Just
Ed McDonald
Another
case of
3 days of…
Diarrhea
Pain
Emesis
Other HPI
Questions
?
PCOS
Long QT
Migraine
Past Medical
History
Temp
98
HR
107
BP
105/57 Vital Signs
WBC
8.3
Hgb
13.5
Plt
187
NL
CMP
CRP
56 ESR 6 Labs
CT
Extensive
colonic
thickening
Severe colitis w/ rectal sparing
Ischemic
Hyalinization
Acute
Colitis
Inflammatory
Exudates
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
Diffusely Adhering (DAEC)
Enteroaggregative
(EAEC)
Enteroinvasive (EIEC)
Pathogenic Strains of Ecoli
Enterohemorrhagic (EHEC)
Enteropathogenic (EPEC)
Enterotoxigenic (ETEC)
Cows are a natural habitat a role for vaccination and probiotics
Hamburger meat is the leading
vehicle of infection
CDC: 2012 Incidence Rate per
100,000 people
16.42 14.30
E. coli
1.12
Vibrio
0.41
Salmonella Campylobacter
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
result in colitis that resembles
ischemic colitis
Would you treat this
patient?
Isolation Hand
Hygeine
Well-Cooked
Food
159 cases of E. coli O157: H7 in children
who attended a fair in Canada in 1999
BMC Public Health. 2013; 13: 799
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.
Non-immune
Hemolytic
Anemia
Thrombocytopenia
Renal Impairment
NHS-0583-3DC-3N
HUS
Hemolytic Uremic Syndrome (HUS) *Most common cause of renal failure in children
Micrographs of Samples from Patients with Hemolytic–Uremic Syndrome.
Noris M, Remuzzi G. N Engl J Med 2009;361:1676-1687.
1997 – 2009: 981 Cases of HUS
National Enteric Disease Surveillance: Shiga toxin-
producing Escherichia coli (STEC) Annual Summary, 2009
Median
4.5 yrs
Deaths
52 (5%)
Summer
569
(58%)
E. Coli
O157:H7
95%
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
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
•Antibiotics were stopped by ID •Hgb 11.7 9.1
•Schistocytes on Smear
•Normal Renal Function