A 38-year-old man with HIV (CD4 count 55 cells/μL) reports 6 weeks of profuse watery, non-bloody diarrhoea unresponsive to antibiotics. Stool examination shows small acid-fast positive oocysts. Which statement about this condition is correct?
- A It resolves fully with nitazoxanide even without immune recovery
- B It is caused by a protozoan transmitted exclusively through sexual contact
- C The definitive management is effective antiretroviral therapy restoring CD4 count above 100 cells/μL ✓
- D Metronidazole is the treatment of choice
Correct answer: C. The definitive management is effective antiretroviral therapy restoring CD4 count above 100 cells/μL
Explanation
Cryptosporidium parvum causes chronic secretory diarrhoea in advanced AIDS, diagnosed by acid-fast oocysts in stool or modified Ziehl-Neelsen stain. There is no reliably curative antimicrobial; nitazoxanide has limited efficacy in immunocompromised hosts. Definitive control comes from ART-driven immune reconstitution above approximately 100 cells/μL. Transmission is faeco-oral via contaminated water, not exclusively sexual. Metronidazole targets Entamoeba and Giardia, not Cryptosporidium.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.