Tuesday, December 30, 2014

A 26-year-old woman travels to a rural area of Nepal.

A 26-year-old woman travels to a rural area of Nepal. Three days after arrival, she develops watery diarrhea with severe abdominal cramping.

She reports two unformed stools daily for the past 2 days. She has noticed no blood in the stool and has not experienced a fever.

What is the most likely cause of the patient’s illness?

A. Campylobacter jejuni
B. Enterotoxigenic Escherichia coli
C. Giardia lamblia
D. Norovirus
E. Shigella spp.

The answers is B  Traveler’s diarrhea is common among individuals traveling to rural affecting 25% to 50% of travelers to these areas. Most traveler’s diarrhea begins within
3 to 5 days after arrival and is self-limited, lasting 1 to 5 days. Most individuals acquire
traveler’s diarrhea after consuming contaminated food or water. Although some organisms
have a geographic association, enterotoxigenic and enteroaggregative Escherichia
coli are found worldwide and are the most common causes of traveler’s diarrhea.

In Asia, Campylobacter jejuni is also common. This presentation would be uncommon for
Shigella spp. because it most frequently causes bloody diarrhea. Norovirus is associated
with a more profuse diarrhea. It has been the causative organism in large outbreaks on
cruise ships. Giardia lamblia is a parasite that is responsible for 5% or less of traveler’s


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