Infectious Diarrhea: The Daily PANCE Blueprint
A 30-year-old woman returns from a trip to Southeast Asia, where she participated in a food tour involving street vendors. Two days after returning home, she begins to experience fever, abdominal cramping, and diarrhea, which becomes bloody on the third day. She also reports nausea and a general feeling of malaise. Her past medical history is unremarkable, and she takes no regular medications. Physical examination reveals a temperature of 37.8°C (100.0°F), pulse rate of 98/min, blood pressure of 110/70 mm Hg, and oxygen saturation of 97% on room air. Abdominal examination shows mild tenderness in the lower quadrants without rebound or guarding. A stool sample reveals gram-negative, curved bacilli. What is the most likely causative organism?
A. Shigella
B. Salmonella
C. Escherichia coli O157
D. Campylobacter jejuni
E. Vibrio cholerae
Answer and topic summary
The answer is D. Campylobacter jejuni
Campylobacter jejuni is a common cause of bacterial gastroenteritis, often associated with consuming undercooked poultry or contaminated water. It is characterized by symptoms including fever, abdominal pain, and bloody diarrhea. The organism is a gram-negative, curved bacillus, often described as comma- or “S”-shaped, which fits the description provided in the question. The travel history to an area with potential food and water contamination further supports this diagnosis.
Incorrect Answers:
- A. Shigella – Shigella can cause bloody diarrhea and fever, but it is more commonly associated with bacillary dysentery. The description of the bacteria does not match Shigella, which typically appears as straight rods.
- B. Salmonella – While Salmonella can cause gastroenteritis with symptoms similar to those described, it does not typically present with the described gram-negative, curved bacilli.
- C. Escherichia coli O157 – This strain of E. coli can cause bloody diarrhea, especially linked to undercooked beef, but it is a straight rod, not curved or “S”-shaped.
- E. Vibrio cholerae – Vibrio cholerae causes profuse watery diarrhea, often described as “rice-water” stools, which is not consistent with the bloody diarrhea described in this case. The bacteria are also curved, but the clinical presentation does not match.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒
Also covered as part of the Emergency Medicine EOR topic list
