*****CASE ANALYSIS:
CESTODES AND TREMATODES
Patient ID:
B.E, a 16 year old male from Bacacay, Albay. A Senior high student of Bicol University, Roman Catholic.
Chief compliant: Bloody stool
History of present illness:
3 months PTA the patient went swimming with his classmates during the Holidays to celebrate their admission in Bicol University. They went to a freshwater spring near their residence. They noticed after swimming, the presence of dermatitis, pruritis on their lower back and both lower extremities. The symptoms disappeared within 1 week so no consult or medication was done.
1 week PTA the patient experienced fever, myalgia, general malaise, fatigue, headache, nonproductive cough and abdominal pain. No skin manifestations were noted. The patient did not seek consult due to the COVID-19 pandemic and opt to self-isolate in his room and took 500 mg paracetamol 4 times in 24 hours but afforded temporary relief.
3 days PTA the patient experienced persistence of the above symptoms and he noticed that his clothes were looser and was accompanied by dyspnea, diarrhea and abdominal tenderness and distention. No skin manifestations were noted. Again due to the pandemic he did not seek consult and opt to self-isolate and took 500 mg paracetamol 5 times in 24 hours but afforded temporary relief.
A few hours PTA, the persistence of the above symptoms and appearance of bloody stool prompted them for consult.
Past medical history:
(-) Heart disease, asthma, DM, HTN, surgery.
Family history:
(+) DM, HTN, Heart disease maternal and paternal side.
(-) asthma maternal and paternal side.
Personal and Social History:
Lives with his parents and two younger siblings. They do not have the same symptoms as the patient but the 4 out of the 5 classmates that he was with during their swimming trip experienced the same dermatitis, pruritis which subsided but did not develop the other symptoms.
He is an active person and likes to exercise 5x a week, a non-smoker and an occasional alcohol drinker. He also eats a balanced diet before the appearance of fever, myalgia, general malaise, fatigue, headache, cough and abdominal pain. He lost his appetite for 1 week and “approximately lost 1 kg”.
ROS:
With weight loss, “mas maluwag na yung damit ko, parang 1 kilo ang pinayat ko.” (+) Fever, headache, cough, palpitations, dyspnea, diarrhea and bloody stool (4x within 24 hours.)
PE:
Wt: 55 kg HT: 150 cms
T: 38.5 deg C.
O2 saturation: 97 %
BP: 130/90
CR: 120/min, RR: 30/min.
HEENT: icteric sclera, pale palpebral conjunctiva, (+) cervical lymphadenopathies.
Chest and heart: Symmetric expansions. Clear breath sounds, tachycardia, no murmurs.
Abd: (+) Right upper quadrant pain and tenderness, abdominal distention.
Extremities: Full and equal pulses, CRT <2>
DRE: No mass, tight sphincter tone, prostate is rubbery and firm, smooth surface and palpable sulcus. Between the left and right lobes, non-tender and no nodularity. (+) Dark red blood on examining finger.
Diagnostics
Fecal analysis:
Color: Dark brown blood streaked
Consistency: Soft 3-4/hpf parasite eggs were identified.
Urinalysis:
Color: Dark Yellow
Specific gravity: 1.015
Protein: Negative
Glucose: Negative
RBC: 0-2/hpf
WBC: 3-4/ hpf
Bacteria: Few
Epithelial cells: Few
CBC:
RBC: 3.9
Hgb: 11 g/dL
Hct: 35 %
WBC: 10,000
Neutrophils: 47%
Eosinophils: 10%
Basophils: 1%
Monocytes: 2%
Lymphocytes: 40%
Plt: 300
Chest x-ray: Normal
COVID-19 screening test: Negative
QUESTION:
What is the drug of choice for the treatment of the disease?
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