CASE 35
Six individuals from a single family presented over the course of 2 days with low-grade fever, abdominal cramps, vomiting, and diarrhea.
PHYSICAL EXAMINATION
Physical examination of one (Patient X) of the six ill-appearing patients is presented here.
LABORATORY STUDIES (PATIENT X)
Diagnostic Work-Up
Table 35-1 lists the likely causes of Patient X’s illness and the outbreak (differential diagnosis). A clinical diagnosis of enteritis was considered. Microscopic examination of the feces demonstrating the presence of WBCs can support the diagnosis. Investigational approach may include
TABLE 35-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Enteritis is a broad category of illness, with multiple bacterial causes. Certain epidemiologic factors can suggest a particular etiology. Poultry exposure is often associated with Campylobacter or Salmonella. E. coli O157:H7 would be more likely to cause bloody diarrhea, as would Shigella. Enteric viruses and protozoa are the least likely to be considered in a presumptive common-source familial outbreak after eating a meal that includes poultry.
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