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A 28-year-old woman presents to the clinic because of mild abdominal cramping for the past 2 weeks and mild right upper quadrant pain for the past 2 days. She recently returned from a trip to Central America and says she was healthy throughout her travel, except for an episode of dyspnea, pleuritic chest pain, cough productive of blood-tinged sputum, and fever that lasted for 2 days and resolved without medication; this episode occurred about 4 weeks ago. She denies any diarrhea. She has no significant past medical history. Physical examination reveals mild right upper quadrant tenderness. Laboratory tests show a moderate eosinophilia (2000/mm³), a normal chemistry panel, and mildly elevated total and direct bilirubin levels.
Which of the following is the most likely diagnosis?
A.Ascaris lumbricoides infection
B.Entamoeba histolytica infection
C.Giardia lamblia infection
D.Inflammatory bowel disease
E.Legionella pneumonia
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cuz B,C,D you have either bloody stools or diarrhea....Legionella doesn't affect biliary system so AA
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Ascaris lumbricoides infections may cause stunted growth, adult worms usually cause no acute symptoms. High worm burdens may cause abdominal pain and intestinal obstruction.
Migrating adult worms may cause symptomatic occlusion of the biliary tract or oral expulsion. During the lung phase of larval migration, pulmonary symptoms can occur (cough, dyspnea, hemoptysis, eosinophilic pneumonitis - Loeffler's syndrome).
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Infected in Central Africa ....larvae migrate to the lungs causing the symptoms as described...than back in intestine ...
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thank u
The correct answer is A. 54% chose this.
Ascaris lumbricoides is the largest intestinal nematode causing disease in humans. Infections are usually minimally symptomatic, most commonly presenting with abdominal cramping. Large worms can enter into the biliary tree causing cholecystitis, cholangitis, or pancreatitis. During the early lung phase (about 9-12 days after egg ingestion), patients can present with dyspnea, pleuritic chest pain, a cough that is sometimes productive of blood-tinged sputum, and fevers; this collection of symptoms is known as Loeffler's syndrome. An infiltrate can be found on x-ray of the chest. Eosinophilia is typical; however, it can be absent in late, established infections.
B is not correct. 33% chose this.
Entamoeba histolytica is a common protozoal infection with a prevalence of about 1%-5% in the United States. Entamoeba infections are often asymptomatic; however, in about 10% of patients the trophozoites invade the intestinal mucosa, causing abdominal pain and bloody, mucoid diarrhea. The trophozoite may also invade into the portal blood circulation, leading to liver and lung abscesses, each of which is associated with high mortality. Entamoeba infections are usually not associated with eosinophilia.
C is not correct. 5% chose this.
Giardia lamblia is the most common intestinal infection worldwide and should be considered in the returning traveler. Giardia infection is often asymptomatic or associated with only mild symptoms including abdominal pain, belching, flatus, sulfurous burping, and nausea. Diarrhea can be mild to fulminant and is usually foul smelling and with large components of mucus and fat. Malabsorption and weight loss can be problematic in chronic Giardia infection. Giardia only rarely causes eosinophilia.
D is not correct. 0% chose this.
