OpenHealth Q&A

Seeking Specialist Insights on Persistent Health Issues

**I am reaching out for expert guidance regarding potential infections or parasitic infections.** For more than two and a half years, my family and I have been on a quest to identify the source of a troubling health condition characterized by significant weight loss and a variety of vague symptoms. Initially, due to heightened anxiety, medical professionals were concerned about cancer, which possibly misdirected focus away from a potential infectious—particularly parasitic—origin. During this time, I have been assessed by a multitude of specialists, yet a definitive diagnosis remains elusive. My primary care physician has indicated that there are no further tests to conduct, compelling me to investigate on my own through medical literature and AI resources. Presently, I am increasingly alarmed as it appears we are confronting a progressive and possibly infectious condition that has persisted for over two years and is now impacting nearly our entire household. Symptoms are present in five out of six family members, including two children aged two and six, with the sixth member also under consideration. Let me outline the developments and emerging concerns. **Symptom Progression:** Initially, I exhibited symptoms, which later manifested in our younger son (after his birth, just a few months later) as he experienced weight loss, lack of growth, pallor, thin skin, and recurrent diarrhea or undigested food. He is currently under the care of a pediatric gastroenterologist who has only conducted celiac disease testing without pursuing further investigations—for instance, parasitological assessments. Despite being on Nestlé Resource nutrition for over a year, there has been no improvement in his condition. Our older son (6) has shown signs of lethargy, fluctuating appetite (first low, then higher, mirroring my experiences), and changes to his stool—these are now yellow, mushy, oily, and more frequent. While physical transformations in him are less apparent, perhaps only noticeable through dry skin and persistent tiredness, his situation concerns me. My wife has begun to show symptoms as well, including mild weight reduction, ongoing fatigue, headaches, and aches in her muscles and joints. Although her weight change is subtle due to her naturally slender physique, she reports experiences akin to my own, including episodes of hunger soon after meals, sometimes even at night. It is worth mentioning that our dietary habits are varied—we consume both meat and vegetables, as we live in a rural area and maintain a garden with fruits and vegetables, avoiding any restrictive diets. What troubles me most is my father’s rapid weight loss of 6 kg within a brief span of 2 to 3 weeks, which he has been unable to regain. Even after undergoing gastroscopy, colonoscopy, and MRI, no underlying issue was identified, and the weight loss is notably striking, exacerbated by age-related skin changes since he is 64 years old. **Considerations and Hypotheses:** Given the symptoms and the familial spread of this condition, I have a strong suspicion of chronic giardiasis (*Giardia lamblia*), though I also consider the possibility of other parasites such as *Cryptosporidium*, *Blastocystis hominis*, *Toxocara*, and *Strongyloides stercoralis*, not to mention diseases like brucellosis. My background includes rural life in Europe, working on a farm with various animals like chickens, donkeys, and cats. Though I didn’t work directly with the animals, the potential for zoonotic transmission exists, especially since we have a dog that roams both inside and outside the house, coupled with my prior exposure to soil from areas with animals, suggesting a possible intestinal parasite or an intracellular bacterial infection. One test for *Giardia* in a stool sample returned negative, though I am aware of the intermittent shedding of cysts that can lead to false negatives. **Symptoms Across Family Members:** - **Chronic gastrointestinal issues**: bloating, oily or mushy stools (Bristol types 5–6), diarrhea - **Unexplained weight loss and growth failure in children** - **Skin changes**: dryness, thinning, and wrinkling; hair and body hair loss - **Hyperhidrosis**, particularly noticeable in armpits and feet - **Malabsorption of fat-soluble vitamins** (A, D, E, K), leading to nutrient deficiency manifestations: fatigue, brittle nails, dental deterioration despite maintaining oral hygiene, and skin that is dry, pale, and wrinkled - **Elevated cholesterol and triglycerides** despite malnutrition, potentially indicating altered metabolism of lipids - **Joint discomfort**: crepitus and sensations of instability, likely related to compromised collagen synthesis - **Children** exhibit inconsistent appetites, developmental delays, paleness, and fatigue - **Temperature regulation shifts**: episodes of chills without fever or sudden sensations of heat **Epidemiological Observations:** - Symptoms have manifested in all household members over the past 2.5 years, though not simultaneously - Our dog may serve as a potential vector for disease - There have been no travels to high-risk locations - Life in rural settings with animal interactions - Other systemic conditions have been ruled out (such as HIV, hepatitis, celiac disease, Crohn’s, etc.) **Further Diagnostic Avenues to Explore:** - Protozoal infections: *Giardia lamblia*, *Blastocystis hominis*, *Cryptosporidium spp.* - Zoonotic diseases: *Toxocara canis*, *Brucella spp.*, *Leishmania infantum* - Bacterial infections - Helminthic infections: *Strongyloides stercoralis*? - Tuberculosis if clinically indicated - Given the household-wide involvement and clinical presentation, could there be a case for initiating empirical treatment with antiprotozoals like metronidazole or nitazoxanide, despite *Giardia* not being confirmed through stool assays? Or is it imperative to conduct PCR-based diagnostics on the stool? I would greatly appreciate your insights regarding this summary, along with any diagnostic or therapeutic strategies you might recommend for this intricate, prolonged predicament. Thank you for your consideration and assistance in advance.

