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Case
Summary
1.
Of the 65 people attending a retirement picnic, 37 patients ranging
in age from 6 to 78 years acquired symptoms of classical
community-acquired food poisoning. Gastroenteritis can be caused by
bacterial enterotoxins or exotoxins. In this case, the
causative agent was determined to be Salmonella
species, serotype epidermitidis.
which produces enterotoxins.
2.
Symptoms consisted mainly of acute abdominal cramps, diarrhea and
vomiting. Only three elderly patients were admitted to the hospital
for overnight observation and treatment for mild dehydration.
3.
The diagnosis is made by isolating the causative agent from the
patient's stool. New laboratory techniques make this possible within
24 hours. A fecal white blood count determines if the organism
is invasive. Serum electrolytes and hematocrit help determine
the degree of dehydration.
4.
Treatment of Salmonella
food poisoning consists of managing the main symptoms (vomiting and
diarrhea), and when indicated, replacement of fluids and
electrolytes. Hospitalization is only required when patients exhibit
severe symptoms, or have an underlying condition (e.g. poor renal
function or gastrointestinal disease) which could worsen the illness.
Antibiotics are not indicated except in severe cases when the
bacteria spreads to the bloodstream or other body sites.
5.
Even though public health agency personnel conducted through
examination of the company which provided the picnic foods, the
source of the Salmonella
could not be confirmed by standard examination procedures.
Suspected foods were sliced sandwich meats (turkey and roast beef)
and the potato salad.
Salmonella is prevalent in
nature, found in meats, dairy products, especially eggs (poultry
carry Salmonella
in their intestinal tracts), and reptiles such as lizards and
turtles.
"Every
year, approximately 40,000 cases of salmonellosis are reported in the
United States. Because many milder cases are not diagnosed or
reported, the actual number of infections may be twenty or more times
greater. Salmonellosis is more common in the summer than winter.
Children are the most likely to get Salmonellosis. Young
children, the elderly, and the immunocompromised are the most likely
to have severe infections. It is estimated that approximately 1,000
persons die each year with acute salmonellosis. " Taken
from the CDC
Public
health agencies, county state and federal all have distinct
guidelines for consumers and food vendors. State agencies require
food handlers permits and facilities preparing and serving food are
regularly inspected for compliance to established guidelines. In
spite of this, there are tens of thousands of cases of bacterial food
poisoning each year, many unreported.
6.
Prevention of food poisoning in general requires careful attention
during food processing and preparation. Un-refrigerated foods
such as salads prepared with dairy products such as mayonnaise should
be avoided. Meats, especially cold meats that have been allowed to
sit in warms environments are also a common source. Unwashed
vegetables can also be a source of Salmonella.
7.
Public health personnel have the responsibility to investigate any
public outbreak of disease. In this case they investigated the
catering company which they could shut down if they found they were
at fault. They also must follow all of the cases involved and
inform others who may have been at the picnic and may be at risk.
The
emergency and family physicians treated the dehydration, ordered
necessary laboratory tests, and prescribed antibiotics to those
patients with severe infections, hospitalizing patients when
necessary.
Nursing
personnel monitored severe cases, administered lactated ringers to
alleviate dehydration and other medications.
Clinical
laboratory personnel cultured the patients' stool samples, identified
the Salmonella, and tested for appropriate antibiotics.
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