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.

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

8. CT
Extensive
colonic
thickening

10. Severe colitis w/ rectal sparing

11. Ischemic
Hyalinization
Acute
Colitis
Inflammatory
Exudates

14. 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

17. Diffusely Adhering
(DAEC)
Enteroaggregative
(EAEC)
Enteroinvasive (EIEC)
Pathogenic Strains of Ecoli
Enterohemorrhagic
(EHEC)
Enteropathogenic
(EPEC)
Enterotoxigenic
(ETEC)

18. Cows are a natural habitat
a role for vaccination and probiotics

19. Hamburger meat is the leading
vehicle of infection

20. CDC: 2012 Incidence Rate per
100,000 people
16.4214.30
E. coli
1.12
Vibrio
0.41
SalmonellaCampylobacter

21. 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

22. result in colitis that resembles
ischemic colitis

23. Would you treat this
patient?

24. Isolation
Hand
Hygeine
Well-
Cooked
Food

25. 159 cases of E. coli O157: H7 in children
who attended a fair in Canada in 1999
BMC Public Health. 2013; 13: 799

26. 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.

27. Non-immune
Hemolytic
Anemia
Thrombocytopenia
Renal Impairment
NHS-0583-3DC-3N
HUS
Hemolytic Uremic Syndrome (HUS)
*Most common cause of renal failure in children

28. Micrographs of Samples from Patients with
Hemolytic–Uremic Syndrome.
Noris M, Remuzzi G. N Engl J Med 2009;361:1676-1687.

29. 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%

30. 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

31. 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

32. •Antibiotics were stopped by ID
•Hgb 11.7  9.1
•Schistocytes on Smear
•Normal Renal Function