The next day, December 5, the patient had the onset of influenza-like symptoms, with fever, diaphoresis, and myalgias. Over the next several days, she noted increasing head, neck, and back pain but did not seek medical care. On December 12, she developed worsening nausea, vomiting, and abdominal cramps with dizziness. On December 14, she went to a local walk-in clinic and was transported immediately to a nearby hospital emergency department. There, she complained of vomiting, lower abdominal tenderness that radiated posteriorly, "hunger pains," and minimally productive cough, but reported not having diarrhea, shortness of breath, pleuritic pain, dysuria, vaginal bleeding, or foreign travel.
Physical examination revealed orthostasis, mild tachycardia, and costovertebral tenderness, but no fever. Abdominal examination showed distension, but active bowel sounds and no tenderness. Laboratory testing indicated a white blood cell count of 43,000/mm3 (normal: 3,900-11,000/mm3) with 68% neutrophils, a hematocrit of 62% (normal: 34%-46%), slight hyponatremia (133 mEq/L [normal: 134-146 mEq/L]), and a blood urea nitrogen of 31 mg/dL (normal: 6-26 mg/dL) with normal creatinine (1.0 mg/dL). She was admitted to the hospital, blood cultures were obtained, and she was treated with ertapenem. Chest radiograph showed lungs well aerated bilaterally, with no infiltrates. Abdominal computed tomography revealed massive ascites, two edematous small bowel segments with highly irregular appearance, and multiple prominent retroperitoneal lymph nodes. She was taken for exploratory laparotomy, followed by a partial bowel resection. After surgery she was stabilized, and, the next day, transferred to a referral hospital. Later review of the bowel pathology by CDC demonstrated a nematode (Enterobius vermicularis) infection of the small intestine and appendix.
・輸入物の動物の皮で作った太鼓は要注意ですね。（古道具屋・アンティーク・ショップでの買い物も注意）私が今持っている、Infections of Leisureという本のAnthraxの項には、太鼓のことは載っておりませんが、Infections in humans are almost always the result of contact with infected animals or their by-products(especially goat hair)とありました。by-productsのみでなく、productsもよね。
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