1. Laura Flanagan July 2010

2. The Case Normally fit and well 28 year old Saturday Pub lunch (burger) Barbecue (bite of a burger, sausage and cupcake) Sunday Veg melt sandwich Burger king Monday M&S salad More M&S salad and their big platter

3. Case cont. Feeling slightly nauseous before bed Woken at 2am Tuesday morning Rest of night spent mainly in bathroom Most of Tuesday spent mainly in bed Returned to work Thursday 2kg lighter

4. Looking like this!

5. Feeling like this!

7. Mr Noro Virus Found in used water and concentrated mainly in shellfish, oysters and plankton Can cause illness at any age as immunity does not last long Most common cause of gastroenteritis in England and Wales More common in winter Incubation period of 24-48 hours but may be as little as 12 hours Symptoms include nausea and vomiting with watery diarrhoea along with abdominal cramps Symptoms last 12-60 hours but most people make full recovery in 1-2 days Management is symptomatic

8. Miss Campy Lo Bacter NOTIFIABLE Commonest cause of bacterial gastroenteritis in England and Wales Source is mainly undercooked meat especially poultry but also unpasteurised milk and untreated water One source is birds pecking milk bottle tops Incubation period is from 1-11 days but usually 2-5 days Prodromal illness with fever, headache and myalgia lasting 24 hours Fever can be up to 40 and may persist for a week Then get abdominal pain, cramps and profuse diarhorrea which is watery and can often become bloody Usually self limiting, approximately 9 in 10 people recover after 1 week Erythromycin eliminates bacteria but does not affect duration of symptoms

9. Ms Sal Monella NOTIFIABLE Found in many animals and contamination occurs from animal faeces Source usually animal origin, beef, poultry, unpasteurised milk and eggs Inadequate thawing from freezing is a common source Heat readily kills salmonella but can survive spit or oven roasting if not properly defrosted Incubation period of 12-72 hours Diarrhoea starts with fever and abdominal cramps, can be bloody Illness last 4-7 days and can have temperature of 38-39 for 48 hours Supportive management Antibiotics do not shorten the illness but may prolong carrier stage

10. Mrs E Coli (0157) NOTIFIABLE Uncommon cause but important as infection can be severe and sometimes fatal Reservoir in intestines of healthy cattle and survives in faeces and soil Infection can occur via inadequately cooked beef mince, milk, contact with farm animals, person to person and infected water Incubation period 1-14 days but usually 3-4 days Consider e coli infection in anyone presenting with acute bloody diarhorrea especially if painful diarhorrea and without fever Uncomplicated cases usually resolve in 2 weeks However associated with complications like haemolytic uraemic syndrome (HUS) especially in children HUS is triad of acute renal failure, haemolytic anaemia and thrombocytopenia, with the thrombocytopenia often been first sign If e coli is suspected you should consider admission especially in at risk groups

11. Master Ro Tavirus Most common cause of gastroenteritis in children Uncommon in adults as infection confers immunity Spread is faeco-oral and also airborne Incubation period of 48 hours Symptoms include fever, vomiting then watery diarhorrea. Diarhorrea can last 3-9 days Management is symptomatic

12. Mr C Perfringens Fourth commonest food borne illness after norwalk, campylobacter and salmonella Spores found in soil, they can survive cooking and germinate during slow cooling or unrefrigerated storage Mostly associated with meat and poultry Typically occurs when a meat dish is stewed or boiled and allowed to stand for 4-24 hours then served without adequate re-heating Incubation period 6-12 hours Symptoms are crampy abdominal pain followed by diarhorrea which subsides 12-24 hours later Management symptomatic

13. Conclusion We may never know Keep vigilant It could be you next! Lots more information about individual suspects at www.patient.co.uk