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Family Medicine (Expert Forum)
Multiple problems
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Multiple problems
by ShawnInge, Jan 18, 2003 12:00AM
male: lived and traveled extensively in the tropics of central america for 12 years).41 yrs old, 6 feet 2 inches tall, 175 lbs, eat well, exercise not enough.4 years ago (1999) diagnosed with malaria (plasmodium vivax) and successfully treated in the hospital.Initially mis-diagnosed for 1.5 years and suffered greatly i had a febrile episodes and at the hospital they would pump me full of the wrong antibiotics.when finally discovered it was malaria, the treatment was so harsh on my body I developed multiple esophageal and stomach ulcers.--at that time,until now, my cholesterol levels never lowered.
may 2002--severe pain in my right side below rib cage-was told I had a swollen gallbladder after ultrasound. suggested to have it removed--had an ERCP performed--ERCP failed--the doctor pierced my bile duct and I developed pancreatitis and peritonitis--was hospitalized for 6 days(multiple antibiotics etc---cured.
june/july/aug 2002--no doctors nor treatments
Sept/2002 I had an unprotected sexual encounter with a woman(foolish I know) who had shown me her negative hiv tests and clean blood tests. About 3 weeks later I went to south america and the jungles of brazil(even fell in a highly polluted river) and had a severe bout of diarrhea(for 1 day) with a rash on my chest while there, also developed reflux disease which I had previously 4 yrs before. Upon my return had an hiv test p24--which was negative, but I had very bad pain in my stomach and particularly on my right side under my rib cage
one evening vomitted profusely the entire evening and morning. vomit was yellow with bile,had chills and fever for that night. since then much pain in my stomach and liver area. gastroscopy performed because a cbc and blood test revealed postive for helicobacter pylori.gastroscopy found I had 3 esophageal ulcers and a hiatal hernia.took treatment of biaxin and flagyl with losec for 1 week. The doctor gave me flagyl to try to get rid of potential parasites and cure the ulcers.while on the medication, I passed several long 4-6 inch worms in my stool(which did not move)--but definitely were worms.Now taking natural medications like wormwood and black walnut to remain parasite free. After gastroscopy went for CT scan--it revealed a stone in my gall bladder. 3.5 months since my unprotected sexual encounter, my HIV test was negative,HEP ABC-NEG but I still have stomach pain and abnormal CBC---RBC 4.9,Hg 152,hematocrit.461,MCV 94; MCH 31 HIGH,MCHC normal, RDW-CV-NORMAL WBC-10.0(HIGH), NEUTROPHILS 7.2-HIGH, LYMPH 1.8 LOW; L/N 0.26(LOW), MONO-NORMAL; EOSIN 0.2; BASO 0.05; PLATELETS 277 TSH NORMAL, GLOBULINS 36 HIGH; AST, BILI-NORMAL; ALT 40 (HIGH); GAMMA GT 74 HIGH; CHOLESTEROL IS VERY HIGH TOTAL CHOL 7.95 TRIGLC-3.79HIGH;LDL-5.12, URINE ANALYSIS NORMAL. QUESTIONS 1)WHAT DOES THIS MEAN? 2)COULD i HAVE A LIVER PARASITE? 3) IS THERE STILL A PARASITE OR DISEASE OF ANY KIND? MY TONGUE IS ALWAYS WHITE--FUNGAL? I ALSO STILL HAVE MY STOMACH SWOLLEN AND TENDER PLEASE HELP?
may 2002--severe pain in my right side below rib cage-was told I had a swollen gallbladder after ultrasound. suggested to have it removed--had an ERCP performed--ERCP failed--the doctor pierced my bile duct and I developed pancreatitis and peritonitis--was hospitalized for 6 days(multiple antibiotics etc---cured.
