A 35-year-old woman comes to the emergency department due to a 4-day history of fever, abdominal pain, and profuse, watery diarrhea. The patient also has nausea and vomiting. She prepares her own food and frequently tastes it while cooking. The patient has no chronic medical conditions and takes no medication. Temperature is 38.8 C (101.8 F), blood pressure is 110/70 mm Hg, and pulse is 100/min. Abdominal examination shows mild, diffuse tenderness. Bowel sounds are increased. Examination of the stool shows numerous leukocytes. Which of the following is the most likely pathogen?

Question

A 35-year-old woman comes to the emergency department due to a 4-day history of fever, abdominal pain, and profuse, watery diarrhea.  The patient also has nausea and vomiting.  She prepares her own food and frequently tastes it while cooking.  The patient has no chronic medical conditions and takes no medication.  Temperature is 38.8 C (101.8 F), blood pressure is 110/70 mm Hg, and pulse is 100/min.  Abdominal examination shows mild, diffuse tenderness.  Bowel sounds are increased.  Examination of the stool shows numerous leukocytes.  Which of the following is the most likely pathogen?

Quizplus · Accepted Answer

11ec160b_3808_b9be_9249_2337e0e10f34_MD0001_00 This patient has inflammatory diarrhea, which is characterized by ≥3 daily loose stools with fecal leukocytes and/or red blood cells. Many with inflammatory diarrhea also have grossly bloody or mucoid stools, but some may have only watery stools, as in this patient. The most common causes of inflammatory diarrhea include Shiga toxin-producing Escherichia coli, Shigella, and Campylobacter, making Campylobacter jejuni the most likely cause in this patient. The transmission of Campylobacter typically occurs after ingestion of contaminated foods, particularly poultry/eggs, that are undercooked/unrefrigerated. This patient who has a history of tasting food during preparation likely ingested undercooked food. Symptoms of Campylobacter gastroenteritis typically begin within a week of transmission and include fever, abdominal pain, and diarrhea. Nausea and vomiting are common, and acute ileocecitis can occur, causing focal right lower quadrant pain that may be mistaken for appendicitis. In addition, bloody stools may develop, but this finding is more common in children. Symptoms typically self-resolve in a week. (Choice B) Clostridioides difficile typically causes profuse, watery diarrhea with positive fecal leukocytes. However, this pathogen is usually associated with recent antibiotic exposure or hospitalization, making it unlikely in this otherwise healthy patient. (Choice C) Enterotoxigenic Escherichia coli is a common cause of travelers' diarrhea and is associated with travel to resource-limited regions, which is not seen in this patient. Moreover, the diarrhea is noninflammatory, and fecal leukocytes would not be seen. (Choice D) Listeria monocytogenes is typically transmitted via ingestion of contaminated food (eg, deli meat, soft cheeses). Although a febrile gastroenteritis with profuse, watery stools is typical, the diarrhea is noninflammatory, and fecal leukocytes would be absent. In addition, the illness typically lasts ≤2 days and usually includes flu-like symptoms (eg, headache, myalgias). (Choice E) Norovirus is the most common cause of viral gastroenteritis but, in contrast to this patient's presentation, causes noninflammatory diarrhea (ie, no fecal leukocytes) lasting 2-3 days. Educational objective: Campylobacter gastroenteritis causes an inflammatory diarrhea characterized by fecal leukocytes and/or red blood cells. Transmission typically occurs via ingestion of contaminated foods that are undercooked/unrefrigerated, and patients typically have fever, abdominal pain, and diarrhea with or without gross blood. __________ References: Campylobacter: from microbiology to prevention. (http://www.ncbi.nlm.nih.gov/pubmed/28900347)

A 35-Year-Old Woman Comes to the Emergency Department Due to a 4-Day