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Microbiology · Parasitology: Cryptosporidium
Sample itemA man with HIV and a CD4 count of 40 per microlitre has had profuse watery diarrhoea for 6 weeks. Which stool test identifies the likely pathogen?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Modified acid-fast stain showing 4 to 6 micrometre oocysts
Cryptosporidium is a coccidian parasite that causes severe prolonged watery diarrhoea in advanced HIV. Its small oocysts stain with modified Ziehl-Neelsen (modified Kinyoun) stain and can also be detected by antigen assays. Restoring immunity with antiretroviral therapy is the key treatment, with nitazoxanide as an adjunct.
Option by option
A. Gram stain showing curved Gram-negative rods
Curved Gram-negative rods suggest Vibrio cholerae, a bacterium that is not identified by acid-fast staining.
B. Modified acid-fast stain showing 4 to 6 micrometre oocysts (correct)
Correct. Acid-fast small oocysts identify Cryptosporidium.
C. Saline mount showing operculate eggs
Operculate eggs indicate flukes such as Fasciola or Clonorchis.
D. Iodine wet mount showing large cysts with chromatoidal bars
Large cysts with chromatoidal bars describe Entamoeba histolytica, which causes dysentery.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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