ICD Case 4: Buffeted

Panganiban, Enrique - Santos, Zharyne

 32 y/o male tricycle driver
CC: 15 episodes of watery, non-bloody, non-mucoid stools

6 days PTC Amoxicillin for cough and colds (self

medicated)

30 hr PTC Ate fried rice, fried chicken, coleslaw given by

passenger

24 hr PTC 15 episodes watery, non-bloody, non-mucoid

stools; (-) fever; (+) crampy abdominal pain;
(+) 3 episodes of vomiting

18 hr PTC (Past 18 hours) Urine output < cupful

*Fond of eating clams and fish balls (market

stalls); drinks unboiled tap water
Physical Exam

● Lethargic

● Sunken eyeballs

● Dry buccal mucosa

● BP 80/60

● HR 107bpm

● RR 24cpm

● temperature 38.3°C
Possible Etiologic Agents & their Modes of
Acquirement

Harrison’s Principles of Internal Medicine 19th ed.

 Etiologic Agent Mode of Acquirement

-Staph carriers- contaminate food by touching w/o handwashing

Staphylococcus aureus -unpasteurized milk and cheese products
-toxins are resistant to heat (not destroyed by cooking) -highest risk food- food people
handle and do not cook
-sliced meat, puddings, pastries, and sandwiches

A variety of foods, particularly rice and leftovers, as well as sauces, soups, and other
Bacillus cereus prepared foods that have sat out too long at room temperature.

Infection occurs when a person eats food, or drinks water or ice contaminated with
Enterotoxigenic E. Coli ETEC bacteria. Human or animal wastes (e.g., feces) are the ultimate source of ETEC
(ETEC) contamination.

A person can get cholera by drinking water or eating food contaminated with the
Vibrio cholera cholera bacterium. Large epidemics are often related to fecal contamination of water
supplies or street vended foods. The disease is occasionally spread through eating raw
or undercooked shellfish that are naturally contaminated.

Centers for Disease Control and Prevention

Concept Map of the Pathophysiology
Clinical & Diagnostic Tools
Etiologic Agent Clinical & Diagnostic Tool

Staphylococcus aureus Culture on blood agar

Bacillus cereus Concentration of 10^5 bacteria or more per gram of food

Enterotoxigenic E. Coli
Nucleic Acid Amplification Tests
(ETEC)

Vibrio cholera Stool cultures on selective medium, i.e. TCBS

Management

The mainstay of treatment is adequate rehydration

ORS- 2.6g of sodium chloride, 2.9 grams of trisodium citrate, 1.5 grams of potassium chloride, and 13.5
grams of glucose per liter of water

Ringer’s Lactate- IV solution for severely dehydrated patients

Prevention

● Good hygiene

● Eating only hot, freshly cooked food

● Avoiding raw vegetables, salads, and unpeeled fruit

● Drinking only boiled or treated water and avoiding ice