case

1. Case Presentation
Austin See

2. History
• Pt: 11 year old female who presented to PAU on 05/09
• PC: 12/7 Fever, watery bloody diarrhoea, body aches, and abdominal pain
(periumbilical, sharp, intermittent, aggravated by food ingestion, relieved after
bowel motion, 3/10)
• TH: Turkey 2/52 – Attended buffet where she was the only one to eat prawns

3. Examination
• Abdomen: SNT, full, no palpable enlarged organ, hyperactive bowel sounds
• Chest clear
• HS I+II+0
• CNS: Alert, well oriented, normal tone and power
• Eyeballs appear sunken, moist buccal mucosa, skin turgor returns quickly, CRT <2
• No significant lymphadenopathy

4. Initial Management
• Originally treated as sepsis, d/w microbiology who were happy with IV cefotaxime
which would cover for salmonella
• IV maintenance fluids
• Stool culture
• Blood culture
• Strict input/output

5. Observations

6. Investigations
5 Sep.
FBC, U&Es, LFTs – NAD
CRP 186
7 Sep.
CRP 56
Stool culture – Salmonella positive

7. Management
• IV fluids stopped
• Switch to PO Ciprofloxacin
• Discharged to virtual ward – Observation for a day
• Contact GP to inform PHE

8. Salmonella
Gastroenteritis Enteric/typhoid fever
Symptoms N+V, diarrhoea, abdo pain Nonspecific inc. fever, anorexia,
headache, myalgia, constipation
Incubation Period 6 to 48 hrs 10 to 14 days
Duration of symptoms 2 to 7 days May be fatal if Abx not promptly
administered
Spread Contaminated food – large animal
reservoir
Ingestion of food or water
contaminated by infected human
faeces
Pathogen S typhimurium and S enteritidis S typhi, S paratyphi-A, and S
schottmuelleri

10. Antimicrobial
• Complicated by resistance to commonly
used drugs
• Severe – Characterised by delirium,
obtundation, coma, or shock

11. Red flags for referral to hospital in children
• Looking sick and toxic
• Unable to take oral medication
• Persistent vomiting
• Signs of severe dehydration
• Abdominal distension with or without tenderness
• Jaundice
• Drowsy or altered consciousness
• Signs of gastrointestinal bleeding (such as passing fresh blood in stools or melaena)
• Signs of haemodynamic shock, including mottled skin and reduced capillary return
• Seizures

12. Public Health England
• Gov.uk Notifiable diseases
• Notification form
• Routine or Urgent
• Routine = Email within 3 days
• Urgent = Phone within 24 hrs and email within
3 days