1 infec 86 - tabish60102

[ArchivalUser]

A 63-year-old woman, who was on a group tour to the Yucatan Peninsula, developed abdominal cramping and flatulence on the third day of her trip. The next day, she had watery diarrhea with five or six stools daily. Five of the other 32 members of the tour had similar symptoms. The group stayed in excellent hotels and ate only in hotel restaurants. They all drank bottled water and tried to eat well-cooked foods.

The patient took loperamide and bismuth subsalicylate for her symptoms. She felt well by the sixth day of the trip and had only two formed stools daily.

Which of the following pathogens was the most likely cause of her diarrhea?

A Vibrio cholerae
B Campylobacter jejuni
] C Shigella dysenteriae
D Salmonella typhimurium
] E Escherichia coli

[ArchivalUser]

ee

[ArchivalUser]

(Correct Answer = E)
Key Points

* Enterotoxigenic Escherichia coli is the most common cause of diarrhea in travelers to developing countries.
* Diarrhea due to enterotoxigenic E. coli is usually a mild and self-limited illness.

Although all of the pathogens listed are possible causes of this patient's illness, enterotoxigenic Escherichia coli diarrhea occurs most often in travelers. This patient's presentation is fairly typical of E. coli infection experienced by travelers to developing countries. Although the disease can be quite severe (fever, nausea, vomiting, abdominal pain, and malaise), it is usually relatively benign and self-limited. Antibiotics are generally not required for mild travelers' diarrhea and may even exacerbate certain types of diarrheal illness.

Vibrio cholerae is an unusual cause of diarrhea in travelers except in areas where cholera is highly endemic. Although Campylobacter jejuni is the most common bacterial cause of diarrhea in the United States, it occurs much less often than enterotoxigenic E. coli diarrhea in other countries. Shigella dysenteriae is a much less frequent cause of diarrhea than E. coli and is associated with a more severe illness that persists longer without treatment. Salmonella typhimurium is also a possible cause of diarrhea in travelers but occurs much less frequently than E. coli infection.
Bibliography

[ArchivalUser]

thanks