After a trip to Peru to adopt a 6-month-old baby, a 32-year-old woman and her new baby both develop profuse, watery diarrhea with flecks of mucus. Both are hospitalized because of the severity and rapidity of the dehydration, but neither one is febrile. What is the most likely causative agent?

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Quizplus · Accepted Answer

The mention of Peru should raise suspicion of cholera. (Rotavirus would have to be ruled out for the baby, but it is not one of the choices.) The loss of fluids and electrolytes is rapid and most severe with Vibrio cholerae. The lack of fever and lack of pus and blood in the stools suggests that the causative agent is not Campylobacter, Salmonella, or Shigella. The lack of blood also decreases the chance of Escherichia coli O157. If untreated, cholera may lead to dehydration, hemoconcentration, and hypovolemic shock.

After a Trip to Peru to Adopt a 6-Month-Old Baby