Cryptosporidium/Criptosporidiosis

Características Generales de Cryptosporidium

• Género Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome: 
  • Parásito protozoario apicomplejo
  • > 30 especies
  • Especies clínicamente relevantes (causan > 90% de infecciones humanas):
    • Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome hominis (anteriormente, C. parvum genotipo 1)
    • Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome parvum (anteriormente, C. parvum genotipo 2)
• Causa la enfermedad criptosporidiosis
• Transmisión fecal-oral
• El ciclo de vida requiere un único huésped (monoxeno).
• El organismo no se multiplica fuera del huésped.
• Los LOS Neisseria ooquistes existen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 2 formas morfológicas:
  • Estructuras de paredes finas, que permanecen en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el huésped y causan autoinoculación (infección de células huéspedes cercanas).
  • Estructuras de paredes gruesas, que salen del huésped en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las heces.
• Las infecciones son zoonóticas o antroponóticas.

Epidemiología y Factores de Riesgo

Epidemiología

• Causa importante de diarrea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños y adultos a nivel mundial
• 2da causa más frecuente de enfermedad diarreica moderada a severa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños menores de 24 meses en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum África y Asia ASIA Spinal Cord Injuries.
• Incidencia por edad:
  • Más común: niños < 5 años
  • 2da más frecuente: mujeres en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum edad fértil
  • Poco frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum adultos inmunocompetentes de países desarrollados
• Seroprevalencia (es decir, criptosporidiosis en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum algún momento de la vida) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum EE.UU: estimada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un 25%-35%.
• Grupos con mayor prevalencia:
  • Pacientes inmunocomprometidos
  • Productores de lácteos
• La infección es más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Climas/condiciones cálidos:
    • Las infecciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum EE.UU. alcanzan su pico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum julio-septiembre.
    • Las infecciones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el Reino Unido alcanzan su pico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum primavera (asociadas a C. parvum y animales de granja) y otoño (asociadas a C. hominis y aguas recreativas).
  • Periodos lluviosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum zonas endémicas

Factores de riesgo

• Hacinamiento
• Condiciones sanitarias deficientes (defecación al AL Amyloidosis aire libre)
• Contacto con animales infectados
• Consumo de agua no filtrada ni tratada
• Ingesta de agua recreativa contaminada (por ejemplo, de piscinas)
• Exposición a materia fecal por contacto sexual
• Inmunosupresión/inmunodeficiencias, incluyendo:
  • Pacientes con infección por VIH con recuento de CD4 < 100 células/μL.
  • Terapia inmunosupresora/pacientes trasplantados de órganos
  • Cáncer
  • Hipogammaglobulinemia

Fisiopatología

Reservorios

• C. hominis infecta principalmente a los LOS Neisseria humanos
• C. parvum infecta principalmente a los LOS Neisseria seres humanos y a otros mamíferos, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum particular al AL Amyloidosis ganado.
• Otras especies de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome infectan:
  • Humanos
  • Otros mamíferos (ganado, roedores, gatos, perros y cobayos)
  • Pájaros
  • Reptiles y peces

Transmisión

La transmisión se produce por vía fecal-oral. La ingestión de ooquistes de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome inicia la infección. Las diferentes fuentes de transmisión son:

• Agua contaminada:
  • Fuentes comunes:
    • Piscinas (brotes asociados a aguas recreativas)
    • Agua potable contaminada
    • Estanques naturales
  • Responsable de brotes comunitarios y diarrea del viajero
  • Los LOS Neisseria ooquistes están presentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de las masas de agua superficiales.
  • La erradicación de los LOS Neisseria ooquistes es difícil porque son resistentes a un gran número de desinfectantes, incluido el cloro.
• Contacto de persona a persona: 
  • Comúnmente se propaga entre:
    • Miembros del hogar
    • Parejas sexuales
    • Niños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum guarderías
    • Cuidadores de niños en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria grupos de edad susceptibles
    • Trabajadores de la salud
  • Tanto C. hominis como C. parvum están implicados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la transmisión de persona a persona.
• Contacto animal: 
  • Exposición a heces de animales infectados con ooquistes
  • Comúnmente se propaga entre:
    • Estudiantes de veterinaria
    • Productores de lácteos
• Comida contaminada: 
  • La exposición es menos frecuente que los LOS Neisseria brotes transmitidos por el agua
  • Se han notificado brotes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la literatura en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum asociación con:
    • Productos crudos
    • Leche de cabra y vaca no pasteurizada
    • Sidra de manzana
    • Carne asada

