What is the source of infection and mode of infection of the parasite?

*-** 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 seconds.

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

QUESTIONS:

What is the source of infection and mode of infection of the parasite?