Watery Diarrhea in an Immune-Competent Traveler

A 43-year-old man presented to our hospital with a 15-day history of watery diarrhea. He did not report any unusual medical history except for multiple stays in Southeast Asia, including China, where he ate local and fresh food products. He had symptoms of gastroenteritis with watery diarrhea, loss of appetite, weight loss (3 kilograms within 10 days), abdominal bloating and cramping, increased flatulence, nausea, fatigue, and a low-grade mild fever. The initial exams, which included two stool specimens for bacterial culture and ova-and-parasite (OP magnification, ×1,000) (Fig. 1c and ​andd)d) in significant quantities. Fig 1 Stool specimen examination for ova and parasites. (a) Direct wet smears (original magnification, ×400). (b) Direct wet smears observed with an oil immersion (original magnification, ×1,000). (c and d) Modified acid-fast staining (Ziehl-Neelsen) ... (For answer and discussion, see page 4194 in this issue [doi:10.1128/JCM.00264-12])