A 23-year-old man develops watery diarrhoea whilst travelling in Egypt. Which one of the following is the most likely responsible organism?
A. Salmonella
B. Shigella
C. Campylobacter
D. Escherichia coli
E. Bacillus cereus
Answer:
D. Escherichia coli
Discussion: E. coli is the most common cause of travellers' diarrhoea
Gastroenteritis may either occur whilst at home or whilst travelling abroad (travellers' diarrhoea)
Travellers' diarrhoea may be defined as at least 3 loose to watery stools in 24 hours with or without one of more of abdominal cramps, fever, nausea, vomiting or blood in the stool. The most common cause is Escherichia coli .
Another pattern of illness is 'acute food poisoning'. This describes the sudden onset of nausea, vomiting and diarrhoea after the ingestion of a toxin. Acute food poisoning is typically caused by Staphylococcus aureus, Bacillus cereus or Clostridium perfringens.
Escherichia coli:
- Common amongst travellers
- Watery stools
- Abdominal cramps and nausea
Giardiasis:
- Prolonged, non-bloody diarrhoea
Cholera:
- Profuse, watery diarrhoea
- Severe dehydration resulting in weight loss
- Not common amongst travellers
Shigella:
- Bloody diarrhoea
- Vomiting and abdominal pain
Staphylococcus aureus:
- Severe vomiting
- Short incubation period
Campylobacter:
- A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
- Complications include Guillain-Barre syndrome.
Bacillus cereus: Two types of illness are seen
- vomiting within 6 hours, stereotypically due to rice
- diarrhoeal illness occurring after 6 hours
Amoebiasis:
- Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks.
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