5-36
Objective: Signs
Using Basic Tools: Right upper quadrant tenderness, liver enlargement and jaundice (rarely).
Using Advanced Tools: Lab: Identification of Clonorchis eggs in the stool on O&P evaluation.
Assessment: Travel to an endemic area suggests diagnosis of clonorchiasis
Differential Diagnosis - cholangitis, cholecystitis and fascioliasis
Plan:
Treatment:
Primary: Praziquantel 75mg/kg/day tid x 1 day
Alternate: Albendazole 10 mg/kg/day x 7 days
Patient Education
General: Avoid improperly prepared seafood.
Activity: As tolerated
Diet: As tolerated
Medications: Occasional gastrointestinal side effects
Prevention and Hygiene: Avoid improperly cooked fish.
No Improvement/Deterioration: Referral for evaluation
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve
Zoonotic Disease Considerations
Principal Animal Hosts: Dogs, cats, swine, rats
Clinical Disease in Animals: Possible hepatic signs
Probable Mode of Transmission: Ingestion of raw or partially cooked infected freshwater fish
Known Distribution: Asia
ID: Cyclosporiasis
LTC Glenn Wortmann, MC, USAIntroduction: Cyclosporiasis is transmitted by fecal contamination of water or food. Cyclospora infections
occur worldwide, and are an increasingly recognized cause of parasitic diarrhea. Transmission seems to be
waterborne and more common during summer months. The incubation period averages one week.
Subjective: Symptoms
Watery (>6 stools per day) diarrhea, fatigue, abdominal cramps and fever (in 25%). Diarrhea can be prolonged
(up to 45 days) but is generally self-limited.
Focused History : Are you experiencing diarrhea? If so, is it watery and non-bloody? (typical diarrhea) How
long have you been experiencing diarrhea? (Diarrhea lasting >1 week is typical.)
Objective: Signs
Using Basic Tools: Watery diarrhea without blood, fatigue
Using Advanced Tools: Lab: Cyclospora oocysts in O&P examination of the stool.
Assessment:
Differential Diagnosis: There are many possible causes of diarrhea. Although the presence of watery