Kentucky--Off to the Races

Man with diarrhea and abdominal pain
50 year old man helped his brother recover from flood damage down in Kentucky. He spent three months there living in rough conditions; sleeping in a car, drinking from a spring, surviving on chiefly bologna.

Two weeks after return to civilized life in Cincinnati he developed watery diarrhea that has persisted for two weeks. (Ten watery bowel movements before seeing you at 2:00 pm). No blood or mucous, but with diffuse abdominal cramping made worse with eating. Some intermittent feverishness. He was able to hold food down without nausea or vomiting. He attributes his illness to return to "normal food."

He is tired appearing. Mildly pale. Afebrile. No orthostatic hypotension. Lungs are clear without wheeze. Heart is unremarkable. Abdomen is diffusely, mildly tender, no guarding. Bowel sounds are normal. Rectal shows no stool, mass or blood. No rash.

Fecal leukocytes: negative.
Ova and parasites: negative.
Stool culture: negative.

Ideas?
Any diagnostic or therapeutic ideas at this point?

Further Requests?
Any further history or lab tests that you might like?

Summary
A man with two weeks of diarrhea and abdominal pain after a three month stay in rough circumstances in Kentucky.

Last update: 7/9/02; 7:23:42 PM.