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ID/Tropical Medicine question (long)From: Henry Gregor (henrygregor@yahoo.com)Fri Nov 2 23:17:56 2007
Listers College student worked in Bengladesh, returned to US and worked several weeks in western North Carolina woods as a river guide and backpacking guide, developed profuse nonbloody loose stools. No family hx of IBD. Rx'd for Giardia.n whether this was diagnosed or presumptive dx) w/metronidazole x 7 days. Sx's persisted w/o significant change. Patient returned to original providor, having had 10 lb weight loss, no fevers/chills/rashes/anorexia. Mild to Moderate GI cramps. Stool test positive for Endolimax nana. (Which references tell me is usually non-pathogenic and not generally treated, thought it can cause diarrhea. It can also "be confused" with Entamoeba histolytica - apologies for spellling.) Pt still sx'c, but decreasing number and volume of stools, seven days after treatment with praziquantel, an antihelminthic which I suspect was given presumtively for the possibility of undocumented helminthic infection. Before further stool testing/ID consult/ GI endo studies would another round of treatment with metr'azole or tinidazole be reasonable. Would "watch and wait" for another interval of seven days be reasonable? I know this is off topic and I know Google and Google Scholar and PubMed are our friends, (and I've been on them during a long stand by in L&D tonite), but what could any of you comment re the situation...com'on El, and others,lets hear your thoughts please. It would be helpful for the student to avoid further time in medical waiting rooms and labs, which would take away from a critical time in the school semsester/exam schedule, though of course that can be done in the interest of health first. Thanks, Hank Tired of spam? Yahoo! Mail has the best spam protection around
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