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Case 6: A Migrant Worker with Abdominal Pain and Diarrhea

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B The patient most likely has giardiasis.  Treatment should be initiated with metronidazole (Flagyl) or tinidazole (Tindamax).

This answer is incorrect. Although patients with giardiasis can develop diarrhea, they typically do not have marked dehydration as seen with this patient. The diagnosis of giardiasis is not made by using a modified acid fast smear, but instead is most often by stool ova and parasite examination or by the giardia antigen test using an enzyme immunoassay.

A The clinical manifestations and the modified acid-fast smear of the stool sample are consistent with a diagnosis of cystoisosporiasis. Treatment should be initiated with trimethoprim-sulfamethoxazole (Bactrim, Septra).
C The clinical manifestations and stool analysis are most consistent with intestinal tuberculosis. An intestinal wall biopsy should be performed to make a definitive diagnosis.
D The clinical manifestations and the stool findings are most consistent with cryptosporidiosis. Treatment should be initiated with paromomycin (Humatin) or nitazoxanide (Alinia).

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