Cryptosporidiosis: diagnosis

Laboratory diagnostics of cryptosporidiosis

The laboratory diagnosis of cryptosporidiosis does not reveal any specific changes. Severe course of cryptosporidiosis develops with a pronounced immunodeficiency (the number of CD4-lymphocytes is below 0.1x10 ⁹ / l), therefore, changes characteristic of its manifestations (eg, leukopenia and erythrocytopenia) are recorded in the analyzes.

At present, methods have been developed for the detection of oocysts of cryptosporidia in feces. To do this, apply methods of painting according to Tsiol-Nielsen, safranin Kester and azur-eosin by Romanovsky-Giemsa, as well as methods of negative staining. Flotation or sedimentation methods are used (if the material contains a small amount of oocysts), with the use of appropriate preservatives, oocysts can be found in the native material stored in the refrigerator for 1 year.

Recently, monoclonal antibodies with a fluorescent label have been used, which makes it possible to visualize the pathogen with high specificity and sensitivity. The reaction of fluorescent antibodies, ELISA and IB is used in epidemiological studies. It is possible to use molecular methods, in particular PCR.

Differential diagnosis of cryptosporidiosis

Differential diagnosis of cryptosporidiosis is carried out with diseases accompanied by diarrhea and dehydration, in particular with cholera (especially with outbreaks), amebiasis, salmonellosis, shigellosis, campylobacteriosis, and in patients with HIV infection with cytomegalovirus colitis, microsporidiosis, isospore, diseases of the biliary system.

Differential diagnosis of cryptosporidiosis and cholera

Symptoms	Cryptosporidiosis	Cholera
Clinical signs	Acute onset, marked diarrhea (frequent watery stool with fetid smell), development of dehydration for several days Moderate spasmodic pains in the abdomen Body temperature not higher than 38 ° C. In 50% of patients, nausea and vomiting. Symptoms self-stop (within 3-10 days) or quickly disappear on the background of rehydration therapy. In patients in the late stages of HIV infection, a chronic course leading to dehydration is depletion and death. In patients with involvement of the biliary system - signs of cholangitis. Cholecystitis	Acute onset, marked diarrhea (frequent stool in the form of rice broth), rapid development of symptoms of dehydration, depending on the degree of dehydration up to the algid. There are no abdominal pains. The body temperature does not increase. Vomiting appears after diarrhea
Laboratory indicators	Signs of dehydration, metabolic acidosis: with lesion of the bile excretory system - increased activity of ALT, ACT, APF. Oocysts of cryptosporidia are found in feces. Low rates of immune status (the number of CD4-lymphocytes in HIV infection is below 0.1x10 9 L)	Severity of metabolic acidosis depending on the degree of dehydration Cholera vibrio is found in vomit and feces
Epidemiological anamnesis	Communication with water outbreaks or occupational risk of HIV infection in advanced stages	Stay in the hearth of cholera

Differential diagnosis of cryptosporidiosis and cytomegalovirus colitis in patients with HIV infection

Cryptosporidiosis

CMV-colitis

An acute or subacute onset of diarrhea is a gradual increase in stool frequency for several weeks-months, which leads to a chronic course of the disease and the development of the Slim syndrome. Body temperature can rise to 38 ° C in many patients, the body temperature is normal. In patients with involvement of the biliary system - signs of cholangitis. Cholecystitis, increased activity of ALT, ACT, APF

The gradual onset of the disease, the prodromal period (the increase in stool frequency for several weeks and even months). In the midst of the disease, the stools are liquid with a frequency of 5-10 times a day. Characterized by severe pain in the lower abdomen is tenderness in palpation. Sometimes the symptoms of an acute abdomen. The body temperature rises to 38.5-40 ° C. In colonoscopy, erosions and ulcers are detected (the colon is most often affected.) High concentration of CMV DNA in the blood

[1], [2], [3], [4], [5], [6], [7], [8]