A 12-year-old girl is brought to an urgent care clinic due to nausea, vomiting, and crampy abdominal pain 3 hours after a summer cookout in a park, where she consumed potato salad, coleslaw, and a hamburger. Two other children who attended the event also had similar symptoms. She has no chronic medical conditions and previously felt well. On examination, the patient is afebrile, and the abdomen is soft and nontender. Her symptoms quickly resolve with supportive care. Which of the following strategies would have been most effective in preventing this patient's illness?

Question

A 12-year-old girl is brought to an urgent care clinic due to nausea, vomiting, and crampy abdominal pain 3 hours after a summer cookout in a park, where she consumed potato salad, coleslaw, and a hamburger.  Two other children who attended the event also had similar symptoms.  She has no chronic medical conditions and previously felt well.  On examination, the patient is afebrile, and the abdomen is soft and nontender.  Her symptoms quickly resolve with supportive care.  Which of the following strategies would have been most effective in preventing this patient's illness?

Quizplus · Accepted Answer

Enterotoxigenic Staphylococcus aureus produces a heat-stable enterotoxin that is a common cause of foodborne illness. This pathogen is typically introduced into high-risk foods (eg, mayonnaise-based salads, eggs, dairy, previously cooked meats) during improper food handling by an asymptomatic carrier. Storage at room temperature for extended periods allows the organism to quickly proliferate and generate enterotoxin. Individuals then ingest the preformed enterotoxin and become rapidly ill with nausea, vomiting, abdominal pain, and, occasionally, fever and mild diarrhea. Symptoms quickly resolve with supportive care. Multiple individuals are often affected due to the consumption of the same food at a picnic, party, or potluck. Staphylococcal foodborne illness can be prevented by washing hands thoroughly with soap and water prior to preparing food (prevents contamination) and ensuring proper refrigerated food storage when food will not be consumed within 2 hours of preparation (prevents bacterial proliferation/enterotoxin production). (Choice A) Close contact with an individual who has rotavirus infection can lead to the transmission of the virus with subsequent acute infectious diarrhea (particularly in young children [age <5]). Staphylococcal gastroenteritis occurs when a preformed toxin is ingested in food; person-to-person transmission does not occur. (Choice B) Enterohemorrhagic Escherichia coli is typically transmitted due to eating undercooked, contaminated ground beef. Manifestations typically begin 3-4 days (not hours) after ingestion and include toxin-mediated (Shiga toxin) colitis with bloody stools; some patients may also develop hemolytic uremic syndrome. (Choice D) Treatment of drinking water can prevent giardia infection, which usually causes foul-smelling, watery diarrhea 7-10 days after transmission. (Choice E) Washing hands prior to eating can prevent the transmission of a wide range of pathogens. Hand washing would not be protective against enterotoxins present in food. Educational objective: Staphylococcal foodborne illness is due to the consumption of a preformed enterotoxin in contaminated food. Most cases can be prevented by washing hands thoroughly prior to food preparation (prevents contamination) and ensuring proper refrigerated storage (prevents bacterial proliferation/enterotoxin production).

A 12-Year-Old Girl Is Brought to an Urgent Care Clinic