Chronic Diarrhea in a Traveler Patient History A 21-year-old male presents with

Question

Chronic Diarrhea in a Traveler

Patient History

A 21-year-old male presents with a 6-week history of watery diarrhea and crampy abdominal pain. He reports that the diarrhea has not been constant and has alternated with periods of constipation. For the past 2 weeks, the diarrhea has been blood streaked, and he has had several weeks of mid-epigastric pain. He spent the last 6 months in a rural community in Guatemala participating in a community service project sponsored by his college. He returned from Guatemala just 10 days ago. While there, he drank the water and ate the food available in the local community, and he did not regularly boil the water for drinking. He denies antibiotic exposure but was taking mefloquine weekly for malaria prophylaxis. Two separate stool specimens taken by student health when he returned were reported as negative for Salmonella, Shigella, Campylobacter, E. coli 0157:H7, Yersinia, Aeromonas, and Plesiomonas, as well as Giardia lamblia. On physical examination, he appeared well-nourished and well-developed but reported an 8–10 pound weight loss. He was afebrile with a blood pressure of 110/80 mm Hg, pulse rate of 84/min, respirations of 14/min, and his lungs were clear. The abdominal examination was significant for tenderness localized to the right upper quadrant without rebound tenderness, but no mass or hepatomegaly was appreciated.

Traveler’s diarrhea is loose, watery diarrhea that occurs within the first week of arriving in a new country. The diarrhea is usually accompanied by nausea, vomiting, abdominal cramps, and fever; however, the disease is self-limited, and the average length of illness is 3–5 days. Because his symptoms have persisted for 6 weeks, the patient is unlikely to have traveler’s diarrhea. Infectious and noninfectious causes include bacteria, parasites, ulcerative colistis, diverticulitis, and carcinoma. As the symptoms have persisted longer than a week, consider parasites as an infectious cause.

Assignment

Provide a 1-page report on this case study. For the report, describe methods of appropriate specimen collection, examination of specimen, and a likely causative agent.

For the causative agent, describe pathogenesis of the organism, treatment, and prevention.

Under pathogenesis, describe how the agent is acquired, its reservoir, its life cycle, likely hosts, and infection process.

Explanation / Answer

The above case study Suggests the Following key observations;

The signs and symptoms shows the 21 year old male in the case study is infected with a protozoal parasite, and most likely causative agent being Entamoeba histolytica that causes Amoebiasis.

The clinical presentation of tenderness in lright upper quadrat suggest mild infection of the liver. loss of weight is common in parasite infections. alteration between diarrohea and constipation is a common symptom found in amebic dysentry.

The life cycle of Entamoeba hystolytica is a simple two stage proliferative trophozoites and cysts which are passed through feaces and ingested through contaminated food and water.

The infection is normally acquired by swallowing the cysts of the organism passed in the feaces of infected patient contaminating food and water..The infections acquired in tropics have more pathogenic effects than in temperate zones. severe infections are sometimes common in areas associated with extremely poor standards of living and nutrition.

Pathogenecity the primary infection of Entamoeba hystolytica always occurs inlarge intestine. it may penetrate the gut wall forming abcessess in the adjacent structures. it may spread extraintestinally va local blood to the liver causing tissue inflammation.

Specimen collection.

for acute infection warm freshly passed stool examinations have to be carried out.

in case of extra intestinal amoebiasis, in liver, removal of content by aspiration needle must be carried out for examination for cysts.in pulmonary involvement diagnosis may be confirmed by finding amoeboid trophozoites in sputum and plueral fluids.

Treatment: metronidazole and tinidazole for invasive disease.

amoebicidal drugs obtained from prepared from streptomyces. paromomycin have been promising in intraluminal amobiasis

Improved sanitation andhygine, drinking of boiled and purified water, eating of cooked food ,clean and washed raw food may help in prevention of the disease.

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