Answers (1)

6/17/2025, 7:01:33 AM

OpenHealth AI

Thank you for sharing your family's complex health journey. Given the symptoms you've described and their prolonged nature, it’s understandable to be concerned about potential infections, particularly parasitic ones. Multiple members of your household experiencing similar symptoms does warrant a thorough investigation of possible infectious causes.

Key Points:

1. Symptoms suggestive of malabsorption and potential infections such as giardiasis or other parasitic diseases.
2. Family-wide impact necessitates a comprehensive approach to diagnosis and management.
3. Continued vigilance and specific testing remain critical.

Explanation:

The symptoms you've outlined, including gastrointestinal distress (like oily stools), weight loss, and growth issues in your children, raise legitimate concerns about malabsorption or infectious processes. Chronic giardiasis is indeed a valid consideration, as other parasites could also be involved given your rural background and interactions with animals.

The negative stool test for Giardia can sometimes be misleading due to intermittent shedding, meaning further testing could be beneficial. A key point of concern is that persistent symptoms across your family suggest that this might not be a simple, isolated condition.

Next Steps:

1. Repeat Stool Testing:

   • Request comprehensive stool tests that include multiple samples over a set period to increase the chance of detecting intermittent parasites. Ask for tests that evaluate for various gastrointestinal pathogens (including Giardia, Cryptosporidium, and other parasites).

2. Consider PCR Testing:

   • If regular assays yield negative results, inquire about PCR testing for stool samples, which can provide more sensitive detection of certain parasitic infections.

3. Empirical Treatment:

   • Discuss the possibility of starting empirical treatment for Giardia or other protozoal infections with your pediatric gastroenterologist or family physician, especially given the symptoms and family-wide presentation. Medications like metronidazole or nitazoxanide could be relevant, even before confirming a positive test.

4. Nutritional Support:

   • Ensure that all family members maintain nutritional support, especially for the children. You might consider supplements for deficiencies in fat-soluble vitamins (A, D, E, K) if deficiencies are suspected, under guidance from a healthcare professional.

5. Routine Follow-Up:

   • Regular check-ups with your GP and specialists (like a gastroenterologist) should be maintained to continually assess symptoms and adjust the management plan as necessary.

6. Assess Animal Factors:

   • Evaluate your dog for parasites with a vet, as they could be potential vectors. Ensure that your dog is dewormed and that hygiene practices around pets and waste management are strictly followed.

Conclusion:

Continuing to pursue comprehensive testing and maintaining open communication with your healthcare providers about the family's evolving symptoms is paramount. In these complex and concerning situations, the persistence of symptoms and a family-centric approach is crucial. Please reach out if additional information or clarification is needed. Your family’s wellbeing is the priority, and gathering more data will hopefully lead you to the answers needed for effective treatment.