Ciclo Vital

La infección se inicia por la ingesta de ooquistes completamente esporulados y resistentes al AL Amyloidosis ambiente.

1. Ooquistes activados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el estómago y la parte superior del intestino → exquistación, liberación de 4 esporozoítos móviles
2. Los LOS Neisseria esporozoítos penetran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la capa mucosa y se adhieren a los LOS Neisseria enterocitos con borde en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cepillo.
3. Se forma una vacuola alrededor del parásito:
   • Se localiza dentro de la membrana plasmática de la célula huésped pero fuera del citoplasma
   • Desencadena la diferenciación de los LOS Neisseria esporozoítos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum trofozoítos .
4. La reproducción asexual ( mitosis Mitosis A type of cell nucleus division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. Cell Cycle) dentro de la vacuola conduce a la formación de un meronte de tipo I, que finalmente produce 6-8 merozoítos de tipo I (similares a los LOS Neisseria esporozoítos).
5. Los LOS Neisseria merozoítos escapan de la vacuola y siguen cualquiera de los LOS Neisseria dos caminos:
   • Continúan los LOS Neisseria ciclos de reproducción asexual: se adhieren a los LOS Neisseria enterocitos → formación de vacuolas → merontes de tipo I → merozoítos.
   • Entran en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ciclo de reproducción sexual: forman un meronto de tipo II → producen 4 merozoítos de tipo II
6. Merozoítos de tipo II:
   • Infectan los LOS Neisseria enterocitos cercanos
   • Forman un gameto indiferenciado que finalmente produce solo uno de los LOS Neisseria siguientes:
     • Macrogamonte (hembra)
     • Microgamonte (macho)
7. El microgamonte libera ≥ 16 microgametos, cada uno de los LOS Neisseria cuales fecunda a un macrogamonte para formar un cigoto diploide.
8. El cigoto diploide se diferencia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un ooquiste, que puede ser:
   • Pared fina (20%) → permanece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el huésped y causa autoinfección (infección de células huéspedes cercanas).
   • Pared gruesa (80%) → excretado por el huésped en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las heces.

Patogénesis

Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome causa diarrea secretora asociada a malabsorción.

• Localización del parásito:
  • Se implanta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las células intestinales epiteliales (enterocitos)
  • Intracelular pero extracitoplasmática
• Implantación parasitaria → distorsión de las microvellosidades (puede causar inflamación) → interfiere en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la absorción y secreción → diarrea secretora.
• Los LOS Neisseria hallazgos típicos incluyen:
  • Aumento de la permeabilidad intestinal/reducción de la función de barrera
  • Secreción de cloruro
  • Hiperplasia de las criptas
  • Atrofia vellositaria → ↓ superficie de absorción.
  • Malabsorción de glucosa
• Extensión de la enfermedad:
  • Pacientes inmunocompetentes → la infección suele limitarse al AL Amyloidosis intestino delgado.
  • Pacientes inmunocomprometidos → la infección puede implicar:
    • Vías biliares e hígado
    • Páncreas
    • Mucosa gástrica
    • Tracto respiratorio

Presentación Clínica

Espectro de la enfermedad

• Asintomático
• Leve: diarrea autolimitada
• Grave: enteritis Enteritis Inflammation of any segment of the small intestine. Lactose Intolerance importante, potencialmente con afectación extraintestinal

Curso de la enfermedad

• Periodo de incubación: aproximadamente 5-10 días
• Típicamente, dura 10-14 días (autolimitada)
• Puede cronificarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocomprometidos

Síntomas

La criptosporidiosis sintomática se presenta con:

• Diarrea:
  • Más común: profusa y acuosa (hasta 25 L/día) → puede llevar a la depleción de volumen.
  • Intermitente o continua
• Malestar
• Náuseas
• Anorexia Anorexia The lack or loss of appetite accompanied by an aversion to food and the inability to eat. It is the defining characteristic of the disorder anorexia nervosa. Anorexia Nervosa
• Dolor Dolor Inflammation abdominal tipo cólico
• Fiebre baja
• Los LOS Neisseria pacientes inmunocomprometidos también pueden presentar enfermedad extraintestinal:
  • Colecistitis
  • Colangitis
  • Hepatitis
  • Pancreatitis Pancreatitis Inflammation of the pancreas. Pancreatitis is classified as acute unless there are computed tomographic or endoscopic retrograde cholangiopancreatographic findings of chronic pancreatitis. The two most common forms of acute pancreatitis are alcoholic pancreatitis and gallstone pancreatitis. Acute Pancreatitis
  • Enfermedad pulmonar

Complicaciones

La criptosporidiosis se asocia a las siguientes complicaciones (más frecuentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocomprometidos):

• Secuelas a largo plazo ( los LOS Neisseria síntomas persisten tras la resolución de la infección aguda):
  • Dolor Dolor Inflammation abdominal
  • Diarrea
  • Síndrome de intestino irritable
  • Pérdida de peso
  • Artralgia
  • Dolor Dolor Inflammation ocular
  • Cefaleas y mareos
  • Fatiga
• Colangiopatía del SIDA: 
  • Infección crónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el tracto biliar → inflamación crónica → estenosis y obstrucción biliar.
  • Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome es el patógeno más común.
  • Puede evolucionar a colangitis esclerosante → colestasis e insuficiencia hepática
  • Aumenta el riesgo de colangiocarcinoma

Diagnóstico

Los LOS Neisseria exámenes parasitológicos de heces no incluyen regularmente el descarte de criptosporidiosis, a menos que haya un brote de diarrea. Si se sospecha la presencia de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome, debe solicitarse una prueba específica cuando se envíen las muestras al AL Amyloidosis laboratorio.

Métodos de diagnóstico

• Microscopía con tinción ácido alcohol resistente modificada de Ziehl-Neelsen:
  • Busca ooquistes parasitarios
  • Los LOS Neisseria ooquistes se tiñen de rojo o rosa.
  • 4-6 μm de diámetro
• Inmunofluorescencia directa: 
  • Anticuerpos marcados con fluoresceína dirigidos contra antígenos de la pared celular de ooquistes
  • Considerado el patrón oro en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el diagnóstico de la criptosporidiosis
• Ensayo inmunoabsorbente ligado a enzimas ( ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus): 
  • De uso común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum investigaciones epidemiológicas
  • No es tan sensible como la PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
• Reacción en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cadena de la polimerasa ( PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)): 
  • Alta sensibilidad
  • Puede diferenciar entre los LOS Neisseria distintos genotipos de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome.
  • Herramienta útil en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum investigaciones epidemiológicas.
• Histopatología de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome (tinción H&E):
  • Aspecto basófilo
  • Solitarios o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum grupos
  • Presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el borde en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cepillo de la superficie mucosa
  • Normalmente, es menos sensible que el examen de heces, ya que las infecciones pueden ser “irregulares” en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todo el intestino.
• Muestras para análisis:
  • Heces:
    • Más común; suele ser la 1era muestra solicitada
    • La toma de muestras durante 3 días aumenta la sensibilidad porque la excreción de ooquistes es intermitente.
  • Aspirado duodenal
  • Secreciones biliares
  • Biopsia del tejido GI afectado
  • Secreciones respiratorias

