A Case of Gastroenteritis

1. A Case of Gastroenteritis Laura Flanagan July 2010

2. The Case • Normally fit and well 28 year old • Saturday • Pub lunch (burger) • Barbecue (bite of a burger, sausage and cupcake) • Sunday • Veg melt sandwich • Burger king • Monday • M&S salad • More M&S salad and their big platter

3. Case cont. • Feeling slightly nauseous before bed • Woken at 2am Tuesday morning • Rest of night spent mainly in bathroom • Most of Tuesday spent mainly in bed • Returned to work Thursday 2kg lighter

4. Looking like this!

5. Feeling like this!

7. Mr Noro Virus • Found in used water and concentrated mainly in shellfish, oysters and plankton • Can cause illness at any age as immunity does not last long • Most common cause of gastroenteritis in England and Wales • More common in winter • Incubation period of 24-48 hours but may be as little as 12 hours • Symptoms include nausea and vomiting with watery diarrhoea along with abdominal cramps • Symptoms last 12-60 hours but most people make full recovery in 1-2 days • Management is symptomatic

8. Miss Campy Lo Bacter • NOTIFIABLE • Commonest cause of bacterial gastroenteritis in England and Wales • Source is mainly undercooked meat especially poultry but also unpasteurised milk and untreated water • One source is birds pecking milk bottle tops • Incubation period is from 1-11 days but usually 2-5 days • Prodromal illness with fever, headache and myalgia lasting 24 hours • Fever can be up to 40 and may persist for a week • Then get abdominal pain, cramps and profuse diarhorrea which is watery and can often become bloody • Usually self limiting, approximately 9 in 10 people recover after 1 week • Erythromycin eliminates bacteria but does not affect duration of symptoms

9. Ms Sal Monella • NOTIFIABLE • Found in many animals and contamination occurs from animal faeces • Source usually animal origin, beef, poultry, unpasteurised milk and eggs • Inadequate thawing from freezing is a common source • Heat readily kills salmonella but can survive spit or oven roasting if not properly defrosted • Incubation period of 12-72 hours • Diarrhoea starts with fever and abdominal cramps, can be bloody • Illness last 4-7 days and can have temperature of 38-39 for 48 hours • Supportive management • Antibiotics do not shorten the illness but may prolong carrier stage

10. Mrs E Coli (0157) • NOTIFIABLE • Uncommon cause but important as infection can be severe and sometimes fatal • Reservoir in intestines of healthy cattle and survives in faeces and soil • Infection can occur via inadequately cooked beef mince, milk, contact with farm animals, person to person and infected water • Incubation period 1-14 days but usually 3-4 days • Consider e coli infection in anyone presenting with acute bloody diarhorrea especially if painful diarhorrea and without fever • Uncomplicated cases usually resolve in 2 weeks • However associated with complications like haemolytic uraemic syndrome (HUS) especially in children • HUS is triad of acute renal failure, haemolytic anaemia and thrombocytopenia, with the thrombocytopenia often been first sign • If e coli is suspected you should consider admission especially in at risk groups

11. Master Ro Tavirus • Most common cause of gastroenteritis in children • Uncommon in adults as infection confers immunity • Spread is faeco-oral and also airborne • Incubation period of 48 hours • Symptoms include fever, vomiting then watery diarhorrea. • Diarhorrea can last 3-9 days • Management is symptomatic

12. Mr C Perfringens • Fourth commonest food borne illness after norwalk, campylobacter and salmonella • Spores found in soil, they can survive cooking and germinate during slow cooling or unrefrigerated storage • Mostly associated with meat and poultry • Typically occurs when a meat dish is stewed or boiled and allowed to stand for 4-24 hours then served without adequate re-heating • Incubation period 6-12 hours • Symptoms are crampy abdominal pain followed by diarhorrea which subsides 12-24 hours later • Management symptomatic

13. Conclusion • We may never know • Keep vigilant • It could be you next! • Lots more information about individual suspects at www.patient.co.uk