M.T. is a 60-year-old, ill-appearing man hospitalized for worsening bloody diarrhea and fever. Two..

M.T. is a 60-year-old, ill-appearing man hospitalized for worsening bloody diarrhea and fever. Two days before admission, he noted the onset of fever, abdominal cramps, and six to seven nonbloody, watery stools. His diarrhea has since worsened to 10 to 12 small-volume stools with blood and mucus, and he now complains of painful straining while passing his stools. His history of present illness is significant for returning 2 days ago from a business trip to Bangladesh. During the business portion of the trip he remained at the hotel where all his meals were prepared by the hotel staff. However, on the day of his departure, he mingled with the local residents and sampled foods from local street vendors. M.T. lives alone in Florida, has no significant medical history or drug allergies, and takes no medications. On admission, his temperature is 101?F. Physical examination reveals an acutely ill man with severe abdominal tenderness, and with signs and symptoms of mild dehydration. Why are his history of present illness and clinical presentation consistent with the diagnosis of dysentery, most likely caused by Shigella dysenteriae?

 

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