Imagenología

• Hallazgos inespecíficos, pero pueden ayudar al AL Amyloidosis diagnóstico
• La TC, la radiografía abdominal o el ultrasonido abdominal pueden mostrar:
  • Distensión de las asas intestinales
  • Niveles de aire-líquido
  • Vesícula biliar agrandada
  • Vías biliares dilatadas o irregulares
• Colangiopancreatografía retrógrada endoscópica (CPRE) o colangiopancreatografía por resonancia magnética (CPRM):
  • Considerar cuando se sospecha enfermedad biliar
  • Puede permitir una intervención terapéutica simultánea

Pruebas serológicas

En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos con diarrea importante:

• Electrolitos (evaluar la necesidad de reposición, estado de volumen)
• Pruebas de función hepática/enzimas pancreáticas (evaluar la posible afectación hepática/pancreática)
• Pruebas del VIH en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con criptosporidiosis prolongada

Tratamiento y Prevención

Tratamiento

La mayoría de los LOS Neisseria pacientes son asintomáticos o presentan una enfermedad leve. El tratamiento de soporte es el enfoque principal.

• Reposición de líquidos y electrolitos → para compensar la pérdida de volumen debida a la diarrea grave, incluyendo:
  • Reposición de volumen (oral o IV)
  • Electrolitos (sodio, potasio y bicarbonato)
  • Glucosa
• Apoyo nutricional:
  • Dieta sin lactosa hasta la recuperación
  • Considerar la nutrición parenteral en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con persistencia crónica de los LOS Neisseria síntomas (> 4-6 semanas), que se asocia a caquexia.
• Antidiarreicos (administrados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de pérdida excesiva de líquidos):
  • Loperamida
  • Combinación de difenoxilato y atropina
  • Tintura de opio
  • Octreótide ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum criptosporidiosis crónica)
• Antiparasitario (nitazoxanida):
  • Único medicamento aprobado por la FDA en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum EE.UU. para el tratamiento de la criptosporidiosis.
  • Normalmente, se reserva para cuadros severos y para pacientes inmunocomprometidos.
  • Inhibe el crecimiento de los LOS Neisseria trofozoitos de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome
  • Acorta la duración de la diarrea
  • Disminuye la mortalidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niños malnutridos
  • Indicada para adultos y niños > 12 meses de edad

Tratamiento de pacientes inmunocomprometidos

La criptosporidiosis es una de las infecciones oportunistas que pueden aparecer en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con infección por VIH.

• Iniciar terapia de soporte
• Continuar (o iniciar) la terapia antirretroviral (TAR) para restablecer la función inmunológica:
  • A menudo necesaria para eliminar la infección
  • Los LOS Neisseria inhibidores de la aspartil proteasa tienen un efecto directo beneficioso sobre el ciclo de vida de Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome.
• Administrar terapia antiparasitaria:
  • Nitazoxanida:
    • Menos efectiva en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocomprometidos
    • Puede administrarse a pacientes con enfermedad severa o síntomas persistentes que no responden a otros tratamientos.
  • Paromomicina:
    • Un aminoglucósido no absorbible con actividad parcial contra Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome
    • Se utiliza si la nitazoxanida está contraindicada
  • Azitromicina:
    • Puede administrarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum combinación con nitazoxanida o paromomicina
    • Proporciona alivio sintomático
• El tratamiento de la colangiopatía del SIDA puede incluir:
  • Colecistectomía (para manejo de colecistitis acalculosa)
  • CPRE con esfinterotomía biliar (para manejo de colangitis esclerosante)
  • Colocación endoscópica de endoprótesis (para manejo de estenosis biliar)
  • Ácido ursodesoxicólico (para manejo de colestasis intrahepática)

