Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with severe, chronic, watery, non-bloody diarrhea (frequency >6-10 episodes/day), associated with significant weight loss, nausea, and diffuse abdominal cramping. Known history of HIV with recent CD4 count <100 cells/ยตL. Denies recent travel or known sick contacts. Symptoms are refractory to conservative management.
Clinical Examination Findings
General: Patient appears cachectic, dehydrated, and chronically ill. Vitals: Tachycardic, hypotensive, afebrile. Abdomen: Soft, non-distended, hyperactive bowel sounds, diffuse tenderness to palpation without guarding or rebound. Skin: Poor turgor, dry mucous membranes. Neurological: Alert and oriented, no focal deficits.
Treatment Protocol
1. Nitazoxanide 500 mg PO BID for 14 days (efficacy limited in severe immunocompromise). 2. Optimization of Antiretroviral Therapy (ART) is the definitive treatment to restore immune function. 3. Aggressive fluid and electrolyte resuscitation (IV NS/LR). 4. Nutritional support (high-calorie, low-residue diet). 5. Antimotility agents (Loperamide/Octreotide) for symptomatic control if refractory.