GI Grand Rounds: A Brief Discussion of E coli 0157:H7

  • 112 views
Uploaded on

A brief talk highlighting a case of food poisoning from E. Coli 0157 given to medical students, residents, and gastroenterology fellows. This is not an exhaustive review and was meant to stimulate …

A brief talk highlighting a case of food poisoning from E. Coli 0157 given to medical students, residents, and gastroenterology fellows. This is not an exhaustive review and was meant to stimulate discussion.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
112
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
2
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Just Ed McDonald Another case of
  • 2. 3 days of… Diarrhea Pain Emesis
  • 3. Other HPI Questions ?
  • 4. PCOS Long QT Migraine Past Medical History
  • 5. Temp 98 HR 107 BP 105/57 Vital Signs
  • 6. WBC 8.3 Hgb 13.5 Plt 187 NL CMP CRP 56 ESR 6Labs
  • 7. CT Extensive colonic thickening
  • 8. Severe colitis w/ rectal sparing
  • 9. Ischemic Hyalinization Acute Colitis Inflammatory Exudates
  • 10. Salmonella 0.9% Shigella 0.6% Campylobacter 1.4% E. Coli O157 0.3% 1996: 233,212 stools tested Overall 1.5%-2.9% Clin Infect Dis. (2001) 32 (3): 331-351
  • 11. Diffusely Adhering (DAEC) Enteroaggregative (EAEC) Enteroinvasive (EIEC) Pathogenic Strains of Ecoli Enterohemorrhagic (EHEC) Enteropathogenic (EPEC) Enterotoxigenic (ETEC)
  • 12. Cows are a natural habitat a role for vaccination and probiotics
  • 13. Hamburger meat is the leading vehicle of infection
  • 14. CDC: 2012 Incidence Rate per 100,000 people 16.4214.30 E. coli 1.12 Vibrio 0.41 SalmonellaCampylobacter
  • 15. Isolation rate of STEC O157 by age United States 2009 (n=1,947) National Enteric Disease Surveillance: Shiga toxin- producing Escherichia coli (STEC) Annual Summary, 2009
  • 16. result in colitis that resembles ischemic colitis
  • 17. Would you treat this patient?
  • 18. Isolation Hand Hygeine Well- Cooked Food
  • 19. 159 cases of E. coli O157: H7 in children who attended a fair in Canada in 1999 BMC Public Health. 2013; 13: 799
  • 20. Cipro- increases Shiga production in mice models Hemolytic Uremic Syndrome No effect on duration of symptoms Is concern about giving antibiotics legitimate? Proulx F, Turgeon JP, Delage G, et al: Randomized, controlled trial of antibiotic therapy for Escherichia coli O157:H7 enteritis.
  • 21. Non-immune Hemolytic Anemia Thrombocytopenia Renal Impairment NHS-0583-3DC-3N HUS Hemolytic Uremic Syndrome (HUS) *Most common cause of renal failure in children
  • 22. Micrographs of Samples from Patients with Hemolytic–Uremic Syndrome. Noris M, Remuzzi G. N Engl J Med 2009;361:1676-1687.
  • 23. 1997 – 2009: 981 Cases of HUS National Enteric Disease Surveillance: Shiga toxin- producing Escherichia coli (STEC) Annual Summar Median 4.5 yrs Deaths 52 (5%) Summer 569 (58%) E. Coli O157:H7 95%
  • 24. Antibiotics and HUS Systemic Reviews Safdar 2002 • 9 Studies • Neither protection nor increased risk • Pooled OR 1.15 (95% CI 0.79-1.68) Panos 2006 • 19 Studies • Inconclusive Safdar N. JAMA 2002; 288:996-1001
  • 25. Other Treatment and HUS Synsorb • an agent that binds to ST to prevent its absorption from the gut. Antibodies • Monoclonal Ab against Shiga 1 and 2
  • 26. •Antibiotics were stopped by ID •Hgb 11.7  9.1 •Schistocytes on Smear •Normal Renal Function