Prevención

• Agua:
  • Vigilar regularmente las fuentes comunes implicadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la transmisión, especialmente el agua potable.
  • Consumir agua filtrada.
  • Evitar la ingestión de aguas recreativas (por ejemplo, piscinas).
• Buenas prácticas de higiene
• Utilizar guantes para manipular pañales sucios en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum guarderías y hospitales.
• Los LOS Neisseria pacientes infectados deben recibir asesoramiento para evitar la propagación de la enfermedad:
  • Evitar las aguas recreativas hasta 2 semanas después de la resolución de los LOS Neisseria síntomas.
  • Realizar un excelente lavado de manos. (Nota: los LOS Neisseria desinfectantes a base de alcohol no son efectivos contra Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome).
• Las poblaciones de riesgo deben limitar la exposición evitando el contacto con fuentes de transmisión públicas o comunes.

Diagnóstico Diferencial

• Giardiasis Giardiasis An infection of the small intestine caused by the flagellated protozoan giardia. It is spread via contaminated food and water and by direct person-to-person contact. Giardia/Giardiasis: enfermedad diarreica causada por el protozoario Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles lamblia. El espectro de la enfermedad va VA Ventilation: Mechanics of Breathing de asintomática a diarrea severa y malabsorción. La mayoría de los LOS Neisseria pacientes presentan diarrea, distensión abdominal, dolor Dolor Inflammation abdominal, náuseas, vómitos y esteatorrea fétida. Diagnosticado por inmunofluorescencia directa y microscopía de heces. El tratamiento incluye terapia de soporte y antimicrobiana.
• Enteritis Enteritis Inflammation of any segment of the small intestine. Lactose Intolerance por rotavirus Rotavirus A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. Seven species (rotaviruses A through G) are recognized. Rotavirus: causa frecuente de diarrea en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la población pediátrica. La enteritis Enteritis Inflammation of any segment of the small intestine. Lactose Intolerance por rotavirus Rotavirus A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. Seven species (rotaviruses A through G) are recognized. Rotavirus cursa con vómitos, fiebre y diarrea acuosa. Se diagnostica mediante pruebas inmunológicas y PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR). El tratamiento es principalmente de soporte, que puede incluir líquidos intravenosos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos de deshidratación severa.
• Microsporidiosis Microsporidiosis Microsporidia are a group of obligate intracellular organisms that were recently reclassified as fungi. The most common species of Microsporidia is Enterocytozoon bieneusi. Microsporidia species are ubiquitous, with a wide range of reservoirs. Immunocompromised individuals (particularly those with AIDS and a CD4 count < 100 cells/µL) most commonly develop symptomatic microsporidiosis. Microsporidia/Microsporidiosis: Los LOS Neisseria microsporidios son organismos intracelulares obligados (recientemente reclasificados como hongos) que infectan principalmente a individuos inmunocomprometidos. La microsporidiosis Microsporidiosis Microsporidia are a group of obligate intracellular organisms that were recently reclassified as fungi. The most common species of Microsporidia is Enterocytozoon bieneusi. Microsporidia species are ubiquitous, with a wide range of reservoirs. Immunocompromised individuals (particularly those with AIDS and a CD4 count < 100 cells/µL) most commonly develop symptomatic microsporidiosis. Microsporidia/Microsporidiosis se presenta clínicamente con diarrea acuosa, dolor Dolor Inflammation abdominal, fiebre e inflamación ocular. Los LOS Neisseria síntomas pueden volverse crónicos y provocar malabsorción y emaciación. El diagnóstico se confirma mediante el examen microscópico de las muestras de heces recogidas. El trastorno se trata mediante la administración de agentes antifúngicos como el albendazol.
