CASE 39
A 31-year-old man returned to the United States in late summer from a 3-week-long trip to Bangladesh. On the second day after his return, he presented with sudden, severe, profuse watery diarrhea. In the emergency department, he passed a large, watery stool with a rice-water appearance. He vomited several times and became slightly sweaty. He complained of muscle cramps and dizziness.
He was on an H2-blocker drug for ulcer disease. Otherwise, he had always maintained good health.
LABORATORY STUDIES
Diagnostic Work-Up
Table 39-1 lists the likely causes of illness (differential diagnosis). A clinical diagnosis of cholera was considered based on symptoms and travel history. Investigational approach may include
TABLE 39-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Watery diarrhea has many causes, including viruses, bacteria, and parasites. ETEC is the most common cause of watery diarrhea in travelers. However, severe, acute watery diarrhea that leads to rapid dehydration is characteristic of one of the above agents. No other illness causes such massive diarrhea. Certain areas of the world, such as South Asia, Africa, and South America, are highly endemic.
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