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GASTROENTERITIS - PARASITIC
Frequently, patients with gastrointestinal parasitic infections do not have any signs and symptoms that are specific for parasitic infections (eg fever, malaise, fatigue, sweating, wt loss, anorexia, edema, pruritus).
Some patients may be asymptomatic.
Gastrointestinal symptoms, if present, include diarrhea, abdominal pain, dysentery, flatulence, jaundice, rectal prolapse, dyspepsia, malabsorption, vomiting and biliary colic. 

History

  • Attempt to elicit a history of possible exposure, especially for helminthic infections (eg eating undercooked meat, ingestion of undercooked or raw fish, swimming in fresh water where certain parasites may be endemic, walking barefoot)
  • Knowledge of the geographic distribution of parasites is helpful in the diagnosis

Physical Examination

  • These are nonspecific

Laboratory Tests

Microscopic Exam of Stools

  • Microscopic exam of the stool is fundamental to the diagnosis of all gastrointestinal parasitic infections
    • A minimum of 3 stool specimens, examined by trained personnel using a concentration & a permanent stain technique, should be used
    • The stool exam is used to detect protozoan cysts & trophozoites, helminth ova, proglottids, larvae or adult worms
    • A fecal sample must be mixed well before examination because eggs are never uniformly distributed in feces

Other Laboratory Tests

  • The following are other tests that may be used to document a parasitic infection, as necessary
    • Duodenal aspirate
    • Biopsy
    • String capsule test
    • Immunofluorescent antibody test
    • Enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR)
    • Cellophane tape test
    • Barium studies
  • Anemia & eosinophilia may be seen on the complete blood count (CBC)
    • Eosinophilia may be seen especially w/ helminthic infections
    • Anemia may be seen especially in severe cases of hookworm infection
  • Sudan stain for malabsorption
  • Liver biopsy, abdominal imaging studies (eg abdominal ultrasound, computerized axial tomography scan) may be considered as supportive evidence in patients w/ suspected Fasciola hepatica infection
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