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A 59-year-old man presents with a one-day history of fever, abdominal cramps, and diarrhea

A 59-year-old man presents with a one-day history of fever, abdominal cramps, and diarrhea

A 59-year-old man presents with a one-day history of fever, abdominal cramps, and diarrhea. His symptoms began six hours after the onset of the “runs” in two of his grandchildren and their mother all of whom had been visiting from their dairy and poultry farm in Wisconsin. The day before becoming ill all had eaten a meal consisting of Caesar salad, pasta with stir-fried vegetables, bread and apples. His wife prepared her popular homemade mayonnaise.  Other than the abdominal pain and six unformed bowel movements which contained mucus, he had no complaints.

On examination, the man appeared ill. The temperature was 39.3 C, pulse 100 and blood pressure 110/80 standing. He had no rash. The abdomen was tender in the periumbilical area. No pain noted otherwise. Laboratory studies presented below.

Image result for salmonella on agar plate

Stool culture on enteric agar

On examination, the man appeared ill. The temperature was 39.3 C, pulse 100 and blood pressure 110/80 standing. He had no rash. The abdomen was tender in the periumbilical area.

WBC                              9.8 X 103 /mm3

Fecal leukocytes              Positive

Fecal occult blood           Negative

Stool culture is growing motile, lactose

non-fermenting, gram rod that is H2S.Positive.

  1. What is the likely cause of this man’s diarrhea?
  2. Do these organisms cause diarrhea by invasion or toxin production?
  3. How did the members of the family become infected?  What is the usual route of infection with this pathogen?
  4. What is the preferred therapy for enteritis due to this organism?
  5. What measures could be adopted by this family to reduce the chance of a repeat infection later?

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