Case history

Case history

A 32-year-old man returns from a 4-week holiday to rural India. He presents with a 10-day history of frequent but small-volume, greasy, foul-smelling, yellowish stools with tendency to float. He admits to camping and drinking water from a freshwater stream while on the trip. His male sexual partner has also developed bloating symptoms for the past 2 days. He also describes nausea, frequent belching with a sulfur smell, abdominal bloating, and flatulence. The only positive finding on physical exam is mild distention of the abdomen with no tenderness, masses, or organomegaly.

Other presentations

Patients may present with watery diarrhea without malabsorption and/or malaise and generalized abdominal discomfort precipitated by eating with little or no diarrhea. Symptoms can wax and wane with periods of diarrhea and constipation. Children may present with weight loss and failure to thrive or other growth delays.[5][6]​ Nutritional deficiency for fat-soluble vitamins, vitamin B12, folate, protein and amino acids, and D-xylose and disaccharides has been described.[4][7]​​​

Extraintestinal manifestations are uncommon, but may include uveitis, reactive arthritis, sacroiliitis, erythema multiforme, biliary tract disease, and urticaria.[7]​​[8]​ Postinfectious intestinal and extra-intestinal symptoms are common. Long-term sequelae of prolonged but asymptomatic infection are under investigation and may include growth restriction and reduced cognitive potential.[8][9][10]

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