Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, November 04, 2007
    It Was the Hollandaise

    Anatomy of a food poisoning outbreak, from the L.A. Times. The author, who suffered a nasty case of salmonella from a restaurant meal, does a good job of explaining how the Department of Public Health handles outbreaks of foodborne illness. To his surprise, it wasn't the sushi he had for dinner that made him sick.

    In a similar vein, I recently had a patient who had been traveling in Jordan on business present with two weeks of diarrhea. I ordered stool samples, usually the first thing you do in this sort of situation, but no antibiotics as he had no fever, no blood in the stool and no vomiting. In many cases antibiotics are not indicated for gastroenteritis and can even worsen the problem if you have, say, certain types of E. coli, leading to hemolytic-uremic syndrome and kidney failure. The next day he emailed me with an article he'd found describing the high level of cryptosporidium (a parasite) in the Jordanian water supply. I congratulated him: he'd diagnosed his own illness. The stool studies came back negative, indicating he'd cleared the parasite (as healthy people generally do). Happy ending.

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