On August 17, 1988, a 42-year-old man was treated for profuse, watery diarrhea, vomiting, and dehydration at an emergency room in Rifle, Colorado. On August 15, he had eaten approximately 12 raw oysters from a new oyster-processing plant in Rifle. Approximately 36 hours after eating the oysters, he had sudden onset of symptoms and passed 20 stools during the day before seeking medical attention. Stool culture subsequently yielded toxigenic Vibrio cholerae O1, El Tor biotype. The patient had no underlying illness, was not taking medications, and had not traveled outside the region during the month before onset.
The oysters had been harvested on August 8, 1988, in a bay off the coast of Louisiana. Approximately 1000 bushels (200 000 oysters) arrived by refrigerator truck at the plant in Rifle on August 11. The patient purchased three dozen of these oysters on August 15. During a 6-day period, eight other persons shared the oysters purchased by the patient. None became ill. Although one of seven tested had a vibriocidal antibody titer of 1:640, none had elevated antitoxic antibody titers, and none had V cholerae isolated from stool. Physicians and local health departments were asked to notify the Colorado Department of Health about similar cases, but no cases were reported.
Question 1 of 3:
What is the probable source of this patient’s V cholerae infection?
A - Oyster bar employee
B - An imported case from Asia
C - Gulf of Mexico
D - Rifle groundwater
E - South America
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