White and red blood cells should not be seen in the stool. Elevated alkaline phosphatase and glutamyl transpeptidase without hyperbilirubinemia are typical signs of biliary infection. When the counts are greater than 200, the diarrhea is likely to resolve spontaneously. Identification of cryptosporidia in bile confirms the diagnosis of cryptosporidiosis. Papillary stenosis may be present.
Small intestine shows the parasite projecting from the brush border of the mucosal surface.
Selective antibiotics are worth trying in scenarios where cryptosporidiosis is a significant clinical problem and does not appear to be improving in the absence of intervention. Symptomatic therapy includes treatment with antidiarrheal agents, eg, loperamide or diphenoxylate-atropine. Treatment is usually not required for cryptosporidiosis in patients who are immunocompetent and no clinical trials have convincingly demonstrated efficacy of antimicrobics. Attention to nutritional aspects of patient care is crucial because malnutrition can cause death. Enteral nutrition frequently exacerbates the diarrhea.