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August 21, 1972

Snakes in the Grass Or, The Worm Turns On

JAMA. 1972;221(8):917. doi:10.1001/jama.1972.03200210061027

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To the Editor.—  This case is presented to illustrate a new avenue for parasitic infestation of patients who never have left the United States.A youngish man in January 1971 complained of watery diarrhea and flatulence for almost a month. He had some mucus but no blood in the stools. He had not been out of the country. There was abdominal tenderness, but the abdomen was soft and there was no guarding. A barium enema revealed only sigmoid spasm and coarse folds. Our villain showed up in the first stool as cysts of Giardia lamblia and E vermicularis. With quinacrine, 100 mg three times a day for one week for the Giardia, and pyrvinium pamoate, 50 mg seven times for the E vermicularis, all symptoms ceased and stool specimens were negative.The monster was considered slain. In November 1971 the same symptoms reappeared. As no source of the original infestation