A 5-year-old girl is brought to the emergency department by her parents because she has had two episodes of bloody diarrhea over the past three days and developed the inability to move her lower extremities two hours ago. Her parents state that they recently came back from a camping trip. Shortly after coming back from trip, the patient stated trouble moving her feet and then the symptoms progressed. Past medical history is unremarkable. The parents also report that they each had a few days of mild joint pain after the camping trip, but these symptoms have resolved. Physical examination reveals absent patellar reflexes bilaterally and 2+ brachioradialis reflexes bilaterally.
Consumption of which of the following foods is the most likely cause of this patient’s symptoms?
E) Undercooked chicken
This patient's progressive ascending paralysis, which is evidenced by her absent lower extremity reflexes compared to her upper extremity reflexes, point to Guillain-Barre syndrome. These signs and symptoms, along with multiple episodes of bloody diarrhea, is most likely caused by Campylobacter jejuni, which is associated with ingestion of undercooked poultry. Other risk factors for Campylobacter infection include contact with infected animals such as dogs and cats. While Campylobacter often presents as bloody diarrhea in young children, it tends to present as a reactive arthritis-like syndrome in adults. Ingestion of raw shellfish is associated with Vibrio cholerae and Vibrio parahemolyticus infection, both of which can cause voluminous watery diarrhea. Ingestion of mayonnaise is associated with Staphylococcus aureus infection, which can cause a fast-onset of gastroenteritis (vomiting and diarrhea) within hours due to the presence of preformed toxin. Ingestion of undercooked beef is associated with enterohemorrhagic E. Coli (EHEC) infection, most commonly the O157:H7 serotype. EHEC can cause bloody diarrhea. However, EHEC also produces shiga-like toxin which can cause hemolytic uremic syndrome (especially in young children), which is characterized by the triad of thrombocytopenia, anemia, and acute kidney injury. Ingestion of fried rice is associated with Bacillus cereus infection, which presents as an acute gastroenteritis-like illness characterized by nausea and vomiting.
Key Learning Point
Campylobacter infection in children can be caused by ingestion of undercooked poultry and can manifest as a progressive ascending paralysis (Guillain-Barre syndrome), bloody diarrhea, and reactive arthritis.
