Meet the Professor- Food Safety and Foodborne Infections Lori Holtz, MD

NASPGHAN: Meet the Professor- Food Safety and Foodborne Infections

Lori Holtz, MD and Mitchell Cohen, MD

Case 1

3 year old with diarrhea that became bloody yesterday.

Learning objectives: 1. Elements at presentation that suggest an infection with E. coli O157:H7 2. Microbial diagnosis of E. coli O157:H7 3. Management strategies for children with suspected or definite E. coli O157:H7 infections 4. Importance of reporting

References: Holtz, LR, Neill, MA, Tarr, PI. Acute Bloody Diarrhea: A Medical Emergency for Patients of All Ages. Gastroenterology 2009 May;136(6):1887-98. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 2005;365:1073–1086.

Case 2 http://www.globe-democrat.com/news/2010/aug/25/health-department-warns- increased-cases-cryptospor/ http://blogs.riverfronttimes.com/dailyrft/2010/08/diarrhea_outbreak_splatters_st_lo uis.php

8 year old previously healthy male with watery diarrhea for the past week.

Learning objectives: 1. Infectious causes of non-bloody diarrhea 2. Risk factors for acquisition of cryptosporidium 3. Clinical features of cryptosporidiosis 4. Diagnosis of cryptosporidium 5. Management of cryptosporidium

References: Chen, XM, Keithly, JS, Paya, CV, LaRusso, NF. Cryptosporidiosis. N Engl J Med 2002; 346:1723. Davies AP, Chalmers RM. Cryptosporidiosis. BMJ 2009: Oct 19;339: b4168.

2 Thought provoking questions:

Case 1

1. What, if any, intravenous fluids would you give a patient with suspected O157? a. none b. half maintenance fluids, because of concern about HUS c. D5NS at maintenance d. D5 ½ NS + 20 mEq of KCL at maintenance

2. How would you manage pain in a patient with suspected O157? a. reassurance b. morphine c. fluid bolus d. lorazepam

Case 2

1. What test would you order if you were suspicious for cryptosporidum? a. Microscopy b. Microscopy on 3 stool samples c. Microscopy with modified acid stain d. Microscopy with DFA e. Cryptosporidium antigen test (EIA)

2. How would you manage an immunocompetent patient with a positive stool for cryptosporidium? a. Reassurance b. IVF c. Nitazoxanide for 1 week d. Nitazoxanide for 3 days