Prevention

Primary prevention: No vaccine, no chemopro-phylaxis, boil water, adequate sanitation. Secondary prevention: Stool trophozites, flexible sigmoidoscopy with colon biopsy, stool/serum antigen detection (ELISA), stool/serum anti-

Flagellated, upper GI (duodenal) protozoan. Reservoir: Humans and wild mammals, especially beavers and raccoons. Infective stage: Fecal cysts; acid, heat, cold, and chlorine resistant.

Sexual stage: Trophozoites, detected by Entero-test®, or passed during severe diarrhea.

Epidemiology

Transmission: Fecal-oral, waterborne > person-to-person > foodborne.

Vehicle: Cyst-contaminated drinking water, or direct contact. Inoculum: Low, few cysts. Incubation: 1-2 weeks.

Warning: Inadequate water treatment in mountain communities, campers in beaver habitats, wading pools, day-care facilities, food handlers, male homosexuals.

Clinical Manifestations

Cyst passers: No symptoms. Acute diarrhea (90%): 1-5 days, and malaise (80%), nausea, cramps/bloating, anorexia (70%), fever and vomiting rare. Chronic diarrhea: Greasy foul-smelling stools, high fecal fat (75%), no blood or pus, malabsorption (30%), lactose intolerance (30%), >10-lb. wt loss (65%).

Primary prevention: Proper water treatment, especially filtration; treat all cyst passers. Secondary prevention: Fecal cysts and trophozo-ites, stool antigen detection by ELISA, Entero-test® or duodenal aspirate for trophozoites. Tertiary prevention: Metronidazole (250 mg) 3 times daily for 7 days.

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