A 22-year-old woman comes to the emergency department with a 2-day history of abdominal pain and diarrhea. She has had about 8 voluminous stools per day, some of which were bloody. She went to an international food festival 3 days ago. Her temperature is 39.5°C (103.1°F), pulse is 90/min, and blood pressure is 110/65 mm Hg. Examination shows a tender abdomen, increased bowel sounds, and dry mucous membranes. Stool examinations of these patients yield oxidase-positive, curved, highly motile, gram-negative rods. Which of the following patient populations do they have a high risk to be infected by this illness?

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Eductional Objective: Vibrio cholerae must survive the acidic environment of the stomach to reach the small intestine and cause disease.  Because the organism is easily destroyed by acid, a high burden of organisms must be ingested to cause infection.  However, conditions that decrease gastric acidity (eg, antacid use) lower the minimum infectious dose of V cholerae by multiple orders of magnitude.

A 22-Year-Old Woman Comes to the Emergency Department with a 2-Day