24th July 2023

A 35-year-old woman presents to A&E with a 5-day history of myalgia

A 35-year-old woman presents to A&E with a 5-day history of myalgia, fatigue, yellowing of her eyes, and abdominal pain. She recently returned from a holiday in India, where she sampled food from various street vendors. She has no past medical history of note and takes no regular medication. She also denies taking any over the counter or herbal remedies and says she had no pre-travel vaccinations.

On examination, she is jaundiced and has right upper quadrant tenderness.

Selected blood results:

• Haemoglobin 132 g/L (130-180 g/L)
• White cell count 11.6 x 10⁹L (3.6 – 11.0 x 10⁹/L)
• Platelets 93 x 10⁹L (140-400 x 10⁹L)
• ALT 400 u/L (<42 u/L)
• ALP 187 u/L (30-130 u/L)
• Bilirubin 82 μmol (<21μmol)

What is the most likely causative organism?

Select the SINGLE most appropriate option from the list below. Select ONE option only.