A Franklin, Tennessee couple, Floyd and May, in their late 30s, take a second honeymoon a weeklong v

1
A Franklin, Tennessee couple, Floyd and May, in
their late 30s, take a second honeymoon a
week-long vacation in Peru. During their
parents vacation, the couples two small
children, Claire and Jack, are sent to spend this
time at their Aunt Lujeans farm in Minnesota.
2
While in Peru, Floyd and May fully participate in
the local culture and cuisine. They purchase
homemade beverages from the ubiquitous street
vendors, enjoy the variety of fresh fruits and
vegetables, and dine regularly in the sidewalk
cafes that specialize in ceviche (raw marinated
fish).
3
Back in Minnesota, Claire and Jack are having a
fine time at Aunt Lujeans farm. They help their
aunt in collecting freshly laid eggs and milking
the cows. They get their first taste of raw
unpasteurized milk obtained directly from the
cow. When their chores are complete, Claire,
Jack, and Lujean go fishing and frolicking in a
nearby pond.
4
At the end of the holiday, the family is reunited
back at their home in Franklin. Almost
immediately, Floyd, May, and Jack develop severe
gastrointestinal illnesses characterized
principally by diarrhea. Although Claire has a
few loose stools for a few days, she remains
otherwise symptom-free.
5
Floyd (age 38) develops voluminous watery
diarrhea. By the time he sees his doctor on the
second day of illness, he is having 15 bowel
movements per day. His temperature is 37.4, his
pulse is 144, and his blood pressure is 90/54.
He complains of feeling weak and lighteaded.
6
What are the possible bacterial causes of
Floyds illness?
ETEC the most common bacterial cause of
travelers diarrhea.
Cholera
Other bacterial causes of secretory diarrhea.
7
Why isnt this Shigella dysenteriae or EHEC?
No fever or bloody stools makes invasive
organisms less likely.
8
May (age 36) actually had begun to feel ill on
the plane ride home. She experienced fever,
nausea, and vomiting. By the next day, her
vomiting had resolved but she began to have lower
abdominal cramping and diarrhea. She accompanied
Floyd to the doctor and reported that she was
only having 8 stools per day. Although her
stools were not as voluminous as Floyds, hers
were filled with blood and mucus. She was found
to have a temperature of 38.6 C, pulse 114, and
a BP of 110/68.
9
What are the possible bacterial causes of Mays
illness?
Shigella
Campylobacter
EIEC (less common)
Salmonella (clinically consistent but not the
usual exposure)
10
Three days later, Jack (age 4) begins
experiencing troublesome symptoms in addition to
diarrhea. His mother notices that his eyes have
become quite puffy and his urine has turned
brown. His stools, which were initially dark
brown, have become frankly bloody.
11
What is Jacks diagnosis?
HUS (hemolytic-uremic syndrome)
What bacteria is most likely associated with HUS?
E. Coli O157 H7 (EHEC)
Where do you think he acquired this infection?
Drinking the raw milk.
12
Two weeks later, the parents are completely
recovered from their illnesses, and although Jack
is still requiring dialysis, his renal function
is improving and his hematocrit is stable.
However, Claire (age 6) who had experienced only
a minor diarrheal illness when the rest of the
family became sick, was now complaining of
difficulty getting out of a chair. Her parents
believed she was acting out because of all the
attention being showered upon Jack. However, by
the next morning, Claire is unable to walk at all.
13
What is Claires diagnosis?
Guillain-Barre syndrome
What bacteria is associated with GBS?
Campylobacter jejuni
Where did she likely acquire her infection?
The chicken houses
14
Why wasnt Claire more symptomatic when she was
initially infected?
Some infections are asymptomatic.
How likely is she to transmit infection to other
family members?
Not likely