Medical Mystery of the Week

      You are on your Public Health rotation and are asked to investigate the cause of death of a 55 year-old-man who was admitted to the hospital with fever, abdominal cramps, vomiting and diarrhea and died before a history and physical could be performed. On talking to a relative, you find that he had attended a Thanksgiving dinner the day before he became ill. Your investigation leads to the discovery that all six persons that attended the dinner had become ill with similar symptoms; one was hospitalized with severe dehydration.
       DIAGNOSIS: Salmonella enteritidis enteritis and bacteremia.
      An estimated 2-4 million cases of salmonellosis occur each year in the United States, resulting in at least 500 deaths. Worldwide, nontyphoidal salmonella species account for ∼ 93.8 million illnesses and 155,000 deaths annually. The most common isolate in patients with salmonellosis is S. enteritidis and the most common source of infection is eggs followed by poultry and butcher meat. In one series, 5.4% of fresh turkeys and 3.5% of butcher meats were contaminated with S. enteriditis.
      After an incubation period of 4-72 hours, patients with salmonellosis typically present with fever, diarrhea, and abdominal pain; 5-10% may be bacteremic. Unfortunately, there is increasing levels of antibiotic resistance to fluroquinolones, cephalosporins, ampicillin, chloroamphenicol, and trimethoprim-sulfamethoxide; this resistance is attributed to the use of these drugs to prevent poultry and butcher animals from carrying salmonella spp. in their GI tracts. Carbipenem would be a reasonable choice for critically ill patients pending culture results and sensitivity testing.
Reference: Antunes, P., Mourão, J., Campos, J., Peixe, L. Salmonellosis: the role of poultry meat. Clin Microbiol Infect. 2016; 22(2): 110-121.

    BONUS QUESTION: How long should you keep your cooked turkey and stuffing after your Thanksgiving dinner? ANSWER: 3-4 days