Laboratory tests could not be performed in Africa and the child was treated by traditional medicine. He experienced a febrile episode 1 week before returning to France, where he was urgently admitted to hospital. On admission, he presented severe signs of dehydration with weight loss, wrinkled skin, and deep-set eyes, but no disorders of consciousness. Malaria test was negative. A rapid diagnostic test for enterovirus/adenovirus in the stool was negative using an immunochromatographic detection (Diarlex Orion Diagnostica). Stool

culture did not grow any enterobacteria including enterotoxigenic E coli. Routine stool examination for enteric parasites including direct saline wet mount examination and two concentration techniques, Bailenger’s method and merthiolate Vorinostat clinical trial iodine formaldehyde (MIF) with both a fixative and a stain was negative. However, Cryptosporidium

antigen was detected in stool by immunochromatographic method (R-biopharm Diagnostic). Modified Ziehl Nielsen staining of a stool smear showed several Cryptosporidium oocysts. Polymerase chain reaction–restriction fragment length polymorphism (PCR/RFLP)5 identified the species as C hominis. Clinical improvement was rapidly obtained in response to symptomatic treatment (parenteral rehydration + Lacteol). A 55-year-old expatriate French bank manager working in Mauritania for 3 years was due to return to France. He held a dinner party before leaving the country Ixazomib supplier and served a meal composed of avocado with shrimp, beef, eggs, Sorafenib clinical trial potatoes, cheese, and dates. On the following day, he developed intestinal discomfort and a low-grade fever and consulted a Mauritanian physician who prescribed a 7-day empirical course of high-dose trimethoprim (TMP) and sulfamethoxazole (SMX); 160 mg TPM, 800 mg SMX. His wife also complained of abdominal pain and diarrhea. He returned to France 5 days after this meal with no improvement. After 4 days, TMP/SMX was replaced by ciprofloxacin and symptomatic treatment. Symptoms improved

after 3 days and diarrhea resolved. Two days later, he experienced a relapse with deteriorating abdominal pain, diarrhea, and fever. He had three unformed stools daily with sweating and shivering. No laboratory tests had been performed up until then. In view of the absence of improvement, his physician referred him to our University Hospital of Amiens. Blood biochemistry and liver function tests were normal, and human immunodeficiency virus (HIV) serological control was negative. Multiple stool cultures for bacterial pathogens, including Salmonella, Shigella, Campylobacter, enterotoxigenic and other pathogenic E coli and vibrio organisms were negative. Routine parasitological evaluation showed immature I belli oocysts and a large number of Charcot Leyden’s crystal on a fresh unstained stool specimen.