june/july/aug 2002--no doctors nor treatments
Sept/2002 I had an unprotected sexual encounter with a woman(foolish I know) who had shown me her negative hiv tests and clean blood tests. About 3 weeks later I went to south america and the jungles of brazil(even fell in a highly polluted river) and had a severe bout of diarrhea(for 1 day) with a rash on my chest while there, also developed reflux disease which I had previously 4 yrs before. Upon my return had an hiv test p24--which was negative, but I had very bad pain in my stomach and particularly on my right side under my rib cage
one evening vomitted profusely the entire evening and morning. vomit was yellow with bile,had chills and fever for that night. since then much pain in my stomach and liver area. gastroscopy performed because a cbc and blood test revealed postive for helicobacter pylori.gastroscopy found I had 3 esophageal ulcers and a hiatal hernia.took treatment of biaxin and flagyl with losec for 1 week. The doctor gave me flagyl to try to get rid of potential parasites and cure the ulcers.while on the medication, I passed several long 4-6 inch worms in my stool(which did not move)--but definitely were worms.Now taking natural medications like wormwood and black walnut to remain parasite free. After gastroscopy went for CT scan--it revealed a stone in my gall bladder. 3.5 months since my unprotected sexual encounter, my HIV test was negative,HEP ABC-NEG but I still have stomach pain and abnormal CBC---RBC 4.9,Hg 152,hematocrit.461,MCV 94; MCH 31 HIGH,MCHC normal, RDW-CV-NORMAL WBC-10.0(HIGH), NEUTROPHILS 7.2-HIGH, LYMPH 1.8 LOW; L/N 0.26(LOW), MONO-NORMAL; EOSIN 0.2; BASO 0.05; PLATELETS 277 TSH NORMAL, GLOBULINS 36 HIGH; AST, BILI-NORMAL; ALT 40 (HIGH); GAMMA GT 74 HIGH; CHOLESTEROL IS VERY HIGH TOTAL CHOL 7.95 TRIGLC-3.79HIGH;LDL-5.12, URINE ANALYSIS NORMAL. QUESTIONS 1)WHAT DOES THIS MEAN? 2)COULD i HAVE A LIVER PARASITE? 3) IS THERE STILL A PARASITE OR DISEASE OF ANY KIND? MY TONGUE IS ALWAYS WHITE--FUNGAL? I ALSO STILL HAVE MY STOMACH SWOLLEN AND TENDER PLEASE HELP?
Doctor's Answer
by Forum-M.D.-DT, Jan 19, 2003 12:00AM
Thank you for visiting the Family Practice Forum.
Ascaris lumbricoides is one thing that comes to mind when you describe the worms that were present in the stool. This is one of the most common roundworms seen. These worms may be as big as an earth worm or bigger. Infestation arises from ingestion of eggs from contaminated soil or food. Serious consequences of infestation are rare unless infestation is very heavy. Occasionally worms may crawl into small ducts and block them or masses of worms may obstruct the small intestine. The eggs may be detected in faeces by microscopic examination.
The inflammation of the liver you are experiencing, based on the blood tests and symptomatology may indeed be related to your previous exposure to Malaria. The malaria parasites initially multiply in the liver. When a liver cell is full of parasites it bursts and the parasites can infect the red blood cells. As a red cell becomes full it bursts (intra-vascular haemolysis, hence blood in the urine), and the parasites released infect other red cells.
My gut feeling here is that you still have some liver inflammation either due to the previous Malaria exposure and/or the presence of these roundworms. Have you had your stool checked recently for parasites or other possible infections?
You may consider speaking to a Gastroenterologist who specializes in liver disease as a next step.
Ascaris lumbricoides is one thing that comes to mind when you describe the worms that were present in the stool. This is one of the most common roundworms seen. These worms may be as big as an earth worm or bigger. Infestation arises from ingestion of eggs from contaminated soil or food. Serious consequences of infestation are rare unless infestation is very heavy. Occasionally worms may crawl into small ducts and block them or masses of worms may obstruct the small intestine. The eggs may be detected in faeces by microscopic examination.
The inflammation of the liver you are experiencing, based on the blood tests and symptomatology may indeed be related to your previous exposure to Malaria. The malaria parasites initially multiply in the liver. When a liver cell is full of parasites it bursts and the parasites can infect the red blood cells. As a red cell becomes full it bursts (intra-vascular haemolysis, hence blood in the urine), and the parasites released infect other red cells.
My gut feeling here is that you still have some liver inflammation either due to the previous Malaria exposure and/or the presence of these roundworms. Have you had your stool checked recently for parasites or other possible infections?
You may consider speaking to a Gastroenterologist who specializes in liver disease as a next step.
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