Case Study: Mateo - Medicine Digital Learning

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Mateo is a 4-year-old boy brought to a rural federally qualified health center (FQHC) in eastern Washington State with a 3-day history of profuse, watery diarrhea without blood. He has colicky abdominal cramping and mild vomiting. He has no fever. On examination, he is mildly dehydrated with dry mucous membranes and decreased skin turgor.

His mother reports that three other children in the neighborhood have had similar diarrhea this week. The family lives in an unincorporated rural community on a private well that has run intermittently this summer after the third consecutive drought year; the water table has dropped significantly.

Several families in the area have been temporarily drawing water from a shared irrigation pond, which the county health department has advised treating with household chlorine bleach while a formal response is arranged. The nearest hospital with inpatient pediatric capacity is 45 miles away.

Question 1

What is the most likely diagnosis, and which features of this case support it?

Question 2

Why has chlorination of the surface source failed to prevent this outbreak?

Question 3

How does drought explain this child's exposure, and how does this differ mechanistically from a flooding scenario?

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