What is the clinical presentation of a patient with diarrhea?

From the Guidelines

A 30-year-old woman presents to the clinic with a 5-day history of diarrhea, which has been persistent and watery, occurring 5-6 times per day. She reports abdominal cramping, nausea, and a fever of 100.5°F. The patient recently returned from a trip to India two weeks ago, where she consumed street food and drank untreated water. Physical examination reveals mild dehydration with dry mucous membranes and mild diffuse abdominal tenderness. Laboratory tests show mild leukocytosis with WBC 10,000/μL.

Questions

• Question 1: What is the most likely diagnosis for this patient? A) Irritable bowel syndrome B) Traveler's diarrhea C) Ulcerative colitis D) Clostridium difficile infection
• Question 2: What is the most appropriate initial management for this patient? A) Oral rehydration therapy and observation B) Intravenous fluids and hospital admission C) Immediate colonoscopy D) Stool transplantation
• Question 3: Which of the following pathogens is most likely responsible for this patient's condition? A) Enterotoxigenic E. coli B) Campylobacter jejuni C) Giardia lamblia D) Salmonella species
• Question 4: What is the best approach to prevent dehydration in this patient? A) Intravenous fluids B) Oral rehydration solutions C) Antimotility agents D) Antibiotics

Answers

1. B) Traveler's diarrhea - This is the correct diagnosis based on the acute onset of watery diarrhea following travel to India, consumption of street food, and associated symptoms of fever and abdominal cramping, as suggested by the guidelines 1.
2. A) Oral rehydration therapy and observation - For most cases of traveler's diarrhea, oral rehydration is the cornerstone of treatment, as recommended by the guidelines 1.
3. A) Enterotoxigenic E. coli - This pathogen is commonly associated with traveler's diarrhea, particularly in individuals who have consumed contaminated food or water, as noted in the guidelines 1.
4. B) Oral rehydration solutions - The use of oral rehydration solutions is the best approach to prevent dehydration in patients with diarrhea, as they provide essential electrolytes and fluids, as recommended by the guidelines 1.

From the Research

Clinic Case: Diarrhea

A 30-year-old man presents to the clinic with a 3-day history of diarrhea, fever, and abdominal cramps. He reports having 5-6 loose stools per day, with no blood or mucus. He has been experiencing nausea and vomiting, but no significant abdominal pain. He has not traveled recently and has not been exposed to anyone with similar symptoms.

Questions

• What is the most likely cause of this patient's diarrhea?
  • A) Viral infection
  • B) Bacterial infection
  • C) Parasitic infection
  • D) Non-infectious cause
• What is the best initial management for this patient?
  • A) Antibiotic therapy
  • B) Oral rehydration therapy
  • C) Intravenous rehydration therapy
  • D) Antidiarrheal agents
• What diagnostic test would be most appropriate for this patient?
  • A) Stool culture
  • B) Molecular studies (e.g. PCR)
  • C) Complete blood count
  • D) Endoscopy

Answers and Explanations

• The most likely cause of this patient's diarrhea is a viral infection, as it is the most common cause of acute diarrhea in adults 2, 3.
• The best initial management for this patient is oral rehydration therapy, as it is the preferred method for replacing water, electrolytes, and nutrients in patients with acute diarrhea 2, 4.
• The most appropriate diagnostic test for this patient would be molecular studies (e.g. PCR), as they are preferred over traditional stool cultures unless an outbreak is suspected 2.