• Ciclosporiasis: infección causada por Cyclospora cayetanensis Cyclospora Cayetanensis Cystoisospora/Cystoisosporiasis and Cyclospora/Cyclosporiasis, un protozoario intracelular obligado que causa enfermedad gastrointestinal. La enfermedad provoca diarrea acuosa, que puede durar semanas o meses si no se trata. El diagnóstico se realiza mediante la identificación de ooquistes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum muestras de heces. El tratamiento incluye terapia antimicrobiana, como trimetoprim-sulfametoxazol.
• Diarrea del viajero: gastroenteritis Gastroenteritis Gastroenteritis is inflammation of the stomach and intestines, commonly caused by infections from bacteria, viruses, or parasites. Transmission may be foodborne, fecal-oral, or through animal contact. Common clinical features include abdominal pain, diarrhea, vomiting, fever, and dehydration. Gastroenteritis causada generalmente por bacterias, virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology o parásitos presentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el agua local, como Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli enterotoxigénica (ECET), Campylobacter Campylobacter Campylobacter (“curved bacteria”) is a genus of thermophilic, S-shaped, gram-negative bacilli. There are many species of Campylobacter, with C. jejuni and C. coli most commonly implicated in human disease. Campylobacter o norovirus Norovirus Norovirus is a nonenveloped, single-stranded, positive-sense RNA virus belonging to the Caliciviridae family. Norovirus infections are transmitted via the fecal-oral route or by aerosols from vomiting. The virus is one of the most common causes of nonbacterial gastroenteritis epidemic worldwide. Symptoms include watery and nonbloody diarrhea, nausea, vomiting, and low-grade fever. Norovirus. (Nota: Cryptosporidium Cryptosporidium A genus of coccidian parasites of the family cryptosporidiidae, found in the intestinal epithelium of many vertebrates including humans. Hyper-IgM Syndrome también puede causar diarrea del viajero.) Los LOS Neisseria síntomas aparecen tras el consumo de agua o alimentos contaminados e incluyen diarrea acuosa, malestar y calambres abdominales. El diagnóstico es clínico y la enfermedad es autolimitada.
• Enfermedad celíaca: enfermedad mediada inmunológicamente que provoca inflamación de la mucosa y atrofia de las vellosidades del intestino delgado; causada por la ingestión de gluten Gluten Prolamins in the endosperm of seeds from the triticeae tribe which includes species of wheat; barley; and rye. Celiac Disease. Los LOS Neisseria síntomas incluyen distensión abdominal y diarrea fétida. Los LOS Neisseria pacientes también pueden presentar deficiencias nutricionales y pérdida de peso debido a la malabsorción. El diagnóstico se establece con marcadores serológicos y una biopsia del intestino delgado. El tratamiento requiere una dieta estricta sin gluten Gluten Prolamins in the endosperm of seeds from the triticeae tribe which includes species of wheat; barley; and rye. Celiac Disease.
• Enfermedad inflamatoria intestinal: incluye la enfermedad de Crohn y la colitis Colitis Inflammation of the colon section of the large intestine, usually with symptoms such as diarrhea (often with blood and mucus), abdominal pain, and fever. Pseudomembranous Colitis ulcerosa. La enfermedad inflamatoria intestinal se caracteriza por una inflamación crónica del tracto gastrointestinal debida a una respuesta inmunológica mediada por células en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mucosa gastrointestinal. Los LOS Neisseria síntomas incluyen diarrea, dolor Dolor Inflammation abdominal, pérdida de peso y manifestaciones extraintestinales. El diagnóstico se realiza por imagen, endoscopia y biopsia. El tratamiento incluye esteroides, aminosalicilatos, inmunomoduladores y agentes biológicos.
• Intolerancia a la lactosa: intolerancia a los LOS Neisseria alimentos que contienen lactosa debido a la deficiencia de lactasa. Los LOS Neisseria síntomas incluyen dolor Dolor Inflammation abdominal tipo cólico, distensión abdominal, náuseas y diarrea después de ingerir lactosa. El diagnóstico se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la asociación con alimentos que contienen lactosa y en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una prueba de hidrógeno en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aliento de tolerancia a la lactosa. El tratamiento incluye la restricción de lactosa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la dieta y la sustitución de enzimas.