Seventy American servicemen in Vietnam had diarrhea of at least two weeks' duration with no evidence of infection with Entamoeba histolytica or Shigella species. The majority had malabsorption as shown by D-xylose absorption, fecal fat excretion, and results of Schilling tests. Jejunal biopsy revealed jejunitis in ten patients; their D-xylose absorption and vitamin B12 excretion levels were significantly lower than those of patients without jejunitis. Fourteen patients had bacterial contamination of the jejunum, and 11 patients harbored the intestinal helminths hookworm or Strongyloides stercoralis; Giardia lamblia was present in 25 patients who had more severe jejunitis and malabsorption than patients without G lamblia. The frequent occurrence of intestinal parasites and the favorable responses in 91% of patients to regimens that included appropriate antiparasitic drugs suggests that intestinal parasitosis, especially giardiasis, was a common cause of diarrhea in these patients.
Butler T, Middleton FG, Earnest DL, Strickland GT. Chronic and Recurrent Diarrhea in American Servicemen in Vietnam: An Evaluation of Etiology and Small Bowel Structure and Function. Arch Intern Med. 1973;132(3):373–377. doi:10.1001/archinte.1973.03650090055010
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