A presentation for the monthly Infectious Disease Conference at DeKalb Medical. I describe a man who came to the hospital with a severe case of Streptococcal Toxic Shock complicated by Arthropathy and Erythema Marginatum typically seen in Rheumatic Fever.
This was a presentation for the monthly Infectious Disease Conference at DeKalb Medical. I presented a man with 40 years of deep vein thrombosis, two years with a painful ulcerating leg wound, and a new diagnosis of Cicatricial Pemphigus who responded to a regimen of prednisone, cyclosporine, dapsone and IVIG.
Food contamination is an increasing risk in a crowded, overpopulated world since much of our food travels long distances and and is widely disseminated from its original sources. Before modern times food contaminations were from local sources and easier to trace. The current E. coli OH157 outbreak in Germany is a particularly virulent process. The bacteria in our bowels are mostly E. coli. The current epidemic outbreak has an E. coli OH157 strain which has acquired a virulent toxin from the shigella bacterium. This chemical toxin can cause a range of illness including severe diarrhea, hemorrhagic diarrhea, acute hemolytic uremic syndrome (HUS) with breakage of the red blood cell and renal failure, or thrombotic thrombocytic purpura (TTP) with overwhelming multi organ failure. Unfortunately washing fruits and vegetables does little to clear them of bacteria. Peeling fruits and vegetables can help reduce risk of bacterial contamination by mechanical removal of the surface bacteria. Unfortunately some foods such as bean sprouts are heavily contaminated, unpeelable and unwashable. The following report suggests that bean sprouts may well be the source of the current European outbreak of E. coli.
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Measles, also known as rubeola, is a highly contagious virus that causes a distinct clinical syndrome. This virus was once the most common cause of a childhood rash and fever in this country. As a result of effective vaccinations, it is now a rare occurrence. Outbreaks today are limited to the developing world and individuals who were not adequately vaccinated in childhood.
Measles has an incubation period from 10-14 days. Symptoms include fever, rash, conjunctivitis, cough and oral lesions known as Koplik spots. Transmission occurs via contact with an infected individual.
3 months ago on the hospital wards, I was consulted on a 22 year old gentleman from Ethiopia who had arrived in Atlanta just 9 days before his presentation. His symptoms of rash, fever, sore throat and weakness began 3 days after his arrival. He was brought to the emergency room by his concerned sister. On arrival he had a fever of 101 degrees Fahrenheit. I saw him on his 2nd hospital day. He still had a fever and there was a diffuse reddish/purple, slightly raised rash over his face, arms, chest and back. Redness was noted in his throat and he had mild conjunctivitis. He appeared weak and had not eaten in 3-4 days. Since his symptoms appeared mostly consistent with a viral syndrome, no antibiotics were started. He had some serologic tests sent and was given supportive therapy only.
On his 3rd hospital day his serology for HIV and syphilis returned negative. By day 4 he was feeling significantly better and was discharged. 2 days after discharge his dengue virus serology returned negative, but measles serology was weakly positive. As per protocol the laboratory alerted the CDC of this result. Patient was tracked to his sister’s home and repeat serology was obtained 1-2 weeks later. This was confirmed to be positive and all of patient’s contacts were tracked. No secondary cases were identified. This was mainly due to the fact that the US population, in general, is well immunized against measles.
This case illustrates the risks of our global community: diseases from faraway lands are only a plane ride away. Without proper immunity, an interesting case could easily become a dangerous outbreak. The importance of routine immunizations cannot be over-emphasized. Individuals can always inquire about their immune status with their primary care providers. A simple blood test can confirm immunity and vaccination can help prevent outbreaks.
-AW/CD
The holidays are a time of year with parties and family gatherings that involve lots of food — some of which may have been sitting out for hours, coughed on by friends and relatives, or otherwise contaminated. Most holiday food illness risk is from Staphylococcus aureus (Staph), Salmonella, or Campylobacter. Here are some helpful tips to avoid these bacteria and keep you and your guests healthy this holiday season.
1. Before handling food, wash your hands thoroughly with 60% alcohol hand sanitizer or with soap and water for at least 60 seconds. Don’t share the germs you’ve acquired from the mall with your family.
2. Staph food poisoning occurs when a toxin producing stain of Staph contaminates unrefrigerated food. So when Uncle Harry coughs uncovered over the freshly prepared stuffing, you may have a problem after 3 or 4 hours. Best to cover leftovers with foil or plastic and refrigerate between servings.
3. Most poultry carries Salmonella, which can result in any symptoms from a mild diarrhea to a typhoidal array of symptoms, including fever, abdominal pain, and blood infection. Cooking kills Salmonella on the surface, but be sure to thoroughly wash all preparatory surfaces and utensils so uncooked items don’t pick up Salmonella.
4. As a guest at a party, be particularly wary of egg and mayonnaise based dishes that have been unrefrigerated for more than three hours. These can easily become contaminated with bacteria that double every twenty minutes and can leave you vomiting later in the night and with diarrhea the following day.
What can I do to protect myself from the flu?
1. Get a flu vaccine (this year’s vaccine combines Influenza B, H1N1, and H3N1)
2. Avoid spreading flu by covering your mouth when coughing or sneezing, discarding tissues, and WASHING YOUR HANDS frequently. Stay away from those who are sick and stay home if you become sick.
3. If you experience flu symptoms see your doctor immediately. Flu medications only work if started within 48 hours of the onset of illness.
What are flu symptoms?
Fever, cough, sore throat, body aches, headache, chills, fatigue, and runny nose. Some people may experience vomiting and diarrhea, which is more specific to H1N1. No single symptom is seen in every person, but the combination of multiple of these severe symptoms is typical of the flu.
Who should be vaccinated?
Everyone over six months of age, but especially the medically fragile such as pregnant women, small children, people over 65 years old, diabetics, asthmatics, and those with heart and lung disease.
Health care workers need vaccination to avoid spreading the disease.
Children under 6 months old cannot be vaccinated but are at high risk if exposed. It is really important for anyone who may have contact with an infant to get vaccinated to protect the infant. You don’t want to bring a Christmas gift of hospitalization to your youngest family member.
Can I get flu from the vaccine?
No. The injection is not alive and cannot give you influenza. Since vaccination is given during cold and flu season, it won’t protect you if you are already incubating flu in the first week and it will not prevent any other cough or cold during cold season.
-CD/RD