An 84-year-old nursing home resident with mild dementia is evaluated for acute onset of vomiting. She has had 6 episodes since this morning and "cannot keep anything down." She also reports an episode of watery diarrhea, muscle pains, and a mild headache. Six residents of her nursing home have had similar symptoms over the last week.
The patient's temperature is 38.1 C (100.6 F). Mucous membranes are dry. Abdominal examination shows no tenderness. The rest of the examination is unremarkable. Stool culture is negative.
Which of the following is the most likely cause of this patient's symptoms?

Question

An 84-year-old nursing home resident with mild dementia is evaluated for acute onset of vomiting.  She has had 6 episodes since this morning and "cannot keep anything down."  She also reports an episode of watery diarrhea, muscle pains, and a mild headache.  Six residents of her nursing home have had similar symptoms over the last week.
The patient's temperature is 38.1 C (100.6 F).  Mucous membranes are dry.  Abdominal examination shows no tenderness.  The rest of the examination is unremarkable.  Stool culture is negative.
Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

11ec193a_9867_a764_853d_87b60a406aee_MD0002_00 This patient has vomiting-predominant gastroenteritis and negative stool culture suggestive of norovirus. Norovirus is the most common cause of epidemic gastroenteritis and is now the most common cause of all gastroenteritis in adults and children. Norovirus is spread via fecal-oral contamination, and the virus can be transmitted from food and water, fomites, or airborne droplets from vomitus. Norovirus commonly occurs in institutionalized and travel settings such as nursing homes, health care facilities, restaurants, and cruise ships. Norovirus can cause: Asymptomatic infectionFever with watery diarrhea - noninflammatory small-bowel processSevere illness - fever, vomiting, headache, and other systemic symptoms Asymptomatic infection Fever with watery diarrhea - noninflammatory small-bowel process Severe illness - fever, vomiting, headache, and other systemic symptoms Vomiting is prominent in norovirus-induced gastroenteritis. Symptoms usually start suddenly and last 48−72 hours. Diagnosis is generally clinical and most patients improve with supportive care. If needed, diagnosis can be confirmed by polymerase chain reaction or nucleic acid-based testing. (Choice A) Campylobacter infection most commonly presents with acute onset of cramping abdominal pain and inflammatory diarrhea (mucus, blood). Diagnosis is by stool culture. (Choice B) Clostridium perfringens is typically associated with traumatic gas gangrene, but it is also an important cause of watery diarrhea. The spores of C perfringens germinate in warm food and, once ingested, the bacteria produce a toxin in the gastrointestinal tract that causes disease. Fever and vomiting are uncommon symptoms. (Choice C) Enterotoxigenic Escherichia coli is the most common causative agent of travelers' diarrhea, but is much less frequently a cause of diarrhea in institutional settings. It presents classically with malaise, anorexia, and abdominal cramps followed by the acute onset of watery diarrhea. (Choice D) Listeria monocytogenes is a rare cause of epidemic gastroenteritis (usually associated with deli meats and soft cheeses). In addition to watery diarrhea, fever, and nausea/vomiting, L monocytogenes gastroenteritis may also present with prominent non-gastrointestinal symptoms such as myalgia, arthralgia, and headache. Diagnosis can be confirmed from special stool culture media. Educational objective: Norovirus is the most common cause of epidemic gastroenteritis in adults and children. Vomiting is more prominent. Outbreaks commonly occur in restaurant, travel, and health care settings. __________ References: Norovirus gastroenteritis. (http://www.ncbi.nlm.nih.gov/pubmed/19864676) Acute gastroenteritis surveillance through the National Outbreak Reporting System, United States. (http://www.ncbi.nlm.nih.gov/pubmed/23876187)

An 84-Year-Old Nursing Home Resident with Mild Dementia Is Evaluated