Case Study for Salmonella, non-typhoid strains A Confidential Reportable Disease Case Report is sent to your office. The report indicates a 12 year old white male was seen in the ER on 1/5/06. The laboratory report indicates Salmonella sp. collected from a stool sample that had anti-microbial testing done. The mother indicated that the illness started on 1/2/06 in the afternoon. She stated that the patient began complaining of abdominal cramps and shortly there after began having nausea, vomiting, diarrhea, and developed a fever of 102 degrees. The patient presented at the ER with continued complains of abdominal pain, fever (101 degrees) and anorexia. He was admitted for treatment of dehydration. Questions: 1. 2. 3. What is the time frame to contact the local health department? Does anything need to be done with the isolate? What pertinent public health information do you need to gather from the patient? Upon speaking to the mother of the patient via phone call and home visit on 1/9/06, you establish that the boy was out of school (Neers Elem. 6th grade) for the holidays and hasn’t returned to school due to illness. His father is a mechanic for a local car dealership and the mother is a home maker. The mother stated that her son likes to play outdoors a lot and is “bad about not washing his hands”. Patient’s environment is clean and neat. No pets. No travel to another state or country recently. No one else in the household has been ill. The patient has an allergy to eggs. He likes fast foods, especially from McDonalds and Taco Bell, according to the mother. They do most of their grocery shopping at Wal-Mart and Save-A-Lot. A 72 hour food history reveals that the patient ate breakfast: sausage biscuit with milk, and lunch: spaghetti and garlic bread at school on 12/30/05. Dinner eaten at home with his parents was homemade chicken quesadillas with lettuce, cheese, and tomato. On 12/31/05, his school was closed due to a water line break. That same day, patient ate cereal with milk for breakfast at home. He went to Taco Bell with his friend at lunch and ate a taco with meat, lettuce, tomato and cheese. His friend ate 2 mexi-melts. That evening, he went to his grandparents’ house for a New Years football game “bowl party”. The patient ate chicken wings, meatballs, nachos with cheese, cheese ball and crackers, and drank coca cola at the party. According to the mother, everyone ate the same foods without any illness onset. On 1/1/06, the patient ate noodles for breakfast. Lunch went to McDonalds with his father for dinner and ate a Happy Meal cheeseburger with ketchup, onion and pickle. His father ate a chicken sandwich with fries. The mother ate at home that evening. On 1/2/06, patient had toast and OJ for breakfast at home. At around 1:30pm, according to his mother, the patient began complaining of abdominal cramps and then nausea, vomiting, diarrhea and fever followed shortly after. The patient was hospitalized for 24 hours for fluid and electrolyte replacement and started on antibiotics. Mother stated that he is feeling much better now. Questions: 4. 5. 6. Does anyone else associated with this patient need to be cultured to check for the presence of Salmonella? If so, who? Does anyone need to be excluded from work and/or school, and if so, for how long? What additional public health action would you take? Written educational literature was explained and given to mother. Encouraged good hand washing as well as safe food handling emphasized Understanding verbalized per mother. Hospital lab sent the isolate to OLS. Results are pending.
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