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

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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.

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

  1. 1. Just Ed McDonald Another case of
  2. 2. 3 days of… Diarrhea Pain Emesis
  3. 3. Other HPI Questions ?
  4. 4. PCOS Long QT Migraine Past Medical History
  5. 5. Temp 98 HR 107 BP 105/57 Vital Signs
  6. 6. WBC 8.3 Hgb 13.5 Plt 187 NL CMP CRP 56 ESR 6Labs
  7. 7. CT Extensive colonic thickening
  8. 8. Severe colitis w/ rectal sparing
  9. 9. Ischemic Hyalinization Acute Colitis Inflammatory Exudates
  10. 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. 11. Diffusely Adhering (DAEC) Enteroaggregative (EAEC) Enteroinvasive (EIEC) Pathogenic Strains of Ecoli Enterohemorrhagic (EHEC) Enteropathogenic (EPEC) Enterotoxigenic (ETEC)
  12. 12. Cows are a natural habitat a role for vaccination and probiotics
  13. 13. Hamburger meat is the leading vehicle of infection
  14. 14. CDC: 2012 Incidence Rate per 100,000 people 16.4214.30 E. coli 1.12 Vibrio 0.41 SalmonellaCampylobacter
  15. 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. 16. result in colitis that resembles ischemic colitis
  17. 17. Would you treat this patient?
  18. 18. Isolation Hand Hygeine Well- Cooked Food
  19. 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. 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. 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. 22. Micrographs of Samples from Patients with Hemolytic–Uremic Syndrome. Noris M, Remuzzi G. N Engl J Med 2009;361:1676-1687.
  23. 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. 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. 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. 26. •Antibiotics were stopped by ID •Hgb 11.7  9.1 •Schistocytes on Smear •Normal Renal Function

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