II. Epidemiology

  1. Seen primarily in advanced HIV in Caribbean, SW USA

III. Pathophysiology

  1. Gastrointestinal infection

IV. Differential Diagnosis

V. Diagnosis

  1. Stool acid fast stain

VI. Management

  1. Trimethoprim-sulfamethoxazole (Bactrim, Septra, TMP-SMZ) DS
    1. Dose: Septra DS one tab twice daily for 7-10 days
    2. Longer course (for 3-4 weeks) or increased frequency (four times daily) may be required in HIV or AIDS
  2. Alternative agents
    1. Pyrimethamine 50 to 75 mg orally daily and folinic acid 10-25 mg orally daily
    2. Ciprofloxacin 500 mg twice daily for 7 days (limited evidence)

VII. Course

  1. Relapse in 50% of patients
  2. Chronic suppressive therapy may be necessary
    1. Example: Septra DS 1 tab orally three times weekly or once orally daily

VIII. References

  1. Gilbert (2016) Sanford Guide, on IOS, accessed 9/12/2016

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