain for 23 days. outpatient stool evaluation disclosed Cryptosporidium parvum but no WBC's. Paromomycin and anti-diarrheal agents failed to stop the diarrhea. She had no tenesmus and denied blood in the stools. She felt warm but did not take her temperature.

Her past history includes HIV infection diagnosed 3 years ago. Oral candidiasis was diagnosed last year. She is single and lives with her mother and 9 year old daughter. She is actively using heroin and cocaine.

Physical Examination. She appeared weak and emaciated but in no acute distress.
T 37.10C, P 120/min, R 24/min, BP 90/50 supine.

Head, eyes, ears, nose and mouth were normal. There was no cervical adenopathy. Lungs were clear to percussion and auscultation. There were increased bowel sounds and mild diffuse abdominal tenderness most prominent in the right upper quadrant. The rectum was unremarkable and stool guaiac was negative. Extremities and neurological examinations were normal.

Laboratory Evaluations:

Hgb : 12.0
WBC : 2,900
Segs:   66 Lymphs: 15 Monos : 18 
Platelets : 203k/mm3 
Na : 133 meq/L  
K: 3.3 meq/L  
Cl : 107 meq/L 
CO2 : 14 meq/L
Creatinine : 2.3 mg/dl

X-rays of chest and abdomen : normal

In the hospital hyperalimentation was started. Octreotide plus azithromycin were started without effect.

Colonoscopy and EGD showed cryptosporidia on the colonic mucosa and in the area of the ampulla.. AFB blood cultures grew Mycobacterium avium complex and she was started on clarithromycin and ethambutol.

Questions

2. How is cryptosporidia acquired? 

3. How does cryptosporidia cause disease? 

4. How is it treated? 

5. What is Mycobacterium avium complex (MAC)?

6. Describe the pathogenesis of infection with MAC in persons infected with HIV.

7. What are the clinical manifestations of infection with MAC in persons with AIDS? 

8. How is infection with MAC diagnosed? What specimens are useful for culture?

9. Is infection with MAC treatable? What medications are used in its treatment? For prevention?