The patient was a previously healthy 11-year-old female who came to the emergenc

Question

The patient was a previously healthy 11-year-old female who came to the emergency department (ED) in mid-September with a 2-day history of bloody diarrhea. Three days previously she had the onset of fever, headache, and lower abdominal pain. Her diarrhea began as watery and became increasingly bloody. She denied any recent travel but reported that her brother also had bloody diarrhea. In her history, she said she had eaten a hamburger at a school picnic prior to the onset of disease, as well as having consumed spinach. There was no family history 30 of inflammatory bowel disease or bloody stools. On physical examination, the patients vital signs were normal and the physi- cal findings were unremarkable except for severe abdominal pain. Her stool was hemoccult positive and showed 2+ white blood cells (WBCs). A complete blood count was within normal limits except for a WBC of 14,900/il, with an absolute neutrophil count of 13,500/yl. She was given morphine in the ED for her abdom- inal pain. An abdominal ultrasound ruled out acute appendicitis but revealed thickened bowel loops consistent with colitis. During the first week of her hospital course she continued to have bloody diarrhea and severe abdominal pain. Her final stool submitted to the laboratory on hospital day 7 was consistent with a blood clot. During her hospital course she developed low urine output and hematuria, with a serum creatinine of 2.1 mg/d on hospital day 5. Her renal symptoms were treated with fluids and her renal function was closely monitored. In addition, on hospital day 6 she had a platelet count of 16,000/pl and a hemoglobin level of 7.2 mg/dl. She received a unit of packed red blood cells on the 6th, 7th, and 11th hospital days. By discharge on the 13th hospital day her serum creatinine, blood urea nitrogen, and platelet count had returned to normal and her hemoglobin had stabilized at 10.2 mg/dl. Culture of her stool on sorbitol MacConkey agar is seen in Fig. 30.1

Explanation / Answer

ans 4 - this patient got infected due to ingestion of infected spinach. E. coli O157:H7 infection develop within 3 to 4 days of eating contaminated spinach. Spinach was previously known to cause severe outbreaks. her symptoms and history of taking spinach suggest that she contracted it from consuming spinach.

ans 5- another variant of same organism that caused severe outbreak in Germany in 2011 was Escherichia coli O104:H4, which is an enteroaggregative E. coli strain. the transmission vehicle was infected food especially the contaminates sprouts/ seeds. the sudden cases and deaths were very unusual in this case. also, the symptoms and rarity of the strain was very unique about this case.

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