Tap Water Enema and Cryptosporidium Infection in Acute HIV Infection

1Beth Israel Medical Center, New York, NY

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 279

Case Presentation:

A 20‐year‐old African American man with a history of MSM (having sex with men) and previously treated for syphilis was admitted with 3 weeks of watery nonbloody diarrhea. Two weeks after symptoms started, the patient went to an outside hospital emergency room. At that time the patient was empirically started on ciprofloxacin and metronidazole and discharged home without stool cultures. The patient's symptoms did not improve, and subsequently he came to our institution. At that time the patient denied fever, nausea, vomiting, or abdominal pain. The patient also denied any international travel, water park activities, or consumption of well water. The patient's current partner was HIV+. Physical exam was unremarkable. Patient's laboratory analysis was significant for leukopenia (3.4 × 103/μL), hyponatremia (131 mmol/ L), and renal insufficiency (1.62 mg/dL). Stool studies including stool cultures and Clostridium difficile assays were negative. Stool for ova and parasites revealed Cryptosporidium by Ziehl‐Neelsen stain. The patient reported that he and his partner routinely use tap water enemas prior to unprotected anal intercourse. HIV antibody was negative. The HIV RNA polymerase chain reaction was >500,000 copies/mL, and CD4 count was 399 cells/mL. The patient was prescribed nitazoxanide 1 g twice daily for a total of 14 days. Patient's diarrheal symptoms improved from 20 episodes down to 3–4 episodes of diarrhea per day at the time of discharge. Patient was sent home with plans for follow‐up in the hospital's HIV clinic.


Cryptosporidium infection is responsible for causing persistent watery diarrhea in children as well as in immunocompromised patients, including HIV + patients, but also causes self‐limited disease in healthy exposed persons. Patients are usually infected via ingestion of oocytes from a contaminated water source. Common sources of Cryptosporidium ingestion are usually attributed to unpurified water or from swallowing recreational water despite chlorination. The incidence of Cryptosporidium infection has fluctuated over the years because of various outbreaks; however, it generally presents at an average rate of 2–3 cases per 100,000 per year. These rates may be underreported, as the diarrhea is generally self‐limited in immunocompetent individuals. The introduction of highly active retroviral therapy has seen a decrease in HIV‐associated cryptosporidiosis. It should be noted that cryptosporidial disease in AIDS patients with low CD4 cell counts has a high mortality. The literature of a possible association between tap water enema and Cryptosporidium infection is limited.


Providers should remember to evaluate stool for cryptosporidia in acute diarrheal illness, especially with known risk factors and in immunocompromised patients. Cryptosporidium infection may be associated with the use of tap water enema and may be the initial presenting illness in acute HIV infection.


G. Francis ‐ none; D. Perlman ‐ none; D. Rizk ‐ none

To cite this abstract:

Francis G, Perlman D, Rizk D. Tap Water Enema and Cryptosporidium Infection in Acute HIV Infection. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 279. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/tap-water-enema-and-cryptosporidium-infection-in-acute-hiv-infection/. Accessed March 31, 2020.

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