II. Epidemiology

  1. Natural Hosts: Wild and domestic mammals, birds
  2. Waterborne Illness source
    1. Natural waters in which E. coli is not present

III. Pathophysiology

  1. Grows at refrigerator Temperatures
  2. Causes Mesenteric Lymphadenitis (mimics Appendicitis)

IV. Differential Diagnosis

V. Labs

  1. Stool Culture on selective growth medium

VI. Management

  1. Indications
    1. Severe disease
    2. Bacteremia
    3. Antibiotics not needed in mild disease or uncomplicated enteritis
  2. Severe disease - first line regimen (combined Doxycycline with Aminoglycoside)
    1. Doxycycline 100 mg IV twice daily AND
    2. Gentamicin or Tobramycin 5 mg/kg/day every 24 hours
  3. Severe disease - alternative regimens
    1. Trimethoprim-Sulfamethoxazole (TMP-SMZ) DS 160/180 mg twice daily for 5 days
    2. Ciprofloxacin 500 mg orally twice daily for 7-10 days
  4. References
    1. Gilbert (2013) Sanford Guide

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