Acute Dysentery in a Returning Aid Worker

A 29-year-old woman presents 3 days after returning from humanitarian fieldwork in a refugee camp in the Democratic Republic of the Congo with high fever, lower abdominal cramping, and frequent small-volume stools. Over the last 24 hours, her stools have become bloody and mucoid, and she reports severe tenesmus with each bowel movement.

She spent several weeks in an overcrowded camp clinic in eastern DRC where sanitation was limited and multiple patients had acute diarrheal illness. She reports poor appetite and malaise but no vomiting. She took no antimicrobial prophylaxis and has not used antibiotics recently.

On examination, she appears ill but not toxic. Temperature is 39.1 C, heart rate 112/min, blood pressure 104/66 mmHg, and mucous membranes are mildly dry. Her abdomen is soft with lower abdominal tenderness but no guarding or rebound. Stool passed in clinic is scant and mixed with visible blood and mucus.

Stool microscopy shows numerous polymorphonuclear cells and red blood cells. Basic metabolic testing is unremarkable, and there is no access to rapid multiplex PCR. She is otherwise healthy and not pregnant.