A 27-year-old policeman presented to Sindhuli Hospital with a chief complaint of epigastric pain, nausea, decreased appetite for several days, and loose stools (3-4 episodes per day). The patient had no previous history of hypertension, diabetes, TB/HIV, and other associated factors which may lead to immunosuppression. He had lived in rural areas (Baitadi district of Nepal) near a piggery farm for 5 years. As described by the patient, he was under antibiotic therapy (amoxycillin) for tonsillitis. Upon his revisit with symptoms of diarrhoea and abdominal cramps to the nearby health post the clinician thought it was a side effect of the antibiotics and suggested coming back if it worsened. The patient has kept himself hydrated with oral rehydration solution (ORS) and came to our hospital then.
His physical examination was all well. The patient was sufficiently hydrated and the previous tonsilitis was resolved. CBC was normal; RFT and LFT were within the normal ranges. Ultrasonography of the abdomen and ECG showed normal findings. A faecal parasitological exam was requested at the Parasitology Laboratory of Sindhuli Hospital.
The received stool specimen was watery and contained blood and mucus. Immediately after receiving the sample, routine stool microscopy was performed which revealed the presence of cysts and actively motile trophozoites measuring about 50 mum long and 35 mum broad (Supplementary Material-1). For the better visualization of the internal structures, giemsa and trichrome staining (wheatley modification for the faecal specimen) were performed (Figure 1). Upon this morphologic characterization, the ciliated trophozoites were identified as B. coli.