28-Year-Old Man With Nausea, Vomiting, and Diarrhea

Nicolas Grundmann, MD, MBA

Disclosures

June 10, 2015

Additional history in patients with foodborne diseases should focus on elements that help localize the epidemiology of possible of food exposure, as well as the potential sequelae of infection. This includes recent travel, camping, and antibiotic use or hospitalization, as well as an immunocompromised or pregnancy state.

Recent travel, particularly to resource-limited countries, significantly increases the likelihood of enterotoxigenic E coli exposure, often referred to as "traveler's diarrhea." These cases may warrant treatment with antibiotics, such as ciprofloxacin or azithromycin, depending on the native resistance patterns of bacteria in the countries visited.

Recent antibiotic use or hospitalization increases the likelihood of gastrointestinal microbe virulence or the incidence of resistant bacterial diseases. Clostridium difficile infections are of great concern in elderly or recently hospitalized patients who have diarrhea without emesis. These cases require a significantly different treatment course and are not considered foodborne diseases.

Medical comorbidities greatly affect the consequences of foodborne illness. Patients with diabetes should be screened to ensure that the illness has not triggered a hyperglycemic state. Elderly persons and infants and children should have special attention focused on their hydration status because their underlying nutritional status can be less robust than that of otherwise healthy patients. Immunocompromised patients should be assumed to have infectious or invasive gastroenteritis; the pathogens in these patients vary significantly from routine foodborne illnesses with an increased incidence of salmonella, cytomegalovirus, herpes simplex virus colitis, and parasitic infections. Pregnant women should be screened for listeriosis and treated as necessary.

General treatment should focus on symptom improvement, with hydration and consideration of antiemetic agents. Care should be taken to ensure that patients are able to tolerate food and fluids by mouth before being discharged home. The patient in this case was released after sufficient improvement of symptoms and a demonstration of food and fluid tolerance.

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