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Abstract: The patient developed diarrhea with abdominal pain after eating cold food, which could be as many as 10 times in a day, and the stool was like water. 2 days later, the symptoms worsened, and blood in the stool and fever appeared, and the patient was diagnosed with enterohemorrhagic Escherichia coli infection after blood analysis and stool culture examination, and was promptly treated with anti-infective, antipyretic and antidiarrheal drugs, and the patient’s symptoms improved significantly, and he basically recovered after 1 week.
Basic information】Male, 69 years old
Disease Type】Enterohemorrhagic Escherichia coli infection
Hospital】Beijing Huairou District Hospital of Traditional Chinese Medicine
Date of consultation】May 2022
Treatment plan】Medication (levofloxacin tablets + rehydration salts Ⅰ + montelukast + compound acetaminophen tablets Ⅱ + bifidobacterium live capsules)
[Treatment Period] 1 week of oral medication, rechecked 3 days and 1 week after the visit
Effectiveness of treatment】Diarrhea, abdominal pain, fever and other symptoms disappeared, blood analysis and stool examination were not abnormal.
I. Initial consultation
After the May Day holiday, the weather started to get hot. An elderly patient came into the department with his hands over his stomach and a painful and helpless expression. The patient said that she started to have abdominal pain after eating cold dishes 2 days ago, and had diarrhea, which was more than 10 times a day, and her stools were like water. The patient said that he was usually in good health, and he usually recovered in 1-2 days without any treatment in the past, but this time, the diarrhea did not reduce for 2 days, and there were more symptoms such as blood in the stool, nausea, vomiting, fever, and weakness, etc. He also did not have any appetite and felt painful, so he came to the clinic. The patient was firstly examined by blood analysis, and the results suggested a high possibility of bacterial infection. The stool examination showed leukocytes and suggested positive occult blood, and the stool culture showed Escherichia coli, but no Vibrio cholerae was detected. Combined with the patient’s symptoms and examination, enterohemorrhagic Escherichia coli infection was considered.
II. Treatment history
Through clinical observation, it was found that although the patient had diarrhea for 2 days and had watery stools more than 10 times a day, no symptoms of dehydration such as dry skin and sunken eyes were observed, and the electrolytes were basically normal. According to the clinical experience of treating enterohemorrhagic Escherichia coli infection, we chose to give the patient oral treatment with quinolone antibiotics that are more sensitive to E. coli, such as levofloxacin tablets, and give oral rehydration salts Ⅰ to improve the electrolyte disorder and oral montelukast for symptomatic antidiarrheal treatment. In addition, for the patient’s febrile symptoms, it was decided to give the patient oral compound acetaminophen tablets (II) for antipyretic treatment, and the patient and his family were instructed to take it only when the patient’s body temperature exceeded 38.5℃.
III. Treatment effect
Three days after the initial diagnosis, the patient came to the follow-up clinic, complaining that his body temperature had returned to normal, and his diarrhea had gradually changed from more than 10 times a day to 4-5 times a day, with loose stools, no watery stools or bloody stools, and no obvious abdominal pain and fatigue, and his appetite had basically returned to normal. In view of the patient’s continued diarrhea, the patient was instructed to continue to take the previous medication orally and to give Bifidobacterium bifidum capsules orally to regulate the intestinal flora. One week after the initial consultation, the patient came for a second follow-up consultation, by which time the diarrhea had returned to normal with no special discomfort, and no abnormalities were found in the blood analysis and stool routine.
IV. Notes
We are glad that the patient’s diarrhea symptoms have been relieved after medication. However, since the patient has recovered from diarrhea for the first time, the gastrointestinal function has not yet fully recovered. It is suggested that the patient should pay attention to the diet in the near future, and should not continue to eat greasy, spicy and cold food. Such foods can irritate the mucosa of the gastrointestinal tract and increase the burden on the gastrointestinal tract, affecting the recovery of gastrointestinal function.
Since the patient is 69 years old and has entered the ranks of the elderly, his resistance is weaker and his gastrointestinal function has deteriorated. Therefore, it is recommended that if the patient has diarrhea and other uncomfortable symptoms appear again, he must actively seek medical treatment to avoid delaying his condition and causing more serious consequences.
V. Personal insight
Enterohemorrhagic Escherichia coli is often found on unheated foods, and the direct cause of this patient’s illness was the dietary intake of cold vegetables. Enterohemorrhagic Escherichia coli invade the body from the oral cavity and parasitize on the intestinal mucosa after reaching the intestinal cavity, causing bleeding and ulceration of the intestinal mucosa, resulting in diarrhea, abdominal pain, blood in the stool, fever and other symptoms. In order to prevent enterohemorrhagic Escherichia coli infection, first of all, we need to pay attention to hygiene, wash hands regularly before and after meals, secondly, food should be fully heated before consumption, if it is determined to eat raw and cold food, it should be fully processed, such as fully washed, etc. Finally, we also need to ensure that meals are fresh, avoid eating meals that have been left for a long time.