Diarrhea (Infectious Disease)-Swimming And Diving

Abstract

HISTORY: 19-year-old men’s collegiate swimming athlete with PMH of anxiety & major depressive disorder presented with 3-days of nausea, vomiting & diarrhea. He reported several teammates with similar symptoms. He returned for reassessment 1 week following initial evaluation endorsing 2 days of symptom improvement followed by return of several episodes of emesis, diarrhea & fatigue. PHYSICAL EXAMINATION: General: Well-developed, Well-nourished, NAD HEENT: -Head: NC, AT -Eyes: conjunctiva clear, EOMI, PERRL, no discharge -Ears: hearing normal on gross assessment, TMs normal -Nose: nares clear, no deformity -Throat: MMM, no erythema or exudate NECK: normal ROM, no lymphadenopathy PULM/CHEST: CTAB, no wheezes, rales or rhonchi CV: RRR, no MRG. CR < 2 sec ABD: BS+, soft, non-tender, non-distended, no organomegaly SKIN: no visualized rashes or skin lesions, skin is warm and dry PSYCH: appropriate mood and affect DIFFERENTIAL DIAGNOSIS: 1) Viral gastroenteritis 2) Bacterial gastroenteritis 3) Parasitic infection 4) Irritable bowel syndrome 5) Anxiety TESTS AND RESULTS: Initial CBC, BMP and TSH were remarkable only for mild thrombocytosis (447 K/mm3) and hypoglycemia (63 mg/dL). After incomplete resolution of symptoms, GI PCR panel was obtained and found to be positive for cryptosporidium. FINAL DIAGNOSIS: Cryptosporidiosis TREATMENT AND OUTCOMES: 1) He was treated with Nitazoxanide 500 mg PO BID x 3 days and held out of the pool for 2 weeks. 2) Athletes with exposure to university pools presenting with diarrhea were tested for cryptosporidium via PCR. 6 were positive and all were held out of the pool for 2 weeks. 3) The public health department and environmental health experts were consulted to assist with management. 4) Administrators from every university and local swimming clubs who shared a common pool with our athletes were notified of potential exposure to cryptosporidium. One head-to-head swimming meet was cancelled in an effort to limit potential exposure. 5) University pools were shut down and treated twice with a high-concentration chlorine. 6) Water samples were collected serially before and after treatment cycles to ensure eradication prior to re-opening the pools.