5-37
diarrhea suggests cyclosporiasis, it can also be seen with Cryptosporidia, Microsporidia or Isospora.
Plan:
Treatment: Most infections are self-limited, but trimethoprim-sulfamethoxazole (160 mg trimethoprim-800
mg sulfamethoxazole) given twice daily x 7 days is suggested in chronic infections.
Patient Education
General: Oral fluids to avoid volume depletion
Activity: As tolerated
Diet: As tolerated
Medications: Trimethoprim-sulfamethoxazole can occasionally cause a rash.
Prevention and Hygiene: Avoid contaminated food and water.
No Improvement/Deterioration: Return for reevaluation.
Follow-up Actions
Return evaluation: Consider alternative causes of diarrhea.
Consultation criteria: Failure to improve with conservative measures.
ID: Enterobiasis (Pinworm)
LTC Glenn Wortmann, MC, USAIntroduction: Enterobiasis is contracted by ingesting the eggs of the Enterobius vermicularis nematode.
Pinworms inhabit the large intestines of humans. Enterobiasis occurs worldwide, particularly in temperate
climates and is common among children.
Subjective: Symptoms
Perianal and perineal itching, as well as restless sleep
Focused History: Have you noticed itching in the perineal or perianal area? (Pinworms often cause itching.)
Is the itching worse at night? (Nocturnal pruritus is common)
Objective: Signs
Using Basic Tools: Adult worms (about 1 cm long) may occasionally be seen in the perianal area).
Using Advanced Tools: Lab: O&P of stool should reveal pinworm eggs. Alternatively, apply Scotch tape to
the perianal region first thing in the morning and then examine the tape microscopically for eggs.
Assessment: The presence of perineal/perianal itching, especially in a child, is very suggestive of
pinworms.
Differential Diagnosis - candidal dermatitis can cause similar complaints.
Plan:
Treatment:
Primary: Pyrantel pamoate 11 mg/kg and repeat in 2 weeks
Alternative: Albendazole 400 mg once, repeat in 2 weeks; or mebendazole 100 mg once, repeat in 2
weeks
Patient Education
General: Treat all family members to avoid re-infection.
Activity: As tolerated
Diet: As tolerated