A 24 four-year old woman reports to a physician for a physical examination after experiencing what she describes as chronic fatigue and a vague recurring chest pain. At first glance she appears to be a healthy young woman of average weight for her height. Her English is poor, so much of her history is obtained through an interpreter friend that is accompanying her.
Further questioning reveals that she has had some discomfort to her throat for the last two weeks that she describes as swollen with periods of difficulty swallowing. For the last few months she has also been experiencing occasional dizziness and has had approximately eight fainting spells during that period. She also complained of constipation with abdominal discomfort.
She immigrated to the United States one month ago from Guatemala where she fled the wide spread violence that had recently increased in that country. When asked about her health history while living in Guatemala she provided nothing of significance. She claimed to have a relatively healthy childhood and early adulthood there. She never had the need to see a physician while she lived there and her illnesses did not require hospitalization or a physician. She did however recollect that as a child “vinchucas” would bite her and her siblings and that it was a constant nuisance for them. She recollected that some of her brothers became very ill soon after being bitten. Once they moved to a better area where their housing improved, the biting stopped altogether. Her family history was significant for two of her siblings whom had died unexpectedly while in their late twenties.
Her physical examination was significant for a slightly palpable enlarged liver and an abdomen that is asymmetrically distended. Heart sounds are atypical and an ECG performed in the office-detected abnormalities consistent with conduction disturbances. A referral to a cardiologist was immediately made.
Based on the clinical history, family history, and clinical presentation the physician has ordered specific tests to rule out an infection with a particular parasite.
Please answer the following questions:
What parasite does the physician suspect the patient having?
What is a “vinchucas” and what is its significance?
What tests, based on the clinical presentation, should the physician order to confirm an infection with the parasite suspected and why?
What is the suggested treatment for this parasitic infection at this stage?