Severe, Acute Watery Diarrhea in an Adult 英文参考文献.docVIP

PhotoQuiz Severe,AcuteWateryDiarrheainanAdult FahimaChowdhury1,AshrafulIslamKhan1,AbuSyedGolamFaruque1,EdwardT.Ryan2,3,4* 1Clinial Sciences Division, International Centre for Diarrhoeal Disease, Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh, 2Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America, 3Department of Medicine, Harvard Medical School, Boston, Massachusetts, United StatesofAmerica,4DepartmentofImmunologyandInfectiousDiseases,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica Figure1.Thepatientonpresentation. doi:10.1371/journal.pntd.0000898.g001 CaseDescription A 30-year-old woman presented to hospital in Dhaka, Citation: Chowdhury F, Khan AI, Faruque ASG, Ryan ET (2010) Severe, Acute Watery Diarrhea in an Adult. PLoS Negl Trop Dis 4(11): e898. doi:10.1371/ journal.pntd.0000898 Bangladesh,with10hoursofsuddenonsetofvoluminousdiarrhea and vomiting. Since onset, the patient had experienced seven episodes of diarrhea and three of vomiting, and ingested approximately 2 liters of oral rehydration solution at home. She lived in an informal settlement area of Dhaka with two young childrenandahusbandwhowasaday-laborer.Thefamilywould oftendrinkunboiledtapwaterstoredinopenlargecontainers,and sharedatoiletwithapproximately20otherfamilies.Thepatient’s pastmedicalhistorywasunremarkable.Onadmission,nofamily memberwassufferingfromseverediarrhea.Onexamination,the patientwaslethargicandthirsty,andhadsunkeneyes,drybuccal mucosa, reduced skin turgor, deep and rapid breathing, and a feeblepulse(Figure1).Shehadnoturinatedsinceonsetofillness. Other systemic examination findings were normal. The patient’s stool(Figure2)hadafishyodor. Editor:CarlosFranco-Paredes,EmoryUniversity,UnitedStatesofAmerica Published:November30,2010 Copyright: ? 2010Chowdhuryetal.Thisisanopen-accessarticledistributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribut