CASO 1

PARASITOLOGIA - TELESUP
History: 53 years old male with a 1 year history of profuse watery diarrhea (10 times per
day) with nausea, vomiting and diffuse abdominal pain. He visited several private sector
emergency rooms for intravenous rehydration and received short treatment courses of
ciprofloxacin and TMP/SMX with only partial improvement. He lost 18 kg since the
beginning of his illness. No cough, no fever, no night sweats. The patient was referred to
our Institute for further evaluation.

Epidemiology: Born and lives in the Lima area where he works as street vendor. Currently
married but over 15 total sexual partners including female sex workers. Alcohol abuse since
age 14 yr. No known TB exposure. No relevant past medical history.

Physical Examination: BP 100/70, HR 73, RR 19, T 36.6°C, body weight 41 kg, BMI 16
kg/m2. Pale, no jaundice or rash. No lymphadenopathy. Chest and cardiovascular normal.
Moderate abdominal pain to deep palpation in the right upper quadrant. Negative Murphy's
sign. No visceromegaly, no peritoneal signs. Normal neurologic examination.

Laboratory Results and Imaging: Hb 12.4, WBC 6 300 (0 bands, 52 neutrophils, 2

eosinophils, 37 lymphs), platelets 446 000, creatinine 0.5 mg/dl, total protein 5.1 g/dl.
albumin 2.3 g/dl. ALT/AST 111/113 UI/L (<40), alkaline phosphatase: 183U/L (<104).
Serological tests for Hepatitis B, C, Syphilis and HIV were non-reactive, HTLV-1:
Reactive.

Chest x-ray was normal

Abdominal ultrasound showed moderate hepatomegaly and chronic calculous cholecystitis.
Colonoscopy showed normal colonic mucosa.
Upper endoscopy showed superficial erosive gastritis in the fundus and gastric body.
A stool wet mount preparation is shown in Image A.