Case1 History

A 26 year old woman comes to the traveler's clinic complaining of profound weakness and severe diarrhea of one and one-half days' duration. She has just returned from Africa where she worked for two months in a refugee camp on the border of Rwanda and Zaire. On the plane she developed abdominal bloating, intestinal gurgling and nausea followed by two loose bowel movements. Soon she was having profuse watery diarrhea occurring hourly. Stools were clear and without odor.

You meet her in the clinic. She looks very weak but has no fever. Blood pressure is 94/60 lying down and drops to 72/40 standing. She is admitted to the hospital. Admitting laboratory studies include the following: .

 Case 1 Questions

1. What is the mechanism of transmission of Vibrio cholerae?    Answer

2. What host factors increase the likelihood of infection with V. cholerae?  Answer

3. Describe the mechanism of action of cholera toxin.  Answer

4. Besides toxin production, what other virulence determinant is essential for the development of cholera?  Answer

5. How would you manage the dehydration? Why can oral rehydration fluid be used in many cases of cholera?  Answer

6. What advice would you provide to other travelers to Rwanda concerning avoidance of cholera?  Answer

7.  List three public health solutions to the global problem of epidemic cholera.  Answer