A 5-year-old boy is brought to the emergency department with worsening somnolence, lethargy, and decreased urine output. The patient has no prior medical conditions but had abdominal cramps and diarrhea several days ago that later became frankly bloody. Physical examination shows mild pallor and moist mucous membranes. Laboratory studies reveal elevated blood urea nitrogen and serum creatinine levels. Peripheral blood smear shows fragmented erythrocytes. This patient's condition is most likely related to consumption of which of the following foods?

Question

A 5-year-old boy is brought to the emergency department with worsening somnolence, lethargy, and decreased urine output.  The patient has no prior medical conditions but had abdominal cramps and diarrhea several days ago that later became frankly bloody.  Physical examination shows mild pallor and moist mucous membranes.  Laboratory studies reveal elevated blood urea nitrogen and serum creatinine levels.  Peripheral blood smear shows fragmented erythrocytes.  This patient's condition is most likely related to consumption of which of the following foods?

Quizplus · Accepted Answer

11ec160b_3803_b0a7_9249_951cd31c42d3_MD0001_00 Hemolytic uremic syndrome (HUS) is a major cause of acute renal failure in children. It is characterized by the triad of renal insufficiency, thrombocytopenia, and microangiopathic hemolytic anemia. Most cases occur due to underlying enterohemorrhagic Escherichia coli (EHEC) infection, particularly with the O157:H7 serotype. EHEC is a gram-negative, enteric rod that acquires the ability to produce Shiga toxin from a lysogenic bacteriophage. Shiga toxin enters the cytosol of host cells and cleaves a protein motif off the 60S ribosomal subunit, which irreversibly halts host protein synthesis and causes cell death. Toxin-mediated injury to the colonic mucosa and the colonic capillaries causes abdominal pain and bloody diarrhea. The absorption of Shiga toxin into the systemic circulation causes glomerular (renal insufficiency) and vascular (thrombocytopenia, microangiopathic hemolytic anemia) injury in a minority of patients, leading to HUS. The primary reservoir for EHEC is the gastrointestinal tract of healthy cattle. Humans primarily acquire the organism after consuming contaminated, undercooked beef. Because low infectious doses (10-100 organisms) are required for disease, meatpacking facilities that process high volumes of ground beef are an important source of outbreaks. Other less common routes of transmission include person-to-person contact and fruits and vegetables contaminated with manure. (Choice A) Canned foods that are contaminated with Clostridium botulinum can be associated with foodborne illness due to the consumption of preformed botulism toxin. Patients typically develop descending, symmetric paralysis. (Choices B and D) The consumption of preformed, heat-stable Staphylococcus aureus enterotoxin causes self-limited nausea, vomiting, and abdominal cramping 1-6 hours after ingestion. Dairy (eg, custard), produce, meats, eggs (eg, mayonnaise), and salads are common culprits and are usually inoculated during preparation by a food handler. (Choice C) Bacillus cereus enterotoxin is classically associated with reheated rice. It causes a vomiting-predominant, foodborne illness that clinically resembles the illness seen with S aureus enterotoxin. (Choice E) Consumption of raw oysters can lead to infection with Vibrio parahaemolyticus (which causes voluminous watery diarrhea similar to cholera) and Vibrio vulnificus (which causes sepsis with high mortality), as well as other Vibrio infections. (Choice F) The consumption of raw eggs or incompletely cooked poultry can lead to Salmonella gastroenteritis, which usually causes watery diarrhea, abdominal cramping, vomiting, and fever. Educational objective: Enterohemorrhagic Escherichia coli (EHEC) is primarily contracted after eating undercooked ground beef. EHEC produces Shiga toxin, which causes hemorrhagic colitis and can lead to hemolytic-uremic syndrome (HUS). HUS is characterized by acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia; children age <10 are at greatest risk.

A 5-Year-Old Boy Is Brought to the Emergency Department with Worsening