A 24 four-year old woman reports to a physician for a physical examination. She has been experiencing chronic fatigue. She also describes having 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.
She has had some throat discomfort for the last two weeks. She describes it as swollen with periods of difficulty swallowing. For the last few months, she has experienced occasional dizziness. She 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. She fled the widespread violence that had recently increased there. 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 needed to see a physician while she lived there. Her illnesses did not require hospitalization or medical attention. She did remember that as a child, “vinchucas” would bite her and her siblings. 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 promptly made.
The physician has reviewed the clinical history, family history, and clinical presentation. Based on this review, they have ordered specific tests. The goal is 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 should the physician order? Base the decision on the clinical presentation. Why are these tests necessary to confirm an infection with the suspected parasite?
What is the suggested treatment for this parasitic infection at this stage?