40

CASE 40


Twenty-four people became ill within 3 hours after eating a meal at an office party. All had nausea, most had vomiting, and several had crampy abdominal pain. Three of the individuals sought medical care at the emergency department of a local hospital.


All 24 individuals had been in good health. The day before the office party, a food preparer had purchased a 17-pound precooked packaged ham, baked it at home at 400°F for 1.5 hours, and transported it to her work place, a large institutional kitchen, where she sliced the hot ham on a commercial slicer. The ham was served cold at the party the next day.



PHYSICAL EXAMINATION


Physical examination of one of the three patients (Patient X) is presented here.


VS: T 37°C, P 84/min, R 14/min, BP 136/80 mmHg

PE: Patient X appeared in mild distress due to abdominal pain. Abdomen was soft and nontender, with normal bowel sounds.


LABORATORY STUDIES (PATIENT X)



Blood



Hematocrit: 42%

WBC: Normal

Differential: Normal

Serum chemistries: Normal


Imaging


Abdominal x-ray was normal.



Diagnostic Work-Up


Table 40-1 lists the likely causes of outbreak (differential diagnosis). For Patient X (and others in the outbreak), a clinical diagnosis of food poisoning was considered based on symptoms, onset, and incriminated food. Illness in this outbreak had a rapid onset, within 3 hours after consumption of precooked ham, incriminating a preformed enterotoxin. Investigational approach and epidemiologic investigation may include


• Search for food handlers with skin infections, particularly of the hands

• Cultures of all purulent lesions and collection of nasal swabs from all food handlers

TABLE 40-1 Differential Diagnosis and Rationale for Inclusion (consideration)






Chemical poisoning

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Aug 25, 2016 | Posted by in MICROBIOLOGY | Comments Off on 40

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