dr_singh246
internal medicine pgy2
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Which of the following organisms would be most likely to cause an
outbreak of enteritis in a day care center in the United States?
A. Helicobacter jejuni
B. Salmonella typhi
C. Shigella species
D. Vibrio cholerae
E. Yersinia enterocolitica
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| AngChop
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yersinia?
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| bactitech
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I'm guessing Shigella sp. Yersinia is rarely isolated, and we do see Shigella in young children. Vibrio cholera is not isolated very often in the US; neither is Salmonella typhi (cause of typhoid fever - usually from bad water). H. jejuni is not involved with enteritis.
The inoculum size for Shigella is only TEN RODS. I was infected with S. flexneri (group B) back in 1982. I lost 15 pounds in two weeks. I got it from a lab specimen. Be extremely careful if you are exposed to this organism. I was extremely ill with a temp of 104 degrees F., severe tenesmus, and my stools turned to blood and mucus. I was unable to eat anything but soda crackers and Ramen noodles for two weeks, and the cramping and discomfort were extreme every time I ate anything. The temperature outside was in the 90's (it was summer) and I was on the couch with a heating pad on my stomach to help with the cramping. This is NOT FUN. My doctor refused to give me any antibiotics as he said the Ampicillin would make my symptoms worse. Needless to say, I did some research on that, and I believe now the thinking is to treat, as it shortens the length of the infection, and possibly reduces symptoms. I stopped going to him after that. Most of the Shigella we see now are resistant to Ampicillin.
This is not a bug to mess around with. Shigella sonnei (group D) has a shorter run. I've known a couple of lab techs who had it, and they were sick for about 4 days. The other tech I knew who had S. flexneri was sick like I was. I've never seen any other groups of Shigella in the US. There is group A and C also, which I believe are found in other parts of the world.
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| phuluong2k
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It is E
Most yersinia enterocolitica occurs in children & the number one cause of enteritis outbreak in day care center
yersinia enterocolitica makes us confuse with acute appendicitis
Don't confuse with yersinia pestis which is a rare agent now
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| bactitech
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I guess that's what the textbooks say. In my practical experience though I have not seen much Y. enterocolitica. We did have a couple of stools on children positive within a week of each other for this organism a couple of months ago, but never heard any more feedback as to whether this was an outbreak situation.
I've probably seen three Y. enterocolitica's in about 30 years, including the two that came up within a week of each other. I've seen many more Shigella sp.
Don't want to screw you up for an exam question though :|
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Clinical Microbiology since 1974
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| bactitech
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http://www.cdc.gov/mmwr/preview/mmwrhtml/00001179...
Article about Y. enterocolitica associated with ingestion of tofu....
http://www.cdc.gov/mmwr/preview/mmwrhtml/00000423...
Article about Cryptosporidium in day care centers (Y. enterocolitica is not the only cause of enteritis in these institutions). This disclaimer was in the article:
Editorial Note: Outbreaks caused by a number of important infectious agents (including Giardia, Shigella, Haemophilus influenza, hepatitis A, rotavirus, and respiratory-tract viruses) have been documented in day-care centers (2). The investigations reported here suggest that the intestinal parasite Cryptosporidium should be added to this list. Although a few children had moderately severe diarrhea, none required hospitalization.
We have had quite a few positive Rotavirus rapid tests in the last couple of days at work. I think we're in the middle of the "season" for it. We reported out two or three positives last night at work.
Just want you all to keep an open mind on this subject. 
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| bactitech
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http://medinfo.ufl.edu/year2/mmid/bms5300/cases/a...
Here is an interactive case study on Day Care Diarrhea. Click on the answer you think is correct. It is very interesting and challenging (meaning I didn't get them all correct  )
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Clinical Microbiology since 1974
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