Podcast #1 – Sick Traveler

A 23-year-old woman comes to the GP because of a 3-day Hx of increasing flatulence, abdominal bloating, and diarrhea 6-12 times daily despite loperamide therapy. The stool is foul-smelling, watery, and non-bloody; she says it is usually brown and sometimes green. She is afebrile. She recently returned from a study abroad program in the Middle East. Her temperature is 98.8F, HR 85, RR 17, BP 115/75. Abdominal exam shows mild distension and tenderness. There is no rebound or guarding. Bowel sounds are normal. Rectal exam shows no abnormalities. Fecal occult blood is negative. What’s the most likely diagnosis? Campylobacter jejuni Clostridium difficile Entamoeba histolytica Enterotoxigenic E. coli Norwalk virus Rotavirus Salmonella Shigella Yersinia enterocolitica