neo335
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on 5th day of a 7day cruise in western caribbean, a 37y/o woman develops
fever, chills, abd discomfort, and watery diarrhea over a 12 hr period. many
other passengers and crew members have had similar symptoms. her temp is
37C; abd exam shows diffuse tenderness without rebound; bowel sounds are
hyperactive; her leukocyte count is 11,000; gram's stain of stool specimen
shows a small number of neutrophils; stool cul grows Salmonella enteritidis;
2 days after tx with bismuth subsalicylate and oral rehydration, her sx
reside. which of the folllowing is the most app immediate measure to prevent
further spread of pathogen?
a-cancellation of shore leave for all crew
members
b-elimination of seafood and shellfish from ship's menu
c-exclusive use of pasteurized eggs
d-hyperchlorination of the ships drinking h20
e-reassignment of all food-handling personnel to other duties
f-tx of all affected persons w/ doxy
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| achilles
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E
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| neo335
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i donot know the answer.. hope u'l can put in ur explanation for ur answers n rule out the others.. i also think its E... but about pasturised eggs? salm ent is caused from infected meat n poultry products ? thank u Achilles
Edited by neo335 on 08/10/06 - 10:12 PM
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| study_ing
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i think c
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/salmen...
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| study_ing
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Egg-associated salmonellosis is an important public health problem in the United States and several European countries
In affected parts of the United States, we estimate that one in 50 average consumers could be exposed to a contaminated egg each year. If that egg is thoroughly cooked, the Salmonella organisms will be destroyed and will not make the person sick
also "what can be done to reduce the risk' in this article by cdc helps
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| achilles
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yup, i made a mistake. should be C. its the better answer.
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| neo335
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C seems to be the right answer.. thank u both.. 
however i wanted to know, if sal enteritidis spreads also thru unwashed hands... like in the typhoid mary case.. something like the fecal to oral transmission...
thank u again..
ps: can u'll help me out with the cholestrol q post also.. ??
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| study_ing
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cud u post the link for it ..i cant seem to find it..
i was actually surprised myself coz i was thinking along the lines of curbing feco-oral spread but the cdc stuff duznt seem to care bout it at all...
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| neo335
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the link for the cholestrol Q: http://www.prep4usmle.com/forum/thread/38482
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| frank100
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one of my teachers used to say: "food related Gi infections, are more related to the hands touching it than the food itself"
I think E is a good answer, but in a cruise, it is a very hard measure.
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| study_ing
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i tot so too..but cud u plz go over the cdc link and comment on it
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| achilles
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wow...you guys really have this discussion going on...actually thats what i thought too when i picked E as the answer and then study_ing came up with the cdc study(which was undoubtedly helpful). i read the chapter in CMDT and i think the question is actually testing us on another issue here- the incubation period.
if food is the contaminating source, the incubation period is shorter, 8-48 hrs. this lady has enteric fever which developed on the 5th day so the more likely route of transmission is most likely a food handler or a close contact of someone suffering from typhoid. in that case the answer will be E. after reading the chapter this is what i thought. pls do correct this if i am not on the right track.
very good discussion. thanks guys.
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| study_ing
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im actually lost now hehe..ppl ur input will be appreciated..
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| krisrama
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For those who can get confused between c) and d).....
The correct answer is C). The most common and important risk factor for salmonellosis is egg. Therefore fix it first before thinking of anything else.
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| Drtweetie
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Is empiric tx for salmonellosis is 3rd-gen ceph, quinolone, or macrolide? Anyone?
I'd go with (C)
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| elitoki
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answer C , and to add some point of Sallmonella gastroenteritis.
ref: emedicine http://www.emedicine.com/ped/topic2033.htm#sectio...
Salmonella gastroenteritis
For uncomplicated gastroenteritis caused by nontyphoidal Salmonella species, antimicrobial therapy is not indicated because it does not shorten the duration of illness.
Treatment involves monitoring hydration status and IV therapy to correct electrolyte imbalance or restore intravascular volume.
Antidiarrheal agents may actually prolong GI transit time and the illness.
Antimicrobial agents and hospital admission may be recommended in Salmonella gastroenteritis in infants younger than 3 months, infants younger than 12 months with temperatures higher than 39°C and unknown blood culture results, and patients with hemoglobinopathies, HIV infection or other causes of immunosuppression, neoplasms, or chronic GI illnesses.
The recommended antibiotics for individuals at high risk of invasive disease include ampicillin, amoxicillin, trimethoprim-sulfamethoxazole (TMP-SMZ), cefotaxime, and ceftriaxone.
Treatment of invasive Salmonella disease (bacteremia, extraintestinal manifestations)
Antibiotic treatment includes ampicillin, amoxicillin, cefotaxime, ceftriaxone, chloramphenicol, TMP-SMZ, or a fluoroquinolone, if susceptible.
A 14-day course of antibiotics is recommended for patients with bacteremia.
Patients with localized infection, such as osteomyelitis or abscess, or patients with bacteremia and HIV infections should receive 4-6 weeks of therapy.
For Salmonella meningitis, ceftriaxone or cefotaxime is recommended for 4 weeks or longer.
Enteric fever caused by S typhi infection
For S typhi infection, a 14-day course of chloramphenicol, ampicillin, or TMP-SMZ is indicated.
In severe infection, parenteral therapy is indicated.
Use antipyretics with caution or not at all because they may cause precipitous drops in temperature and shock.
Relapse is common, and patients must be re-treated.
Corticosteroids may be involved in treatment of patients with neurologic complications of enteric fever.
In particular parts of the world, namely India, Pakistan, and Egypt, multiply antibiotic-resistant strains of S typhi are found. Travelers from these regions should be treated with a 7- to 10-day course of ceftriaxone or 5- to 7-day course of ciprofloxacin or ofloxacin.
High-dose ampicillin or high-dose amoxicillin plus probenecid for 4-6 weeks has cured many chronic carriers
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| gr8doc
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| MAGY17
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correct ans please????????
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| radonc
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I think the answer is E.
Infected crew members and staff will excrete Salmonella in their faeces. They should not be preparing food.
Using pasteurized eggs will not prevent spreading of infection if the cook has been infected and excreting Salmonella and not washing his hands after toileting.
http://www.cfsan.fda.gov/~dms/a2z-p.html
It’s important to note that foods can become contaminated even after they have been pasteurized. For example, all pasteurized foods must be refrigerated. If temperature is abused (e.g., if milk or eggs are not kept refrigerated), pasteurized foods can become contaminated. Therefore, it’s important to always handle food properly.
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| lq2006
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Exclusive use of pasteurized eggs
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