Case history
Case history #1
A 42-year-old man presents with a 48-hour history of bloody diarrhea. He has 6 to 8 bowel movements per day and associated nausea, lethargy, and generalized abdominal discomfort. There is no recent travel history. He lives with his wife and 2 children, who are all well. They had a meal in a restaurant 5 days ago, when he ate a beef burger and French fries. A friend who was with them ate the same meal and has developed similar symptoms. Exam shows a low-grade fever (100.5°F [38°C]) but is otherwise unremarkable. Complete blood count reveals an elevated white blood cell count (15,000/mm³). Stool culture results are available 3 days later and are positive for Escherichia coli, and serotyping confirms the presence of E coli O157:H7.
Case history #2
A 21-year-old woman presents with profuse watery diarrhea occurring up to 20 times per day. There is associated nausea, anorexia, and lethargy. She returned 4 days ago from Kenya, where she had tried many local delicacies, often from street vendors. On physical examination she has dry mucous membranes and reduced skin turgor. She is hypotensive (blood pressure 95/50 mmHg) and tachycardic (pulse 110 bpm). Abdominal exam reveals mild diffuse tenderness. She responds well to intravenous fluid replacement, with resolution of her symptoms within 48 hours. Stool cultures and serotyping are subsequently positive for enterotoxigenic E coli (ETEC).
Other presentations
Escherichia coli infections can affect all ages, although infants and older people may be more susceptible than other groups.
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