GI Grand Rounds: A Brief Discussion of E coli 0157:H7
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A brief talk highlighting a case of food poisoning from E. Coli 0157 given to medical students, residents, and gastroenterology fellows. This is not an exhaustive review and was meant to stimulate discussion.
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GI Grand Rounds: A Brief Discussion of E coli 0157:H7
- 10. Severe colitis w/ rectal sparing
- 14. 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
- 17. Diffusely Adhering (DAEC) Enteroaggregative (EAEC) Enteroinvasive (EIEC) Pathogenic Strains of Ecoli Enterohemorrhagic (EHEC) Enteropathogenic (EPEC) Enterotoxigenic (ETEC)
- 18. Cows are a natural habitat a role for vaccination and probiotics
- 19. Hamburger meat is the leading vehicle of infection
- 20. CDC: 2012 Incidence Rate per 100,000 people 16.4214.30 E. coli 1.12 Vibrio 0.41 SalmonellaCampylobacter
- 21. 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
- 22. result in colitis that resembles ischemic colitis
- 23. Would you treat this patient?
- 25. 159 cases of E. coli O157: H7 in children who attended a fair in Canada in 1999 BMC Public Health. 2013; 13: 799
- 26. 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.
- 27. Non-immune Hemolytic Anemia Thrombocytopenia Renal Impairment NHS-0583-3DC-3N HUS Hemolytic Uremic Syndrome (HUS) *Most common cause of renal failure in children
- 28. Micrographs of Samples from Patients with Hemolytic–Uremic Syndrome. Noris M, Remuzzi G. N Engl J Med 2009;361:1676-1687.
- 29. 1997 – 2009: 981 Cases of HUS National Enteric Disease Surveillance: Shiga toxin- producing Escherichia coli (STEC) Annual Summar Median 4.5 yrs Deaths 52 (5%) Summer 569 (58%) E. Coli O157:H7 95%
- 30. 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
- 31. 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
- 32. •Antibiotics were stopped by ID •Hgb 11.7 9.1 •Schistocytes on Smear •Normal Renal Function