1 / 16

A Death due to non-0157 STEC

A Death due to non-0157 STEC. Susan Farley R.N. Communicable Disease Programs Contra Costa Health Services. A Death due to non-0157 STEC Objectives. Public health workers will: understand the potential severity of non-O157 STEC infection

dorit
Download Presentation

A Death due to non-0157 STEC

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. A Death due to non-0157 STEC Susan Farley R.N. Communicable Disease Programs Contra Costa Health Services

  2. A Death due to non-0157 STECObjectives • Public health workers will: • understand the potential severity of non-O157 STEC infection • recognize the importance of following up with a shiga toxin-positive result to have the fecal broth saved and forwarded to a public health laboratory

  3. A Death due to non- 0157 STECCASE-PATIENT • 20-year-old • Single • Female • College student • Vegetarian • Living with boyfriend

  4. A Death due to non-0157 STEC Office Visit with PMD on 2/23 • Onset of symptoms 2 days prior to visit • Lower abdominal cramping • No fever • Frequent loose bowels • No vomiting, some nausea • Bright red bleeding

  5. A Death due to non-0157 stec • No history of Inflammatory Bowel Disease or colitis • PMD documented in patient record “no suspect foods” • Rectal exam was negative for hemorrhoids and fissures • Stool Guaic was positive

  6. A death due to non-0157 stec • Plan: • Treat with metronidazole and ciprofloxacin • Obtain stool testing for Giardia, Clostridium difficile, WBC and C & S • Patient sent home

  7. A Death due to non-0157 stec Patient sought care same day via ED  Admit to Hospital 2/23 c/o Increased rectal bleeding HgB12.5 BP 121/77 WBC 10.6 HR 70 Plt 212,000 T 98.5 Diagnosis R/O Inflammatory Bowel disease Plan Colonoscopy

  8. A death due to non-0157 stec • Hospitalized 2/23 - 2/27 • Colonoscopy:“moderate active colitis” • Continued on Flagyl, Asocal • Vital Signs stable • Chemistry panel WNL • Abdominal discomfort resolved • Continued 1-2 loose stools • Discharged home with boyfriend 2/27 Monday

  9. A death due to non-0157 stec 2/28 Tuesday • Returned to ED with c/o nausea, vomiting, abdominal pain and brownish urine. • ED physician noted stool EIA positive for E. Coli Shiga toxin;Cipro, Asocal and Flagylwere discontinued • Readmitted to Hospital

  10. A Death due to non-0157 STEC 2/28 Tuesday - Public Health received notification of STEC case via Lab: Labcorp E coli Shiga Toxin EIA, Result- Positive Collection date 2/24 Result Date 2/27 -NO demographic info on lab report -message to MD office requesting additional patient information -no contact with patient at this point

  11. A Death due to non-0157 stec 2/29 Wednesday (CD control not aware of this) Patient transferred to ICU • Altered mental status • Decreased urine output • Worsening renal function

  12. A death due to non-0157 stec 3/2 Friday - Mother of patient contacted CDPH FDB to report daughter had history of consuming raw milk products - Contra Costa CD was contacted by CDPH regarding this case - Contra Costa CD attempted to contact case-patient; however, patient not available (in ICU) - Hospital ICN managed brief interview with patient - Food history: raw milk, raw spinach, raw broccoli, raw milk cheese - Boyfriend offered some information regarding grocery stores where foods purchased - Raw milk products were picked up by CDPH FDB at patient’s home

  13. A Death Due to Non-0157 stec 3/2 (continued) • Contra Costa CD contacted Lab Corp regarding specimen; advised that specimen was forwarded to State MDL for serotyping and confirmation • Further investigation into location of specimen found specimen at Contra Costa Public Health Lab. • PHL is able to do STEC culture but not typing • Results were negative for E.coli 0157, positive ST2

  14. A Death due to Non-0157 stec 3/3 Friday Pt transferred to UCSF Clinical status was poor T > 39° CNS failure 2° to s/p seizure Anuric acute renal failure Anemia Thrombocytopenia Leukocytosis Hypocalcemia • TTP-HUS

  15. A death due to non-0157 stec Patient developed left ventricular systolic failure requiring ECMO on 3/5 3/8 Thursday Patient expired immediately after life support withdrawn. 3/7 Specimen forwarded on to State MDL 4/19 State MDL reported STEC 021:H19, Stx 2 Milk from patient’s home tested negative

  16. A death due to non-0157 stecDiscussion Tragic HUS death due to non-O157 STEC Should admitting MD notify Public Health when stool EIA positive for Shiga toxin? Did delay in identifying non-O157 STEC contribute to follow up delay? Difficult to implicate source if only one case identified

More Related