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Opportunistic Infections: TreatmentQuestion 19/20

A 26-year-old woman presents to an emergency room for evaluation of diarrhea. She is visiting from Haiti and arrived in the United States 2 weeks ago. She describes multiple daily episodes of watery, nonbloody diarrhea associated with low-grade fever, bloating, cramping abdominal pain, and anorexia.  She is not taking any medications. A modified acid-fast stain of a stool sample demonstrates large (15 to 30 µm), red, elliptical-shaped oocysts (Figure 1). A point-of-care HIV antigen-antibody test is reactive. 

In addition to starting antiretroviral therapy, which one of the following antimicrobial regimens is recommended as appropriate acute therapy for this gastrointestinal infection?

This modified acid fast stain of a stool sample shows an <em>I. belli</em> sporoblast, which are typically 15 by 30 microns in size.
Figure 1. Modified Acid-Fast Stain of a Stool Sample.
This modified acid fast stain of a stool sample shows an I. belli sporoblast, which are typically 15 by 30 microns in size.
Image courtesy of Carolyn Wallis, Harborview Medical Center Microbiology Laboratory.
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Question Last Updated
April 30th, 2026

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