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Answer 6
  1. T. cruzi. The patient has Chagas’ disease caused by T. cruzi, likely acquired during her trip to Argentina, where the disease is commonly encountered. Chronic Chagas’ disease can lead to megaesophagus with a nonrelaxing lower esophageal sphincter and can have a clinical presentation identical to that seen in classic achalasia. Some patients can also develop megacolon with chronic constipation. I. belli typically causes acute watery diarrhea in immunocompetent individuals and chronic diarrhea and malabsorption in immunocompromised individuals. E. coli (pinworm) infection is often asymptomatic but can cause vulvovaginitis in some women. A. caninum is a hookworm commonly found in cats and dogs; when it infects humans, it can produce colicky abdominal pain and peripheral eosinophilia. O. sinensis is a liver fluke that can cause chronic biliary tract disease and predispose patients to cholangiocarcinoma.

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