233.4 📌 章末速記

233.4.0.0.1 Giardia

• Cyst (chlorine-resistant) + trophozoite forms
• Foul-smelling, greasy steatorrhea + lactose intolerance post-infectious
• Stool antigen + PCR diagnosis
• Tinidazole single dose or metronidazole / nitazoxanide

233.4.0.0.2 Cryptosporidium

• Acid-fast + chlorine-resistant + Milwaukee 1993 outbreak
• Immunocompetent self-limited
• HIV CD4 < 100: chronic severe + cholangiopathy
• Nitazoxanide + ART critical

233.4.0.0.3 Cyclospora

• Foodborne (raspberries, basil)
• USA summer outbreaks
• Modified acid-fast + UV autofluorescence
• TMP-SMX × 7-10 d

233.4.0.0.4 Microsporidia

• Reclassified as fungi
• HIV chronic + disseminated
• Modified trichrome stain
• Albendazole (Encephalitozoon) / Fumagillin (E. bieneusi)

233.4.0.0.5 Cystoisospora

• Coccidian, HIV chronic diarrhea
• TMP-SMX × 7-10 d + secondary prophylaxis

233.4.0.0.6 Stool Studies

• Antigen tests (Giardia, Cryptosporidium) — high sensitivity
• Modified acid-fast (Crypto, Cyclospora, Cystoisospora)
• Modified trichrome (Microsporidia)
• PCR multiplex (BioFire) — broad

233.4.0.0.7 HIV + Chronic Diarrhea

• Differential: Crypto, Microsporidia, Cystoisospora, Cyclospora, CMV, MAC
• Multiplex stool + colonoscopy + biopsy + ART optimization
• TMP-SMX prophylaxis for some (PJP coverage doesn’t fully cover others)